Combined 04 clinical training--pathology benign_inflam bowel disease

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Transcript

  • 1. The Next Era in GI Surgery BioDynamix TM Anastomosis The Colon Ring Clinical Training Team BENIGN PATHOLOGY Inflammatory Bowel Disease
  • 2. Inflammatory Bowel Disease – Overview
    • The term inflammatory bowel disease (IBD) covers a group of disorders in which the intestines become inflamed due to unknown factors.
    • Two major types of IBD are described: ulcerative colitis (UC) and Crohn’s disease (CD), also known as granulomatous colitis .
    • The two entities are different from each other and do not occur together in the same patient.
    • Both entities are characterized by remissions and exacerbations.
    • When there is severe inflammation, the disease is considered to be in an active stage.
    • When the degree of inflammation is less (or absent), the person is often without symptoms.
  • 3. Inflammatory Bowel Disease – Ulcerative Colitis
    • Ulcerative colitis is limited to the large intestine.
    • The rectum is almost always involved (proctitis), but it may involve rectum and sigmoid (proctosigmoiditis) or the entire colon and rectum (full-blown proctocolitis).
    • There are usually no “skip” areas.
    Tiny ulcers
  • 4. Inflammatory Bowel Disease – Crohn’s Disease
    • Crohn’s disease can involve any part of the gastrointestinal tract from the mouth to the anus, but it most commonly affects the small intestine and/or the colon, often with “skip” areas.
    Granulomas “ Cobblestone” Street
  • 5. Inflammatory Bowel Disease – Causes
    • Researchers do not yet know what causes inflammatory bowel disease. Therefore, IBD is called an idiopathic disease.
    • An unknown factor/agent (or a combination of factors) triggers the body’s immune system to produce an inflammatory reaction in the intestinal tract that continues without control.
    • As a result of the inflammatory reaction, the intestinal wall is damaged, leading to bloody diarrhea and abdominal pain .
  • 6. Inflammatory Bowel Disease – Symptoms
    • Symptoms may range from mild to severe and generally depend upon the part of the intestinal tract involved. They include the following:
      • Abdominal cramps and pain
      • Severe urgency to have a bowel movement
      • Bloody diarrhea
      • Anemia (due to blood loss)
      • Loss of appetite
      • Weight loss
  • 7. Inflammatory Bowel Disease – Complications
    • Intestinal complications of inflammatory bowel disease include the following:
      • Profuse bleeding from the ulcers.
      • Perforation (rupture) of the bowel.
      • Strictures and obstruction.
        • In Crohn’s disease, strictures often are inflammatory and frequently resolve with medical treatment.
        • In ulcerative colitis, colonic strictures should be presumed to be malignant .
      • Fistulae and perianal disease.
        • These are more common in Crohn’s disease.
        • They may not respond to medical treatment.
        • Surgical intervention often is required, and there is a high risk of recurrence.
  • 8. Inflammatory Bowel Disease – Complications
      • Toxic megacolon (acute non-obstructive dilation of the colon):
        • This is a life-threatening complication of  ulcerative colitis  and requires urgent surgical intervention.
      • Malignancy:
        • The risk of colon cancer in ulcerative colitis begins to rise significantly above that of the general population after approximately 8-10 years of diagnosis.
        • The risk of cancer in Crohn’s disease may equal that of ulcerative colitis if the entire colon is involved.
        • The risk of small intestine malignancy is increased in Crohn’s disease.
  • 9. Surgery
    • Surgical treatment in persons with inflammatory bowel disease varies, depending upon the disease.
    • Ulcerative colitis is a surgically curable disease because the disease is limited to the colon.
    • Surgical resection is not curative in persons with Crohn’s disease and is used to treat complications of the disease.
    • Excessive surgical intervention in persons with Crohn’s disease can lead to more problems.
  • 10. Surgery – Ulcerative Colitis
    • Ulcerative colitis:
      • In about 25-30% of persons with ulcerative colitis, medical treatment is not completely successful.
      • In such persons and in persons with dysplasia, surgery may be considered.
      • Options:
        • First option: removal of the entire colon and rectum (proctocolectomy) with the creation of an ileostomy.
        • Second option: removal of the colon, creation of an internal ileal pouch (from the small intestine) with attachment to the anal sphincter muscle (ileoanal anastomosis), and creation of a temporary ileostomy. After the ileoanal anastomosis heals, the ileostomy is closed; and passage of feces through the anus is reestablished.
  • 11. Surgery – Crohn’s Disease
    • Crohn’s Disease—
      • Even though surgery is not curative in Crohn’s disease, approximately 75% of patients will require surgery at some point in time for complications.
      • Options:
        • The most simple surgery for Crohn’s disease is segmental resection of the involved segment.
        • Ileorectal or ileocolic anastomosis is an option in some persons who have lower small intestine or upper colonic disease.
        • In patients with severe perianal fistulae, diverting ileostomy/colostomy is a surgical option.