Inflammatory Bowel Disease

CLINICAL
History
CD with gastroduodenal involvement may mimic:
peptic ulcer disease and can
progress to gastric outlet obstruction
 Inflammatory Bowel Disease
CLINICAL
History
Many patients with inflammatory bowel disease
(IBD) have irritable bowel syndrome, which can
produce occasional:

Cramping
irregular bowel habits and
passage of mucus without blood or pus
 Inflammatory Bowel Disease

CLINICAL
History
Weight loss is observed more commonly in CD
than in UC because of the malabsorption
associated with small bowel disease
 Inflammatory Bowel Disease
Physical
Fever
Tachycardia
Dehydration and
Pallor may be noted, reflecting anemia

The magnitude of these factors is related directly to

the severity of the attack

► Evaluate for signs of localized peritonitis

 Inflammatory Bowel Disease
CLINICAL
Physical
► Patients with toxic megacolon appear septic.
They have:
high fever
lethargy
chills
tachycardia
increasing abdominal pain
tenderness and
distention
 Inflammatory Bowel Disease

CLINICAL
Physical
Patients with CD may develop a mass in the right
lower quadrant

The rectal examination often reveals bloody stool on:

gross or
hemoccult examination
 Inflammatory Bowel Disease
CLINICAL
Physical
Complications
e.g.:
perianal fissures or fistulas
abscesses
rectal prolapse
may be observed in up to 90% of patients with CD
 Inflammatory Bowel Disease

CLINICAL
Physical
Include in the examination a search for extraintestinal
manifestations, such as:
iritis
episcleritis
arthritis and
dermatologic involvement
 Inflammatory Bowel Disease

Illustration (episcleritis)
 Inflammatory Bowel Disease
Causes
The etiology of IBD is unknown
Environmental
smoking
infectious
genetic
autoimmune and
host factors have been suspected

Interactions among these factors may be more important

 Inflammatory Bowel Disease

Causes
The risk of developing UC is higher in nonsmokers and former
smokers than in current smokers

On the contrary, patients with CD have a higher incidence of

smoking than the general population, and those patients with CD
who continue to smoke appear to be less likely to respond to
medical therapy
 Inflammatory Bowel Disease

Differential diagnosis

Appendicitis, Acute

Diverticular Disease

Endometriosis

Pelvic Inflammatory Disease

Lab Studies
CBC with differential

Anemia may result from:

1) acute or chronic blood loss

2) or malabsorption ▼
Iron
Folate
vitamin B-12
3) or may reflect the chronic disease state
 Inflammatory Bowel Disease
Lab Studies
CBC with differential
► Leukocytosis, anemia, and thrombocytosis are
common

A modestly elevated WBC is observed in active

disease

but a marked elevation suggests the presence of an

abscess or other suppurative complication
 Inflammatory Bowel Disease

Lab Studies
Serum chemistry
Hypokalemia reflects the severity of the diarrhea

►Abnormal liver function test results may represent:

pericholangitis or
sclerosing cholangitis
Lab Studies
Serum chemistry
Hypoalbuminemia
resulting from protein-losing enteropathy, suggests
extensive colitis

Decreased serum calcium

may reflect reduced serum albumin

Erythrocyte sedimentation rate

is typically elevated
 Inflammatory Bowel Disease

Imaging Studies
Upright chest radiography and abdominal series
Evaluate for an edematous irregular colon with
"thumb printing." Occasionally, there may be
pneumatosis coli (air in the colonic wall)
 Inflammatory Bowel Disease
Imaging Studies
► Upright chest radiography and abdominal
series.
Associated findings include:

nephrolithiasis

cholelithiasis

arthritis of the:▼
spine or
the sacroiliac joints
 Inflammatory Bowel Disease
Barium enema
In UC, a barium enema (BE) may reveal:
1) a shortened colon
2) with loss of haustrations and
3) destruction of the mucosal pattern
lead-pipe colon
 Inflammatory Bowel Disease

Barium enema
Skip areas and rectal sparing are noted in
CD

BE is contraindicated in patients with moderate-to-

severe colitis because it risks:
perforation or
precipitation of a toxic megacolon
 Inflammatory Bowel Disease
• Endoscopic differentiation:
UC CD
Distribution rectum always rectal sparing
Inflammation diffuse and uniform asymmetrical, focal
Skip areas continuous diffuse disease yes
Granularity, friability ++++ +

Ulceration small ulcers in a diffuse aphthoid ulcer

inflamed mucosa

Stricture uncommon common

Cobblestoning uncommon common
 Inflammatory Bowel Disease

• Illustration: cobblestone street and in CD

 Inflammatory Bowel Disease
• Illustration: aphthoid ulcer (ulcer over a lymphoid
follicle)

(earliest radiographic sign in Crohn,s colitis)

Inflammatory Bowel Disease

Complications

Pseudopolyps

Stricture

Cancer

Perianal complications
 Inflammatory Bowel Disease

TREATMENT
Initiate supportive care with:
bowel rest
nasogastric suction and
intravenous (IV) fluids containing electrolytes
 Inflammatory Bowel Disease
TREATMENT
Admit for:▼
toxicity
Obstruction
hemorrhage or
localized peritonitis
► Laparatomy
TREATMENT
► Monitor severe cases for fat malabsorption
Treat perirectal disease
Sitz baths

Soap and water after stooling

Surgical drainage of perirectal abscesses

Surgical treatment of recurrent fistulas if medical

management fails
Thanks