Diseases of intestine

Diseases of intestine
By
Dr. Laraib Jamil Rph
Find me on Slideshare.net
https://www.slideshare.net/

Crohn’s disease
• Definition: Crohn's disease is a chronic, or long-
term, condition that causes inflammation of the
digestive tract. It is a type of inflammatory bowel
disease.
• Crohn's disease + ulcerative
colitis = inflammatory bowel disease (IBD)
• [Ulcerative colitis that involves only the colon
called ulcerative colitis]
• Synonym: It also is called granulomatous enteritis
or colitis, regional enteritis, ileitis, or terminal
ileitis.

• It primarily causes ulcerations (breaks in the
mucosal lining) of the small and large
intestines, but can affect the digestive
system anywhere from the mouth to the anus.

• Causes:
1-The exact cause of Crohn's disease is unclear, but it is thought to stem from an
abnormal reaction in the immune system.
• The theory is that the immune system attacks foods, good bacteria, and beneficial
substances as if they are unwanted substances.
• During the attack, white blood cells build up in the lining of the gut(intestine), and
this buildup triggers inflammation. The inflammation leads to ulcerations and
bowel (intestine) injury.
• However, it is unclear whether the abnormal immune system causes Crohn's
disease or results from it.
• Normally, the immune system is activated only when the body is exposed to
harmful invaders. In individuals with IBD the immune system is abnormally and
chronically activated in the absence of any known invader. This results in chronic
inflammation and ulceration. The susceptibility to abnormal activation of the
immune system is genetically inherited. Thus, first degree relatives (brothers,
sisters, children, and parents) of people with IBD are more likely to develop these
diseases..

2- Recently a gene called NOD2( nucleotide binding
oligomerization domain containing protein-2)
has been identified as being associated with Crohn's disease.
This gene is important in determining how the body responds
to some bacterial products. Individuals with mutations in this
gene are more susceptible to developing Crohn's disease
3- here also have been studies which show that in the
intestines of individuals with Crohn's disease, there are higher
levels of a certain type of bacterium, E. coli, which might play
a role in the disease. One postulated mechanism by which this
could occur is though a genetically determined defect in the
elimination of the E. coli, by intestinal mucosal macrophages.
The exact roles that these various factors play in the
development of this disease remain unclear.

Pathomechanism of crohn’s disease
towards intestine
• In the early stages, Crohn's disease causes small, scattered,
shallow, crater-like ulcerations (erosions) on the inner
surface of the bowel. These erosions are called aphthous
ulcers.
• With time, the erosions become deeper and larger,
ultimately becoming true ulcers (which are deeper than
erosions), and causing scarring and stiffness of the bowel.
• As the disease progresses, the bowel becomes increasingly
narrowed, and ultimately can become obstructed.
• Deep ulcers can cause puncture holes or perforations in
the wall of the bowel, and bacteria from within the bowel
can spread to infect adjacent organs and the surrounding
abdominal cavity.

• When Crohn's disease narrows the small intestine to the point of
obstruction, the flow of the contents through the intestine ceases.
Sometimes, the obstruction can be caused suddenly by poorly-digestible
fruit or vegetable matter that plug the already-narrowed segment of the
intestine. When the intestine is obstructed, food, fluid and gas from the
stomach and the small intestine cannot pass into the colon. The symptoms
of small intestinal obstruction then appear, including severe abdominal
cramps, nausea, vomiting, and abdominal distention. Obstruction of the
small intestine is much more likely since the small intestine is much
narrower than the colon.
• Deep ulcers can cause puncture holes or perforations in the walls of the
small intestine and the colon, and create a tunnel between the intestine
and adjacent organs. If the ulcer tunnel reaches an adjacent empty space
inside the abdominal cavity, a collection of infected pus (an
abdominal abscess) is formed. Individuals with abdominal abscesses can
develop tender abdominal masses, high fevers, and abdominal pain.

• When the ulcer tunnels into an adjacent organ, a channel (fistula) is
formed.
• The formation of a fistula between the intestine and the bladder
(enteric-vesicular fistula) can cause frequent urinary tract infections
and the passage of gas and feces during urination.
• When a fistula develops between the intestine and the skin
(enteric-cutaneous fistula), pus and mucous emerge from a small
painful opening on the skin of the abdomen.
• The development of a fistula between the colon and the vagina
(colonic-vaginal fistula) causes gas and feces to emerge through the
vagina.
• The presence of a fistula from the intestines to the anus (anal
fistula) leads to a discharge of mucous and pus from the fistula's
opening around the anus.

• Types:
• 1- Ileitis: This type of Crohn's disease just affects the ileum.
• 2- Ileocolitis: This is the most common type of Crohn's disease. It
affects the small intestine, known as the ileum, and the colon.
Crohn's terminal ileitis and ileo-colitis are the most common types
of Crohn's disease.
• 3- Gastroduodenal Crohn's disease: This form affects the stomach
and duodenum, which is the first part of the small intestine.
• 4- Jejunoileitis: This type of the disease causes areas of
inflammation in the jejunum, which is the middle part of your small
intestine.
• 5- Crohn's (granulomatous) colitis : This form of Crohn's disease
affects only the colon.

• Symptoms:
• Symptoms of Crohn’s disease include: Abdominal pain
• Diarrhea (in inflammation of bowel disease, when
intestine is inflammed, it absorbs much less sodium &
water & leak more fluids) some times bloody diarrhea
due to inflammation
• Vomiting
• Fever
• Bloody diarrhea
• Anal fistulae
• Weight loss

• Diagnosis:
• There is no specific diagnostic test for Crohn’s disease. The
diagnosis of Crohn's disease is suspected in patients with
fever, abdominal pain and tenderness, diarrhea with or
without bleeding, and anal diseases, such as ulcers or
fissures.
• Laboratory blood tests may show elevated white blood
cell counts and sedimentation rates, both of which suggest
infection or inflammation.
• Other blood tests may show low red blood cell counts
(anemia), low blood proteins, and low body minerals,
reflecting loss of these minerals due to chronic diarrhea.

• 2- Barium X-ray studies can be used to define the
distribution, nature, and severity of the disease.
Barium is a chalky material that is visible by X-ray
and appears white on X-ray films. When barium is
ingested orally (upper GI series) it fills the
intestine, and pictures (X-rays) can be taken of
the stomach and the small intestines. When
barium is administered through the rectum
(barium enema), pictures of the colon and the
terminal ileum can be obtained. Barium X-rays
can show ulcerations, narrowing, and,
sometimes, fistulae of the bowel.

• 3- Direct visualization of the rectum and the large
intestine can be accomplished with flexible
viewing tubes (colonoscopes). Colonoscopy is
more accurate than barium X-rays in detecting
small ulcers or small areas of inflammation of the
colon and terminal ileum. Colonoscopy also
allows for small tissue samples (biopsies) to be
taken and sent for examination under the
microscope to confirm the diagnosis of Crohn's
disease. Colonoscopy also is more accurate than
barium X-rays in assessing the degree (activity) of
inflammation

• 4- Computerized axial tomography (CAT or CT)
scanning is a computerized X-ray technique that
allows imaging of the entire abdomen and /w
pelvis(b/w abdomen & thigh) It can be especially
helpful in detecting abscesses. CT
and MRI enterography are imaging techniques
which use oral contrast agents consisting of
watery solutions with or without low
concentrations of barium to provide more
adequate luminal distension, have been reported
to be superior in the evaluation of small bowel
pathology in patients with Crohn's disease.

• 5- Video capsule endoscopy (VCE) has also been added to the list
of tests for diagnosing Crohn's disease. For video
capsule endoscopy, a capsule containing a miniature video camera
is swallowed. As the capsule travels through the small intestine, it
sends video images of the lining of the small intestine to a
receiver carried on a belt at the waist. The images are downloaded
and then reviewed on a computer. The value of video capsule
endoscopy is that it can identify the early, mild abnormalities of
Crohn's disease. Video capsule endoscopy may be particularly
useful when there is a strong suspicion of Crohn's disease but the
barium X-rays are normal. (Barium X-rays are not as good at
identifying early, mild Crohn's disease.)
• Precautions: Video capsule endoscopy should not be performed in
patients who have an obstruction of the small intestine. The
capsule may become stuck at the site of obstruction and make the
obstruction worse.

• Treatment:
• There is no medication that can cure Crohn's disease.
Patients with Crohn's disease typically will experience
flares, or periods of relapse (worsening of
inflammation) followed by periods of remission
(lessening of inflammation) lasting months to years.
During relapses, symptoms of abdominal pain,
diarrhea, and rectal bleeding worsen. During
remissions, these symptoms improve. Remissions
usually occur because of treatment with medications
or surgery

• Since there is no cure for Crohn's disease, the goals of treatment are to 1)
induce remissions, 2) maintain remissions, 3) minimize the side effects of
treatment, and 4) improve the quality of life.
• 1- anti-inflammatory medications:
• 5 aminosalicylic acid (5-ASA) compounds, for
example, sulfasalazine (Azulfidine)
and mesalamine (Pentasa, Asacol, Dipentum, Colazal, Rowasa enema, Can
as suppository).
• It is same like aspirin which is used to reduce inflammation of arthritis etc
• On the other hand, 5-ASA can be effective in treating Crohn's disease and
ulcerative colitis if the drug can be delivered topically onto the inflamed
intestinal lining. For example, mesalamine (Rowasa) is an enema
containing 5-ASA that is effective in treating inflammation in the rectum.
However, the enema solution cannot reach high enough to treat
inflammation in the upper colon and the small intestine. Therefore, for
most patients with Crohn's disease involving both the ileum (distal small
intestine) and colon, 5-ASA must be taken orally.

• Corticosteroids that act systemically (without the need for
direct contact with the inflamed tissue) to decrease
inflammation throughout the body. Systemic
corticosteroids have important and predictable side effects
if used long-term. Corticosteroids are faster-acting than 5-
ASA, and patients frequently experience improvement in
their symptoms within days of beginning them.
• Topical corticosteroids, for example, budesonide (Entocort
EC). This class of corticosteroids has fewer side effects than
systemic corticosteroids, which are absorbed into the body.
• Antibiotics(FOR BACTERIA OR OTHERS EX-E.COLI) that
decrease inflammation, for example, metronidazole (Flagyl)
and ciprofloxacin (Cipro).

• Immuno-modulator medications
• Immuno-modulator drugs decrease tissue inflammation by
reducing the population of immune cells and/or by interfering with
their production of proteins. Decreasing the activity of the immune
system with immuno-modulators increases the risk of infections;
however, the benefits of controlling moderate to severe Crohn's
disease usually outweigh the risks of infection due to weakened
immunity. Examples of immuno-modulators are:
• 6-mercaptopurine (6-MP),
• Azathioprine (Imuran),
• methotrexate (Rheumatrex, Trexall, MTX, Mexate),
• infliximab (Remicade),
• adalimumab (Humira),

• Other medications are
• Anti-diarrheal- loperamide
• Pain reliever- acetaminophene
• Iron supplements. If you have chronic
intestinal bleeding, you may develop iron
deficiency anemia and need to take iron
supplements.

• Surgery:
• it only improves symptoms but not permanent cure
• There is no surgical cure for Crohn's disease. Even when all of the
diseased parts of the intestines are removed, inflammation
frequently recurs in previously healthy intestines months to years
after the surgery. Surgery in Crohn's disease is used primarily for:
• Removal of a diseased segment of the small intestine that is causing
obstruction.
• Drainage of pus from abdominal and peri-rectal abscesses.
• Treatment of severe anal fistulae that do not respond to drugs.
• Resection of internal fistulae (such as a fistula between the colon
and bladder) that are causing infections.

• Complications:
• All below are due to auto-immune system
• Skin involvement includes painful red raised spots on the legs (erythema
nodosum) and an ulcerating skin condition generally found around the
ankles called pyoderma gangrenosum.
• Due to strep infections
• Painful eye conditions (uveitis, episcleritis) can cause visual difficulties.
• Arthritis can cause pain, swelling, and stiffness of the joints of the
extremities.
• Inflammation of the low back (sacroiliac joint arthritis) and of the spine
(ankylosing spondylitis) can cause pain and stiffness of the spine.
• Inflammation of the liver (hepatitis) or bile ducts (primary sclerosing
cholangitis) also can occur. Sclerosing cholangitis causes narrowing and
obstruction of the bile ducts draining the liver and can lead to yellow skin
(jaundice),

• Dietary supplements which are effective In corhn’s disease:
• Since fiber is poorly digestible, it can worsen the symptoms
of intestinal obstruction. A low fiber diet for Crohn's diease
may be recommended, especially in those patients with
small intestinal disease.
• A liquid diet may be of benefit when symptoms are more
severe.
• Intravenous nutrition or TPN (total parenteral nutrition)
may be utilized when it is felt that the intestine needs to
"rest."
• Supplementation of calcium, folate and vitamin B12 is
helpful when malabsorption of these nutrients is apparent.

Irritable bowl syndrome
• Definition: IBS is a common condition that affects the
digestive system BUT MOSTLY affects the large intestine. It
causes abdominal pain, bloating (extended due to
pressure), mucous in stools, irregular bowel habits, and
alternating diarrhea and constipation.
• IBS is a chronic condition that you'll need to manage long
term.
• Some people can control their symptoms by managing diet,
lifestyle and stress. More-severe symptoms can be treated
with medication and counseling.
• Synonym: spastic colitis, mucus colitis, and nervous colon.
• Spasm: involuntary contraction of muscles

IBS
• Causes:
1- Muscle contractions in the intestine. The
walls of the intestines are lined with layers of
muscle that contract as they move food through
your digestive tract. Contractions that are
stronger and last longer than normal can cause
gas, bloating and diarrhea. Weak intestinal
contractions can slow food passage and lead to
hard, dry stools.

IBS
2- Nervous system. Abnormalities in the nerves
in your digestive system may cause you to
experience greater than normal discomfort
when your abdomen stretches from gas or stool.
Poorly coordinated signals between the brain
and the intestines can cause your body to
overreact to changes that normally occur in the
digestive process, resulting in pain, diarrhea or
constipation.

IBS
• 3- Inflammation in the intestines. Some people
with IBS have an increased number of immune-
system cells in their intestines. This immune-
system response is associated with pain and
diarrhea.
• 4- Severe infection. IBS can develop after a
severe bout of diarrhea (gastroenteritis) caused
by bacteria or a virus. IBS might also be
associated with a surplus of bacteria in the
intestines (bacterial overgrowth).

• 5- Changes in bacteria in the gut
(microflora). Microflora are the "good" bacteria that
reside in the intestines and play a key role in health.
Research indicates that microflora in people with IBS
might differ from microflora in healthy people.
• 6- Food intolerance – impaired absorption of the sugar
lactose (found in dairy and many processed foods) is
the most common dietary trigger for IBS. Other sugars
believed to trigger IBS are fructose (present in many
syrups) and sorbitol.
• Example- lactose intolerance
• gluten-sensitive

• 7- Researchers found that patients with a subset of IBS have a
specific genetic defect, a mutation of the SCN5A gene. This defect
causes patients to have a disruption in bowel function, by affecting
a sodium channel in the gastrointestinal smooth muscle and
pacemaker cells.
• sodium voltage-gated channel alpha subunit 5
• The SCN5A gene belongs to a family of genes that provide
instructions for making sodium channels. These channels open and
close at specific times to control the flow of positively charged
sodium atoms (sodium ions) into cells. The sodium channels
containing proteins produced from the SCN5A gene are abundant in
heart (cardiac) muscle cells and play key roles in these cells' ability
to generate and transmit electrical signals. (heart beat & maintains
rhythm) These channels play a major role in signaling the start of
each Contractions and maintaining normal movement of organ such
as contraction & relaxation of intestine.

• Voltage gated channels: our body has nerves that connect your brain to the rest of
your organs and muscles, just like telephone wires connect homes all around the
world. When you want your hand to move, your brain sends signals through your
nerves to your hand telling the muscles to contract. But your nerves don’t just say
“hand, move.” Instead your nerves send lots of electrical impulses (called action
potentials) to different muscles in your hand, allowing you to move your hand with
extreme precision.
• Neurons are a special type of cell with the sole purpose of transferring information
around the body. Neurons are similar to other cells in that they have a cell body
with a nucleus and organelles. However, they have a few extra features which
allow them to be fantastic at transferring action potentials:
• dendrites: receive signals from neighboring neurons (like a radio antenna)
• axon: transmit signals over a distance (like telephone wires)
• axon terminal: transmit signals to other neuron dendrites or tissues (like a radio
transmitter)
• myelin sheath: speeds up signal transmission along the axon
•

• Concentration gradients
• Concentration gradients are key behind how action
potentials work. In terms of action potentials, a
concentration gradient is the difference in ion
concentrations between the inside of the neuron and the
outside of the neuron (called extracellular fluid).
• If we have a higher concentration of positively charged ions
outside the cell compared to the inside of the cell, there
would be a large concentration gradient. The same would
also be true if there were more of one type of charged ion
inside the cell than outside. The charge of the ion does not
matter, both positively and negatively charged ions move in
the direction that would balance or even out the gradient.

• Resting membrane potential
• Neurons have a negative concentration gradient
most of the time, meaning there are more
positively charged ions outside than inside the
cell. This regular state of a negative concentration
gradient is called resting membrane potential.
During the resting membrane potential there are:
• more sodium ions outside than inside the neuron
• more potassium ions inside than outside the
neuron

• The concentration of ions isn’t static though! Ions are flowing in and
out of the neuron constantly as the ions try to equalize their
concentrations. The cell however maintains a fairly consistent
negative concentration gradient (between -40 to -90 millivolts).
How?
• The neuron cell membrane is super permeable to potassium ions,
and so lots of potassium leaks out of the neuron through potassium
leakage channels (holes in the cell wall).
• The neuron cell membrane is partially permeable to sodium ions, so
sodium atoms slowly leak into the neuron through sodium leakage
channels.
• The cell wants to maintain a negative resting membrane potential,
so it has a pump that pumps potassium back into the cell and
pumps sodium out of the cell at the same time.

• How action potentials work
• Action potentials (those electrical impulses that send signals around
your body) are nothing more than a temporary shift (from negative
to positive) in the neuron’s membrane potential caused by ions
suddenly flowing in and out of the neuron. During the resting state
(before an action potential occurs) all of the gated sodium and
potassium channels are closed.
• These gated channels are different from the leakage channels, and
only open once an action potential has been triggered.
• We say these channels are “voltage-gated” because they are open
and closed depends on the voltage difference across the cell
membrane.

• Voltage-gated sodium channels have two gates (gate m and gate h), while the
potassium channel only has one (gate h).
• Gate m (the activation gate) is normally closed, and opens when the cell starts to
get more positive.
• Gate h (the deactivation gate) is normally open, and swings shut when the cells
gets too positive.
• Gate n is normally closed, but slowly opens when the cell is depolarized (very
positive).
• Voltage-gated sodium channels exist in one of three states:
• Deactivated (closed) - at rest, channels are deactivated. The m gate is closed, and
does not let sodium ions through.
• Activated (open) - when a current passes through and changes the voltage
difference across a membrane, the channel will activate and the m gate will open.
• Inactivated (closed) - as the neuron depolarizes, the h gate swings shut and blocks
sodium ions from entering the cell.
• Voltage-gated potassium channels are either open or closed.

• There are three main events that take place during an action potential:
• A triggering event occurs that depolarizes the cell body. This signal comes
from other cells connecting to the neuron, and it causes positively charged
ions to flow into the cell body. Positive ions still flow into the cell to
depolarize it. These incoming ions bring the membrane potential closer to
0, which is known as depolarization. (-70-0mV)
• 1- Depolarization - makes the cell less polar (membrane potential gets
smaller as ions quickly begin to equalize the concentration gradients)
• Voltage-gated sodium channels at the part of the axon closest to the cell
body activate, thanks to the recently depolarized cell body. This lets
positively charged sodium ions flow into the negatively charged axon, and
depolarize the surrounding axon. We can think of the channels opening
like dominoes falling down - once one channel opens and lets positive ions
in, it sets the stage for the channels down the axon to do the same thing.
Though this stage is known as depolarization, the neuron actually swings
past equilibrium and becomes positively charged as the action potential
passes through!

• 2- Repolarization - brings the cell back to resting potential. The
inactivation gates of the sodium channels close, stopping the
inward rush of positive ions. At the same time, the potassium
channels open. There is much more potassium inside the cell than
out, so when these channels open, more potassium exits than
comes in. This means the cell loses positively charged ions, and
returns back toward its resting state.
• 3- Hyperpolarization - makes the cell more negative than its typical
resting membrane potential. As the action potential passes
through, potassium channels stay open a little bit longer, and
continue to let positive ions exit the neuron. This means that the
cell temporarily hyperpolarizes, or gets even more negative than its
resting state. As the potassium channels close, the sodium-
potassium pump works to reestablish the resting state.

• Categorization:
• Irritable bowel syndrome can be subdivided into three
major categories:
• Constipation-predominant – the person tends to alternate
constipation with normal stools. Symptoms of abdominal
cramping or aching are commonly triggered by eating.
• Diarrhoea-predominant – the person tends to experience
diarrhoea first thing in the morning or after eating. The
need to go to the toilet is typically urgent and cannot be
delayed. Incontinence may be a problem.
• Alternating constipation and diarrhoea.

• Symptoms of IBS can be triggered by:
• Food. Dietary factors can play a role. Symptoms are often worse after
consuming certain products, such as chocolate, milk, or alcohol. There
may be either constipation or diarrhea.
• Some fruits, vegetables, and sodas can trigger bloating and discomfort. It
is unclear whether a food allergy or intolerance plays a role.
• Stress. Most people with IBS experience worse or more frequent signs and
symptoms during periods of increased stress. But while stress may
aggravate symptoms, it doesn't cause them. Stress can affect the nerves of
the bowel in susceptible people.
• Hormones. Women are twice as likely to have IBS, which might indicate
that hormonal changes play a role. Many women find that signs and
symptoms are worse during or around their menstrual periods.
• Medication – certain types (such as antibiotics, antacids and painkillers)
can lead to constipation or diarrhea

• Symptoms:
• changes in bowel habits
• abdominal pain and cramping, which often lessen after
using the bathroom
• a feeling that the bowels are not fully emptied after
using the bathroom
• excess gas
• passing of mucus from the back passage, or rectum
• a sudden urgent need to use the bathroom
• swelling or bloating of the abdomen

• Diagnosis:
Diagnosis methods include:
• full medical check-up
• blood tests, including blood tests for
coeliac disease,
lactose intolerance test
• stool tests
• family history of inflammatory bowel disease, colorectal cancer, or
celiac disease.
• investigation of the bowel lining by inserting a small tube
(sigmoidoscopy)
• investigation of the bowel under sedation (colonoscopy) or barium
enema, if necessary.

• Lactose intolerance is a digestive disorder caused by
the inability to digest lactose, the main carbohydrate
in dairy products. It can cause various symptoms,
including bloating, diarrhea and abdominal cramps.
People with lactose intolerance don't make enough of
the enzyme lactase, which is needed to digest lactose.
• Lactose tolerance test.
The lactose tolerance test gauges your body's reaction
to a liquid that contains high levels of lactose. Two
hours after drinking the liquid, you'll undergo
blood tests to measure the amount of glucose in your
bloodstream.

• Celiac disease (gluten-sensitive enteropathy), sometimes
called sprue or coeliac, is an immune reaction to eating
gluten, a protein found in wheat, barley and rye.
• If you have celiac disease, eating gluten triggers an immune
response in your small intestine. Over time, this reaction
damages your small intestine's lining and prevents
absorption of some nutrients (malabsorption). The
intestinal damage often causes diarrhea, fatigue, weight
loss, bloating
• Test: Serology testing looks for antibodies in your blood.
Elevated levels of certain antibody proteins indicate an
immune reaction to gluten.

• Sigmoidoscopy:
Sigmoidoscopy is the
minimally invasive medical
examination of the large
intestine
from the rectum through the
nearest part of the colon,
the sigmoid colon. There are two types of sigmoidoscopy:
flexible sigmoidoscopy, which uses a flexible endoscope,
and rigid sigmoidoscopy, which uses a rigid device

• A sigmoidoscopy is similar to, but not the
same as, a colonoscopy. A sigmoidoscopy only
examines up to the sigmoid, the most distal
part of the colon, while colonoscopy examines
the whole large bowel. It is a procedure that
lets your doctor look inside your sigmoid colon
by using a flexible tube with a light on it. It
helps your doctor check for: ulcers. abnormal
cells.

• Treatment:
• IBS cannot be cured with medication or special diets. The primary
preventative measure is to identify and avoid individual triggers.
Treatment options may include:
• a modest increase in dietary fibre, together with plenty of clear fluids
• reducing or eliminating common gas-producing foods, such as beans and
cabbage
• reducing or eliminating dairy foods, if lactose intolerance is a trigger
• antidiarrhoea medication, such as imodium or lomotil – these can be an
essential part of management in those with diarrhoea-predominant IBS.
These are Antimotility medications, which slows down the contractions of
the intestinal muscles.
• pain-relieving medication – opiates such as codeine can provide effective
pain relief. One of their most common side effects, constipation, may also
relieve the diarrhoea of diarrhoea-predominant IBS

• treatments to treat constipation (Bulk-forming laxatives)
• antispasmodic drugs, which may ease cramping – examples
include mebeverine, belladonna, hyoscine and peppermint
oil capsules
• tricyclic antidepressants – these can be effective in treating
the pain of IBS, but are best prescribed for a trial period
with monitoring of symptoms. Use of these does not mean
that IBS is caused by depression
• stress management, if stress seems to be triggering the
attacks
• establishing eating routines and avoiding sudden changes
of routine.

• Preventions:
• Counseling. A counselor can help you learn to modify or change your
responses to stress. Studies have shown that psychotherapy can provide
significant and long-lasting reduction of symptoms.
• Biofeedback. Electrical sensors help you receive information (feedback) on
your body's functions. The feedback helps you focus on making subtle
changes, such as relaxing certain muscles, to ease symptoms.
• Progressive relaxation exercises. These exercises help you relax muscles in
your body, one by one. Start by tightening the muscles in your feet, then
concentrate on slowly letting all of the tension go. Next, tighten and relax
your calves. Continue until the muscles in your body, including those in
your eyes and scalp, are relaxed
• Mindfulness training. This stress-reduction technique helps you focus on
being in the moment and letting go of worries and distractions

Sprue
• Definition: sprue is a diseases with malabsorption and
severe lesions of the proximal small intestinal mucosa.
• The main source of confusion is a lack of agreement on
reliable diagnostic criteria to define the different
disease entities. There are many criteria that one can
choose to delineate a disease or syndrome; in the
absence of complete understanding of etiology it
would appear to us that the best names are those
which indicate predictable similarities in pathogenesis,
prognosis, and treatment

• Different sprue syndrome:
Tropical & non-tropical sprues are both diseases
which
• share similar morphological(study of shape &
structure) features with varying degrees of
villus atrophy of the small intestinal mucosa,
and both present clinically with
malabsorption.

• Tropical: An area with tropical climate is one with
an average temperature of above 18 degrees
Celsius (64 degrees Fahrenheit) and considerable
precipitation during at least part of the year.
These areas are nonarid (not dry) and are
generally consistent with equatorial climate
conditions around the world.
• Three very large areas conform to the definition
of a tropical climate. These are the Amazon Basin
in Brazil, the Congo Basin in West Africa and
much to all of Indonesia.

• Villus: Villi (singular is villus) are small, finger-
like structures in the small intestine. They help
to absorb digested food. Each villus has micro-
villi which increase the surface area of the
intestinal walls. A larger surface area allows
nutrients to be taken in more quickly

• Celiac sprue: In North America the most frequently
diagnosed of these diseases is one which we call celiac
sprue. This is a hereditary type of malabsorption which
improves dramatically after removal of gluten from the
diet.
• Celiac disease is a condition caused by damage to the
lining of the small intestine. This damage comes from
a reaction to eating gluten. This is a substance that is
found in wheat, rye, barley, and possibly oats. It is also
found in food made from these ingredients.
• The damaged intestine is not able to absorb nutrients
from food.

• Causes: The exact cause of celiac disease is not known. The
lining of the intestines have small areas called villi which
project outward into the opening of the intestine. These
structures help absorb nutrients.
• When people with celiac disease eat foods with gluten,
their immune system reacts by damaging the villi. Because
of the damage, the villi are unable to properly absorb iron,
vitamins, and other nutrients. This may cause a number of
symptoms and other health problems.
• The disease can develop at any point in life, from infancy to
late adulthood.
• People who have a family member with celiac disease are
at greater risk of developing the disease..

• Non-tropical or celiec sprue destroys villi and causes inflammation of linning of
intestinal mucosa and produces malabsorption, it effects
• The digestion of proteins, carbohydrates, and lipids is compromised due to
decreased pancreatic and biliary secretion.
• Protein-losing enteropathy (inflammation of intestine) is characterized by the
severe loss of serum proteins into the intestine. Normal protein loss in the
gastrointestinal tract mainly consists of slide of enterocytes (intestinal absorptive
cells, are simple columnar epithelial cells found in the small intestine) and
pancreatic and biliary secretions.
• Hypoalbuminia: Albumin (It carries various substances throughout your body,
including hormones, vitamins, and enzymes.) loss through the gastrointestinal
tract normally accounts for 2-15% of the total body degradation of albumin, but, in
patients with severe protein-losing gastrointestinal disorders, the enteric protein
loss may reach up to 60% of the total albumin pool.
• The serum protein level reflects the balance between protein synthesis,
metabolism, and protein loss. Protein-losing enteropathy is characterized by more
loss of proteins via the gastrointestinal tract than synthesis leading to
hypoalbuminemia

• The absorption of the digestive products is
also severely affected due to decreased
activity of microvillus enzymes (dipeptidases
and disaccharidases)
• and a presumed reduction in the number of
transport carriers.

• Symptoms: The symptoms of celiac disease can be different from
person to person. This can make diagnosis difficult. For example,
one person may have constipation, a second may have diarrhea,
and a third may have no problem with stools.
• Gastrointestinal symptoms include: nausea vomiting diarrhea
indigestion gas bloating constipation abdominal pain weight loss
• Decreased appetite (may also be increased or unchanged)
• Diarrhea, either constant or off and on
• Lactose intolerance (common when the person is diagnosed, often
goes away after treatment)
• Stools that are foul smelling, oily, or stick to the toilet when flushed
• Unexplained weight loss (although people can be overweight or
normal weight)

• Other problems that can develop over time because the
intestines do not absorb key nutrients include:
• Easy bruising (physical injury, The injury causes tiny blood
vessels called capillaries to burst. Blood gets trapped below
the skin's surface, which causes a bruise)
• Depression or anxiety
• Fatigue
• Growth delay in children
• Hair loss
• Missed menstrual periods
• Tingling or numbness in the hands or feet

• Tropical sprue: Tropical sprue is a malabsorption disease commonly found in
tropical regions, marked with abnormal flattening of the villi and inflammation of
the lining of the small intestine. Tropical sprue is caused by inflammation of your
intestines. This swelling makes it more difficult for you to absorb nutrients from
food. This is also called malabsorption.
• Tropical sprue makes it particularly difficult to absorb folic acid and vitamin B12.
• If you suffer from malabsorption, you’re not getting enough vitamins and nutrients
in your diet. This can cause a number of different symptoms. Your body needs
vitamins and nutrients to function properly.
• It differs significantly from coeliac sprue. It appears to be a more severe form
of environmental enteropathy.
• Tropical areas:
• India
• South Africa
• Southeast Asia

• Symptoms:
• The illness usually starts with an attack of acute
diarrhoea, fever and malaise following which, after a variable
period, the patient settles into the chronic phase of diarrhoea,
steatorrhoea, weight loss, anorexia, malaise, and nutritional
deficiencies. The symptoms of tropical sprue are:
• Diarrhoea
• Steatorrhoea or fatty stool (often foul-smelling and whitish in
colour)
• Indigestion
• Cramps
• Weight loss and malnutrition
• Fatigue

• Left untreated, nutrient and vitamin deficiencies may develop in
patients with tropical sprue. These deficiencies may have these
symptoms:
• Vitamin A (Vitamin A helps form and maintain healthy teeth,
skeletal and soft tissue, mucus membranes,
and skin)deficiency: hyperkeratosis or skin scales
• Vitamin B12 (It is also involved in the formation of red blood cells
and helps to create and regulate DNA. ) and folic
acid deficiencies: anaemia
• Vitamin D (Your body must have vitamin D to absorb calcium and
promote bone growth)and calcium deficiencies: spasm, bone
pain, numbness, and tingling sensation
• Vitamin K (play a role in blood clotting, bone metabolism, and
regulating blood calcium levels)deficiency : bruises

• Causes:
• unknown
• Visit to tropical areas (The pathogenetic insult in tropical
sprue appears to be a persistent overgrowth of the small
intestine by enteric pathogens after a bout of tour.)
• It may be caused by persistent bacterial, viral, amoebal,
or parasitic infections
• When tropical sprue occurs, the lining of the small intestine
is damaged so that it is unable to absorb nutrients
efficiently.
• Folic acid deficiency, effects of malabsorbed fat
on intestinal motility, and persistent small intestinal
bacterial overgrowth may combine to cause the disorder

• Diagnosis:
• Diagnosis of tropical sprue can be complicated because
many diseases have similar symptoms. The following
investigation results are suggestive:
• Abnormal flattening of villi and inflammation of the lining
of the small intestine, observed during
an endoscopic procedure.
• Presence of inflammatory cells (most often lymphocytes) in
the biopsy of small intestine tissue.
• Low levels of vitamins A, B12, E, D, and K, as well as serum
albumin, calcium, and folate, revealed by a blood test.
• Excess fat in the feces (steatorrhoea).
• Thickened small bowel folds seen on imaging.

• Bone density
• Cholesterol (may be low)
• Complete blood count (CBC - test for anemia)
• Blood tests can detect antibodies, called
antitissue transglutaminase antibodies (tTGA)
or anti-endomysial antibodies (EMA) which
may help detect the condition. The health
care provider will order these antibody tests if
celiac disease is suspected.

• Bone density test: Central DXA
• NOF recommends a bone density test of the hip and spine using a central DXA machine to diagnose
osteoporosis. DXA stands for dual energy x-ray absorptiometry. When testing can’t be done on the
hip and spine, NOF suggests a central DXA test of the radius bone in the forearm. Healthcare
providers measure bone density in the hip and spine for several reasons. First, people with
osteoporosis have a greater chance of fracturing these bones. Second, broken bones in the hip and
spine can cause more serious problems, including longer recovery time, greater pain and even
disability. Bone density in the hip and spine can also predict the likelihood of future breaks in other
bones.
• bone density test results are reported using T-scores.
• A T-score shows how much your bone density is higher or lower than the bone density of a healthy
30-year old adult.
• According to the World Health Organization (WHO):
• A T-score of -1.0 or above is normal bone density. Examples are 0.9, 0 and -0.9.
• A T-score between -1.0 and -2.5 means you have low bone density or osteopenia. Examples are T-
scores of -1.1, -1.6 and -2.4.
• A T-score of -2.5 or below is a diagnosis of osteoporosis. Examples are T-scores of -2.6, -3.3 and -
3.9.

• Cholesterol test: to measuring the total cholesterol in your
blood, the standard cholesterol test (called a "lipid panel")
measures three specific kinds of fat:
• Low-density lipoproteins (LDL). This is the "bad
cholesterol," the main cause of plaque build-up, which
increases your risk for heart disease. In general, the lower
the number, the better.
• High-density lipoproteins (HDL). This is the "good
cholesterol." It transports bad cholesterol from the blood to
the liver, where it is excreted by the body
• Triglycerides. Another type of fat in the
bloodstream, triglycerides are also linked to heart disease.
They are stored in fat cells throughout the body.

• Treatment for celiac disease:
• Celiac disease cannot be cured. Your symptoms
will go away and the villi in the intestines will heal
if you follow a lifelong gluten-free diet. Do not eat
foods, drink beverages, or take medicines that
contain wheat, barley, rye, and possibly oats.
• Sometimes, short-term use of corticosteroids
(such as prednisone) may be needed if sprue
does not respond to treatment.

• Treatment for tropical sprue:
• Topical sprue is treated with antibiotics. This kills the
bacteria overgrowth that results in this condition.
Antibiotics may be given for a period of two weeks or
one year.
• Tetracycline is the most commonly used antibiotic for
treating tropical sprue. Other broad-spectrum
antibiotics may also be prescribed, including:
• sulfamethoxazole and trimethoprim (Bactrim)
• oxytetracycline
• ampicillin

Treating malabsorption:
• Your doctor will prescribe you therapy to replace
the vitamins, nutrients, and electrolytes that your
body is lacking. This type of supplementation
should begin as soon as you’re diagnosed. You
may be given:
• fluids and electrolytes
• iron
• folic acid
• vitamin B12

• Complication:
• Bone disease (osteoporosis, kyphoscoliosis,
fractures)
• Certain types of intestinal cancer
• Low blood count (anemia)
• Infertility or repeated miscarriage

Enteritis
• Definition: Enteritis is inflammation of the small intestine.
• Enteritis may also include gastritis,
where inflammation affects the stomach or, in some cases,
colitis, which involves inflammation of the large intestine.
• Types:
• infectious enteritis, caused by bacteria or viruses,
• radiation enteritis
• medication induced
• enteritis related to poor blood flow
• enteritis related to inflammatory conditions, such
as Crohn’s disease or ulcerative colitis

Infectious enteritis
• The most common type of bacterial enteritis is caused by food poisoning. You can get it after
ingesting food or water that is contaminated with bacteria. The bacteria can enter the food supply
in a number of ways, including:
• improper food handling
• poor hygiene
• during poultry and meat processing
The foods most often associated with food poisoning are:
• raw poultry and meat
• unpasteurized milk
• fresh produce
Some common bacteria that cause enteritis include:
• Salmonella
• Escherichia coli (E. coli)
• Staphylococcus aureus (S. aureus)
• Shigella
• Yersinia enterocolitica (Y. enterocolitica)
• Bacillus species

• Radiation enteritis
• This type of enteritis can occur after radiation
therapy. Radiation works by killing rapidly
dividing cells. This kills cancer cells, but also
healthy cells. This includes mouth, stomach,
and bowel cells.
• Radiation enteritis develops when your
normal, healthy intestinal cells are damaged
by radiation and become inflamed

• Medication induced enteritis:
• NSAID: they destroy the mucous membrane of
stomach and then intestine when they come
to contact. As mucous membrane is defensive
to intestine, its destruction by
ibuprofen/asprin will definitely effect the
intestine & can cause inflammation.

• Enteritis related to poor blood flow: Intestinal ischemia describes a variety of
conditions that occur when blood flow to your intestines decreases due to a
blocked blood vessel, usually an artery. Intestinal ischemia can affect your small
intestine, your large intestine (colon) or both.
• Intestinal ischemia is often divided into categories:
• 1- Colon ischemia (ischemic colitis)
• This type of intestinal ischemia, which is the most common, occurs when blood
flow to the colon is slowed. The cause of diminished blood flow to the colon isn't
always clear, but a number of conditions can make you more vulnerable to colon
ischemia:
• Dangerously low blood pressure (hypotension) associated with heart failure, major
surgery, trauma or shock
• A blood clot in an artery supplying the colon
• Twisting of the bowel (volvulus) or trapping of intestinal contents within a hernia
• Excessive bowel enlargement from bowel obstruction caused by scar tissue or a
tumor

• 2- Acute mesenteric ischemia
• Inadequate blood flow through mesentric blood vessels resulting in ischemia &
gangrene(necrosis-death of cell or tissue through injury due to lack of blood
supply) of bowel (intestinal) wall
• This type of intestinal ischemia usually affects the small intestine. It has an abrupt
onset and may be due to:
• A blood clot (embolus) that dislodges from your heart and travels through your
bloodstream to block an artery, usually the superior mesenteric artery, which
supplies oxygen-rich blood to your intestines. This is the most common cause of
acute mesenteric artery ischemia and can be brought on by congestive heart
failure, an irregular heartbeat (arrhythmia) or a heart attack.
• A blockage that develops within one of the main intestinal arteries and slows or
stops blood flow, often as a result of fatty deposits (atherosclerosis) building up on
the wall of an artery
• Impaired blood flow resulting from low blood pressure due to shock, heart
failure, it's not due to a blockage in the artery.

• 3- Chronic mesenteric ischemia
• Chronic mesenteric ischemia, also known as intestinal
angina, results from the buildup of fatty deposits on an
artery wall (atherosclerosis). The disease process is
generally gradual, and you may not require treatment
until at least two of the three major arteries supplying
your intestines become severely narrowed or
completely obstructed.
• A potentially dangerous complication of chronic
mesenteric ischemia is the development of a blood
clot within a diseased artery, causing blood flow to be
suddenly blocked (acute mesenteric ischemia).

• Ischemia that occurs when blood can't leave your intestines
• A blood clot can develop in a vein draining deoxygenated blood
from your intestines. When the vein is blocked, blood backs up in
the intestines, causing swelling and bleeding. This is called
mesenteric venous thrombosis, and it may result from:
• Acute or chronic inflammation of your pancreas (pancreatitis)
• Abdominal infection
• Cancers of the digestive system
• Bowel diseases, such as ulcerative colitis, Crohn's disease or
diverticulitis(inflammation of small pouches that develos around
intestine (benign condition)

• Enteritis due to autoimmune disorder:
Crohn's disease is a chronic, or long-term, condition that causes inflammation
of the digestive tract. It is a type of inflammatory bowel disease. Causes:
1- autoimmune
2- a gene called NOD2( nucleotide binding oligomerization domain
containing protein-2)
has been identified as being associated with Crohn's disease. This gene is
important in determining how the body responds to some bacterial products.
Individuals with mutations in this gene are more susceptible to developing
Crohn's disease
3- here also have been studies which show that in the intestines of individuals
with Crohn's disease, there are higher levels of a certain type of bacterium, E.
coli, which might play a role in the disease. One postulated mechanism by
which this could occur is though a genetically determineddefect in the
elimination of the E. coli, by intestinal mucosal macrophages

• Ulcerative colitis (UC) is a chronic
inflammatory disease of the colon. Pathogens
or cause of corhn’s disease makes inflamed to
colon this can lead to ulcer (lesion, shallow
holes and fistula-channels to other organs)

• Symptoms:
• diarrhea
• nausea and vomiting
• loss of appetite
• abdominal cramps and pain
• pain, bleeding, or mucus-like discharge from
the rectum
• fever

• Diagnosis:
• A stool culture to look for the type of
infection. However, this test may not always
identify the bacteria causing the illness.
• A colonoscopy and/or upper endoscopy to
look at the small intestine and to take tissue
samples if needed.
• Imaging tests such as CT scan and MRI (if
symptoms are persistent).

• Treatment:
• Mild cases often do not need treatment.
• Antidiarrheal medicine is sometimes used. However, it may
not be recommended in some cases because it can slow
the germ from leaving the digestive tract.
• You may need rehydration with electrolyte solutions if your
body does not have enough fluids.
• You may need medical care and fluids through a vein
(intravenous fluids) if you have diarrhea and cannot keep
fluids down. This is often the case with young children.
• You may need to take antibiotics.
• People who have Crohn disease will often need to take anti-
inflammatory medicines.

• Herbal medicines:
• Potentilla erecta (tormentil)- belongs to rose
family(function as astringent-causing
contraction of skin cells and tissues. used in
diarrhea, dysentery and sore throat)
• carob(evergreen shrub) bean juice,
• and Diarrhoesan for diarrhea;
• peppermint oil (Colpermin) for functional
abdominal pain

Prevention
• The following steps may help prevent enteritis: (improving
hygiene)
• Always wash your hands after using the toilet and before
eating or preparing food or drinks. You may also clean your
hands with a 60% alcohol-based product.
• Boil water that comes from unknown sources, such as
streams and outdoor wells, before drinking it.
• Use only clean utensils for eating or handling foods,
particularly when handling eggs and poultry.
• Cook food thoroughly.
• Use coolers to store food that needs to stay chilled.

• Complications:
• Dehydration is a potential complication. It may cause kidney and urinary
problems, as well as heart problems. It is particularly dangerous in infants
and young children, older adults, and those with chronic illnesses.
• Symptoms of dehydration may include:
• excessive thirst
• urinating less frequently or in lower amounts
• dark urine
• fatigue
• weakness
• lethargy
• dizziness
• sunken eyes
• lack of tears
• dry mouth

Diseases of intestine

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Diseases of intestine

Similar to Diseases of intestine (20)

More from laraib jameel

More from laraib jameel (20)

Recently uploaded

Recently uploaded (20)

Diseases of intestine