Combined 04 clinical training--pathology benign_inflam bowel disease


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  • Combined 04 clinical training--pathology benign_inflam bowel disease

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