This document discusses inflammatory bowel disease (IBD), specifically focusing on Crohn's disease. It begins with objectives and definitions of IBD and its two main types: Crohn's disease and ulcerative colitis. It then covers the causes, pathophysiology, clinical manifestations, diagnostic tests, complications, and medical and surgical management of Crohn's disease. The goals of treatment are reducing inflammation, suppressing the immune response, providing bowel rest for healing, improving quality of life, and preventing complications. Nutritional therapy, medications like aminosalicylates, corticosteroids, and immunosuppressants may be used. Surgery is indicated for complications like obstruction or severe perianal disease.
3. Objectives
By the end of this lecture all of us well be able to
Understand Inflammatory Bowel Disease and the
pathophysiology.
Identify the assessment and diagnostic test used to
confirm Inflammatory Bowel Disease.
Identify the management protocols for IBD.
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4. Definition:
IBD characterized by a tendency for chronic or relapsing
immune activation and inflammation within the
gastrointestinal tract (GIT)
Compose of the:
Regional enteritis ( Crohn’s disease or granulomatous colitis)
Ulcerative colitis.
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6. Causes:
the cause of IBD is still un-known. But triggered by:
1. Environmental agents such as tobacco.
2. Radiation.
3. Nonsteroidal anti-inflammatory drugs.
4. Immune disorders
5. Abnormal response to dietary or bacterial antigens.
6. genetic factors.
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8. REGIONAL ENTERITIS (CROHN’S DISEASE)
CD commonly occurs in adolescents or young adults but can
appear at any time of life.
It can occur anywhere along the GI tract, but the most
common areas are the distal ileum and colon.
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9. Pathophysiology
CD is a subacute and chronic inflammation that extends
through all layers of the bowel wall from the intestinal
mucosa.
The disease process begins with edema and thickening of
the mucosa and appear of ulcer on the inflamed mucosa.
Abscesses form as the inflammation extends into the
peritoneum
The bowel wall thickens, and the intestinal lumen narrows,
bowel loops sometimes adhere to other loops.
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10. Clinical Manifestations
1. prominent lower right quadrant abdominal pain.
2. diarrhea unrelieved by defecation.
3. abdominal tenderness and spasm.
4. weight loss, malnutrition, and secondary anemia.
5. Ulcers in the membranous lining of the intestine.
6. In some patients, the inflamed intestine may perforate,
leading to intra abdominal and anal abscesses.
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11. Cont…
7. Fever and leukocytosis occur.
8. Non GI symptoms:
joint involvement (arthritis)
skin lesions (erythema )
ocular disorders (conjunctivitis)
oral ulcers.
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14. Diagnostic test:
1. Sigmoidoscopic examination
2. Stool analysis is also performed
3. Barium study of the upper GI tract
4. Endoscopy and intestinal biopsy
5. Barium enema .
6. CT scan .
7. Complete blood cell count
8. Erythrocyte sedimentation rate .
9. Albumin and protein levels
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15. Complications:-
Complications of regional enteritis include
1. intestinal obstruction or stricture formation
2. perianal disease and fistula and abscess formation.
3. Fluid and electrolyte imbalances, malnutrition from
malabsorption.
4. Increased risk for colon cancer.
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16. Medical management:-
Aim of medical treatment:
Reducing inflammation
suppressing inappropriate immune responses
providing rest for a diseased bowel so that healing may take place,
improving quality of life
preventing or minimizing complications.
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17. NUTRITIONAL THERAPY
Provide high-protein, high-calorie diet with vitamin and iron
supplements.
Balance fluid and electrolyte.
Avoid exacerbate diarrhea food.
Cold foods and smoking are avoided (increase intestinal
motility).
Parenteral nutrition (PN) may be indicated.
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18. Parenteral nutrition (PN)
Is a ready and mixed IV nutrients to improve nutritional status,
maintain muscle mass, promote weight gain, and enhance the
healing process.
Components:
1. water 30-40 ml/kg/day.
2. amino acid 1-2 g/kg/day.
3. carbohydrate 4-5 mg /kg/min.
4. fatty acid 20-30 total calories.
5. minerals such as ( calcium 15mcg, magnesium 20meq, potassium
100meq , sodium 100meq).
6. vitamins such as (Vitamin A 4000iu, thiamin 3mg, vitamin K 200mcg)
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19. PHARMACOLOGIC THERAPY
1. Sedation and antidiarrheal medications such as:
loperamide
cholestyramine powder, 3 times per day.
Side effect: constipation.
2. Anti-inflammatory drug such as:
Aminosalicylate formulations such as sulfasalazine
3. Corticosteroids are used to treat severe disease such as:
Prednisone, orally, topically and injections.
4. Immunosuppressive Agents such as:
Methotrexate tab 1,5 mg/kg/day, cyclosporine tab 2,5-5
mg/kg/day
5. Surgery.
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20. INDICATIONS FOR SURGERY
In patients with CD
Obstruction, severe perianal disease unresponsive to medical
therapy, difficult fistulas, major bleeding, severe disability
30 % relapse rate
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Protect mucosa become inflame after exposure to noxious agent
Because eating stimulates intestinal peristalsis, the crampy pains occur after meals. To avoid these bouts of crampy pain, the patient tends to limit food intake, reducing the amounts and types of food to such a degree that normal nutritional requirements are not met.
and other inflammatory changes result in a weeping, swollen intestine that continually empties an irritating discharge into the colon.
