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Inflammatory Bowel
Disease
INTRODUCTION
• IBD is an idiopathic disease , probably involving an
immune reaction of the body to its own intestinal trac...
INTRODUCTION
• CD is a condition of chronic granulomatous
inflammation potentially involving any location of the
GIT from ...
EPIDEMIOLOGY
• UC:
15-40 yrs (Young adults)
No variation between between men and women or
between socioeconomic group
H...
EPIDEMIOLOGY
CD
1st
peak 15-30 years of age, 2nd
peak around 60 y
Marginally more common in females
High incidence area...
ETIOLOGY
• Immunology
• Initiating pathogen
• Environmental Factors
• Genetic factors
SYMPTOMS
UC:
• Rectal bleeding or bloody diarrhea
• Pain of colonic origin, often left sided and related to
defecation
CD:...
INVESTIGATIONS
• Endoscopy
• Colonoscopy
• Histopathology
• Radiology
• Hematological tests and microbiological stool test...
UC CD
ESR elevation
Hypoalbuminemia
Anaemia
Electrolyte imbalance
Leucocytosis
ESR ↑
Hypoalbuminemia
Anaemia
LABORATORY IN...
Feature UC CD
Location Only colon GIT
Anatomic
distribution
Continuous, begins
distally
Skip lesions
Rectal involvement In...
Feature CD UC
Transmural inflammation Yes Uncommon
Granulomas 50-75% No
Fissures Common Rare
Fibrosis Common No
Submucosal...
UC CD
Collar button ulcers Nodularity
Granularity
RADIOLOGIC FEATURES OF CD AND UC
PATHOPHYSIOLOGY
• Bacterial antigens are taken up by specialized M cells, pass
between leaky epithelial cells or enter the...
PATHOPHYSIOLOGY
• Further amplification of T cells perpetuates the inflammatory
process with activation of non immune cell...
MANAGEMENT OF IBD
Non-pharmacological
• Initial tretment is nonoperative Stop Smoking (for
crohn’s disease)
• Nutrition
PHARMACOLOGICAL
• Aminosalicilates (5-ASA): sulfasalazine, mesalazine,
olsalazine
• Corticosteroids : Budesonide, presniso...
PHARMACOLOGICAL
• Antispasmodic agent: Dicyclomine
• Immunoglobulin - İnfliximab
• Miscellaneous( Total or supplementary p...
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE
INFLAMMATORY BOWEL DISEASE
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INFLAMMATORY BOWEL DISEASE

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INFLAMMATORY BOWEL DISEASE

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Transcript of "INFLAMMATORY BOWEL DISEASE"

  1. 1. Inflammatory Bowel Disease
  2. 2. INTRODUCTION • IBD is an idiopathic disease , probably involving an immune reaction of the body to its own intestinal tract • Crohn’s disease (CD) • Ulcerative colitis (UC)
  3. 3. INTRODUCTION • CD is a condition of chronic granulomatous inflammation potentially involving any location of the GIT from mouth to anus. • UC is an non granulomatous inflammatory disorder that affects the rectum and extends proximally to affect variable extent of the colon.
  4. 4. EPIDEMIOLOGY • UC: 15-40 yrs (Young adults) No variation between between men and women or between socioeconomic group High incidence areas: USA and northern-western Europe More common in non-smokers
  5. 5. EPIDEMIOLOGY CD 1st peak 15-30 years of age, 2nd peak around 60 y Marginally more common in females High incidence areas: North America, UK,northern Europe More common in smokers
  6. 6. ETIOLOGY • Immunology • Initiating pathogen • Environmental Factors • Genetic factors
  7. 7. SYMPTOMS UC: • Rectal bleeding or bloody diarrhea • Pain of colonic origin, often left sided and related to defecation CD: • Diarrhea • Recurrent abdominal pain • Anorectal lesions, Anorexia, Anemia • Malnutrition (weight loss) • Fever
  8. 8. INVESTIGATIONS • Endoscopy • Colonoscopy • Histopathology • Radiology • Hematological tests and microbiological stool test for infection
  9. 9. UC CD ESR elevation Hypoalbuminemia Anaemia Electrolyte imbalance Leucocytosis ESR ↑ Hypoalbuminemia Anaemia LABORATORY INVESTIGATION
  10. 10. Feature UC CD Location Only colon GIT Anatomic distribution Continuous, begins distally Skip lesions Rectal involvement Involved in >90% Rectal spare Gross bleeding Universal Only 25% Peri-anal disease Rare 75% Fistulization No Yes Granulomas No 50-75% DISTINGUISHING CHARACTERISTICS OF CD AND UC
  11. 11. Feature CD UC Transmural inflammation Yes Uncommon Granulomas 50-75% No Fissures Common Rare Fibrosis Common No Submucosal inflammation Common Uncommon PATHOLOGIC FEATURES OF CD AND UC
  12. 12. UC CD Collar button ulcers Nodularity Granularity RADIOLOGIC FEATURES OF CD AND UC
  13. 13. PATHOPHYSIOLOGY • Bacterial antigens are taken up by specialized M cells, pass between leaky epithelial cells or enter the lamina propria through ulcerated mucosa • After processing they are presented on type 1 T-helper cells by antigen presenting cells (APC) in the lamina propria. • T-cell activation and differentiation results in Th1 T cell mediated cytokine response • With the secretion of cytokines including gamma interferon (IFN )ƴ
  14. 14. PATHOPHYSIOLOGY • Further amplification of T cells perpetuates the inflammatory process with activation of non immune cells and release of the important cytokines. • Eg: IL-12, IL-23, IL-1, IL-6 and tumor necrosis factor (TNF) • These pathways occur in all normal individual exposed to inflammatory insults and this is self limiting in healthy subjects • In genetically predisposed persons, dysregulation of innate immunity may trigger inflammatory bowel disease.
  15. 15. MANAGEMENT OF IBD Non-pharmacological • Initial tretment is nonoperative Stop Smoking (for crohn’s disease) • Nutrition
  16. 16. PHARMACOLOGICAL • Aminosalicilates (5-ASA): sulfasalazine, mesalazine, olsalazine • Corticosteroids : Budesonide, presnisolone, methylprednisolone • Immunosuppressants: azathioprine , 6-mercaptopurine • Antibiotics : metronidazole, ciprofloxacin • Anti diarrhoals : loperamide, Diphenoxylate & atropine
  17. 17. PHARMACOLOGICAL • Antispasmodic agent: Dicyclomine • Immunoglobulin - İnfliximab • Miscellaneous( Total or supplementary parenteral nutrition, fish oils, sodium cromoglycate, lidocaine, nicotine trans dermally) • Surgical management
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