This document summarizes inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It covers the definition, epidemiology, etiology, pathology, diagnosis, and treatment. Diagnosis involves clinical evaluation, laboratory tests, endoscopy, and radiological imaging. Disease activity is assessed using several clinical indices. Treatment focuses on inducing remission of active IBD.
inflammatory bowel disease is a diagnosis of exclusion and it has two form known as crohn's disease which can affect all GI tract from ''gum to bum'' with skip lesion and the formation of cobblestones. ulcerative colitis affect only the colon and also causes proctitis and toxic megacolon. both of the disease has extraGI symptoms like sclerosing cholangitis, uveitis, ankylosing spondylitis,conjunctivitis, liver cirrhosis, pyoderma gangrenosum, arthropathy and althralgia, etc .
inflammatory bowel disease is a diagnosis of exclusion and it has two form known as crohn's disease which can affect all GI tract from ''gum to bum'' with skip lesion and the formation of cobblestones. ulcerative colitis affect only the colon and also causes proctitis and toxic megacolon. both of the disease has extraGI symptoms like sclerosing cholangitis, uveitis, ankylosing spondylitis,conjunctivitis, liver cirrhosis, pyoderma gangrenosum, arthropathy and althralgia, etc .
Inflammatory Bowel Disease ( Pathogensis & Steps of Diagnosis and Management) For Resident at Gastroenterology and Hepatology department at Kafrelsheikh by Dr/ Mohammed Hussien ( Assistant Lecturer).
Enfermedad Inflamatoria de Intestino ¿Como Diagnosticarla? - www.grupodeapoyo...Grupo De Apoyo EII
Enfermedad Inflamatoria de Intestino ¿Como Diagnosticarla?
Forma parte del taller del Grupo De Apoyo De Enfermedades Inflamatorias Del Intestino. Para mas informacion visita: www.grupodeapoyoeii.org
Diagnostics in Inflammatory Bowel Disease (IBD): UltrasoundAbhineet Dey
Intestinal ultrasound has a good accuracy in the diagnosis of Crohn's disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses.
Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn's disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery.
Similarly to Crohn's disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy.
Short-term data also evidence the role of intestinal ultrasound in evaluating therapy response, with ultrasound changes observed after 2 weeks of treatment and significant improvement after 12 weeks of follow-up in ulcerative colitis.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ulcerative colitis explanation, management and therapyYuliaDjatiwardani2
A chronic, inflammatory bowel disease that causes inflammation in the digestive tract.
Ulcerative colitis is usually only in the innermost lining of the large intestine (colon) and rectum. Forms range from mild to severe. Having ulcerative colitis puts a patient at increased risk of developing colon cancer.
Symptoms include rectal bleeding, bloody diarrhoea, abdominal cramps and pain.
Treatment includes medication and surgery.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. IBD
Definition ,Epidemiology ,Etiology and Pathology .
Diagnosis and Activity Assessment :
1. Clinical .
2. Radiological .
3. Endoscopic .
4. Histological .
Treatment of active IBD
3. (IBD)
It is an idiopathic inflammatory intestinal disease resulting from
an inappropriate immune activation to host intestinal
microflora.
Types of IBD are
Ulcerative colitis
Crohn’s disease
Indeterminate colitis
5. Ulcerative Colitis Crohn’s Disease
Age-Specific Incidence of IBD *
Incidence in both CD and UC have 2 peaks
( in 3 rd and 6 th decades ).
10
0
2
4
6
8
0 20 40 60 80
10
0
2
4
6
8
0 20 40 60 80
Age (yrs) Age (yrs)
7. One model of IBD pathogenesis. Aspects of both CD and UC.
8.
9. Comparison of the distribution patterns, ulcers and wall
thickenings of CD and UC.
10. Pathological Features That Differ between CD and UC
Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,
www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.
15. Clinical presentation of IBD
A- symptoms:
- diarrhea
- rectal bleeding
- tenesmus
- passage of mucus
- abdominal pain
- other symptoms: anorexia,
nausea, vomiting, fever,
and weight loss
16. B- Signs
Examination findings in CD
Loss of weight
General ill health
Aphthous ulceration of mouth, glossitis angular stomatitis
Abdominal tenderness and RIF mass
Perianal skin tags, fissures, fistulae
17. Examination findings in UC
Hydration & volume status determined by B.P
Pulse rate
High temperature
Abdominal: Tenderness & evidence
of peritoneal inflammation
Presence of blood on DRE
18. Clinical findings That Differ between CD and UC
CD UC
Defecation Often porridge like
,sometimes steatorrhea
Often mucus-like and
with blood
Tenesmus Less common More common
Fever Common Indicates severe
disease
Fistulae Common Seldom
Weight loss Often More seldom
Malignant
potential
With colonic
involvement
Yes
Toxic megacolon No Yes
after surgery Recurrence is common No recurrence
19. Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,
www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.
20.
21. Complication of UC
Haemorrhage
Perforation
Toxic megacolon (transverse colon with a diameter of
more than 5 cm to 6cm with loss of haustration
Cancer: with active colitis of more than eight year
22. Complication of CD
Strictures with intestinal obstruction
Abscesses
Fistulas
Cancer: Risk related to the severity and duration of the disease.
watering-can perineum secondary to severe
perianal Crohn disease.
23. Clinical Assessment of Activity in IBD
A-Ulcerative colitis Clinical Activity Index(UCCAI)
B-Crohn's Disease clinical Activity Indices:
I - Harvey-Bradshaw index
II - Crohn's Disease Activity Index
24. Criteria Mild
Disease
Severe Disease Fulminant Disease
Stools < 4/day > 6/day > 10/day
Blood in stool Intermittent Frequent Continuous
Temperature Normal > 37.5°C > 37.5°C
Pulse Normal > 90 beats/min > 90 beats/min
Hemoglobin Normal < 75% of normal Transfusion required
ESR ≤30 mm/hr > 30 mm/hr > 30 mm/hr
Colonic
features on
radiography
_ Air, edematous wall,
thumbprinting
Dilatation
Clinical signs _ Abdominal
tenderness
Abdominal distention
and tenderness
A-Ulcerative colitis Clinical Activity Index.
Criteria for Evaluating Severity of Ulcerative Colitis
25. B-Crohn's Disease clinical Activity Indices
I - Harvey-Bradshaw index
A-general well-being (0 = very well, 1 = slightly below
average, 2 = poor, 3 = very poor, 4 = terrible)
B- abdominal pain (0 = none, 1 = mild, 2 = moderate, 3 =
severe) .
C- number of liquid stools per day.
D- abdominal mass (0 = none, 1 = dubious, 2 = definite, 3 =
tender) .
E- Complications, with one point for each.
-----------------------------------------------------------------------------
A score of less than 5 represent clinical remission.
26. II - Crohn's Disease Activity Index(CDAI)
Clinical or laboratory variable Weighting factor
Number of liquid or soft stools each day for seven days x 2
Abdominal pain (graded from 0-3 on severity) each day for seven
days
x 5
General well-being, subjectively assessed from 0 (well) to 4
(terrible) each day for seven days
x 7
Presence of complications* x 20
Taking Lomotil or opiates for diarrhea x 30
Presence of an abdominal mass (0 as none, 2 as questionable, 5 as
definite)
x 10
Hematocrit of <0.47 in men and <0.42 in women x 6
Percentage deviation from standard weight x 1
Crohn's Disease Activity Index.
Remission of CD below 150.
Severe CD greater than 450
28. A-Routine blood work
CBC: HB, WBCS and platelets.
Nutritional evaluation:
Vitamin B12 , iron studies, folate & other nutritional
markers
29. B - Serological Markers
ESR
In UC, the correlation between ESR and disease activity is good.
In CD, the ESR appears to be a less accurate measure of disease
activity.
CRP
CRP is a valuable marker to detect the activity of IBD Can be
used as a marker to treatment response
Orosomucoid :
The levels of circulating orosomucoid correlate with
disease activity of IBD.
31. D-Fecal Biomarkers
Fecal calprotectin
Measured in stool by ELISA
sensitive marker of inflammation
Fecal lactoferrin
Measured in stool by ELISA
Sensitive marker of inflammation
Fecal S100A12:
Detectable in serum and stool
But the fecal assay is more sensitive and specific for
IBD
40. Magnetic resonance enterography with gadolinium contrast in
CD. shows mural hyperenhancement, mural thickening, and the comb
sign (engorged perienteric vasculature) involving the terminal ileum.
(signs of active disease ).
41. VI - Wireless capsule endoscopy
(WCE)
VII-Double balloon enteroscopy
42. VIII-Nuclear Medicine
Tc-99m (WBC) imaging is superior to contrast
radiology for assessing the extent and activity of
inflammatory bowel disease. can be used to accurately
distinguish CD from UC .
More recently PET/CT and PET-MRI has been
combined with CT enterography or enteroclysis
techniques to further improve localization and reduce
false positives
47. 2- Endoscopic Indices of IBD Activity
A-Endoscopic assessment of disease activity in the UC
I - The Mayo Score.
II- The Baron Score
III - The Ulcerative Colitis Endoscopic Index of Severity (UCEIS).
B - Endoscopic assessment of disease activity in the CD
I - Crohn’s Disease Endoscopic Index of Severity (CDEIS).
II - Endoscopic Crohn’s Disease Index (SES-CD).
III - Rutgeerts’ score .
48. A - Endoscopic assessment of disease activity in
the ulcerative colitis.
score Endoscopic Findings Disease
severity
0 Normal mucosa , Mucosal healing or
inactive UC
Inactive
1 Mild friability, reduced vascular pattern, and
mucosal erythema
Mild disease
2 Friability, erosions, complete loss of
vascular pattern, and significant erythema
Moderate
disease
3 Ulceration and spontaneous bleeding Sever disease
I - The Mayo Score
49. II-The Baron Score
Endoscopic activity is defined as a Baron Score of >1
score Endoscopic findings
0 Normal mucosa with no bleeding and normal
vascular pattern present throughout the colon
1 Abnormal mucosa that is not expressly hemorrhagic
2 Bleeding with light intervention with an instrument
of the mucosa but no spontaneous bleeding
3 Spontaneous bleeding before the instrument is
introduced.
50. III-The Ulcerative Colitis Endoscopic Index of Severity
(UCEIS) (It is a newer scoring system)
Score Endoscopic findings (vascular pattern)
1 normal vascular pattern
2 partial loss of pattern
3 complete obliteration of vascular pattern
Score Endoscopic findings (Bleeding)
1 none
2 mucosal bleeding
3 mild colonic luminal bleeding
4 moderate or severe luminal bleeding
Score Endoscopic findings (Erosions and ulcers )
1 none
2 erosions
3 superficial ulcerations
4 deep ulcers
51. B - Endoscopic assessment of disease activity in the CD
I - Crohn’s Disease Endoscopic Index of Severity (CDEIS)
Rectum Sigmoid and left colon Transverse colon Right colon Ileum
Total
Deep ulcerations (12 if present) Total 1
Superficial ulcerations (12 if present) Total 2
Surface involved by disease (cm) Total 3
Surface involved by ulcerations (cm) Total 4
Total 1 + Total 2 + Total 3 + Total 4 = Total A
Number of segments totally or partially explored n
Total A ⁄ n = Total B
If an ulcerated stenosis is present anywhere add 3 = C
If a non-ulcerated stenosis is present anywhere add 3= D
Total B + C + D = CDEIS
52. II - Rutgeerts’ score
Grade Endoscopic findings
i0 No lesions in the distal ileum
i1 ≤ 5 apthous lesions
i2 >5 apthous lesions with normal mucosa between the
lesions, or skip areas of larger lesions or lesions
confined to ileocolonic anastomosis
i3 Diffuse apthous ileitis with diffusely inflamed mucosa
i4 Diffuse inflammation with already larger ulcers,
nodules, and ⁄ or narrowing
Rutgeerts’ score is the gold standard for
Endoscopical post-surgical recurrence evaluation
54. Grade 0 Structural (architectural change) Subgrades : 0.0 No
abnormality 0.1 Mild abnormality 0.2 Mild or
moderate diffuse ormultifocal abnormalities 0.3 Severe
diffuse or multifocal abnormalities
Grade 1 Chronic inflammatory infiltrate Subgrades 1.0 No increase
1.1 Mild but unequivocal increase 1.2 Moderate increase
1.3 Marked increase
Grade 2 Lamina propria neutrophils and eosinophils
2A Eosinophils 2B Neutrophils
Grade 3 Neutrophils in epithelium
Grade 4 Crypt destruction
Grade 5 Erosion or ulceration.
A - Histological Assessment of activity in UC
Histologic scoring system for the assessment of severity in UC.
55. B - Histological Assessment of activity in CD
Histologic findings Score
Epithelial damage 0-2
Architectural changes 0-2
Mononuclear infiltrate in LP 0-2
PMN infiltrate in epithelium 0-3
Erosion / ulcers 0-1
Granulomas 0-1
Proportion of biopsies affected 0-3
Pointes of histologic assessment of disease activity in CD
56. Fig. 14:UC. Mucosal atrophy with loss
of crypts. Neutrophils are still present
in the lumen and wall of one of the
crypts indicating persistent activity.
(H&E x10).
Fig.15: CD Stomach. Gastric mucosal
biopsy containing two characteristic
granulomas. (H&E x10).
66. General Care
Proper resuscitation.
Hospitalization.
Bowel rest to reduces the volume of diarrhea.
Blood products should be administered to treat
significant anemia or coagulopathy.
Pain relievers. Acetaminophen.
Iron supplements.
Nutrition(TPN).
Avoid (Narcotics, antidiarrheal agents and
anticholinergic ) can precipitate toxic dilation of the
colon.
68. Oral
•Varies by agent: may be released in the
distal/terminal ileum, or colon1
Distribution of 5-ASA Preparations
Suppositories
• Reach the upper rectum2,5
(15-20 cm beyond the anal verge)
Liquid Enemas
• May reach the splenic flexure2-4
• Do not frequently concentrate in the rectum3
1. Sandborn WJ, et al. Aliment Pharmacol Ther. 2003;17:29-42; 2. Regueiro M, et al. Inflamm Bowel Dis. 2006;12:972–978; 3. Van Bodegraven AA,
et al. Aliment Pharmacol Ther. 1996; 10:327-332; 4. Chapman NJ, et al. Mayo Clin Proc. 1992;62:245-248; 5. Williams CN, et al. Dig Dis Sci. 1987;32:71S-75S.
1- 5-ASA; Sulfasalazine (Supp. , enemas or Oral)
69.
70. 2 - Hydrocortisone or Methylprednisolone (IV , Oral or
enema)
Fast symptom relief
40 to 60 mg/day in a continuous I.V. infusion
5 to 10 days
Not advised for prolonged use (120 day max)
Does not improve long term surgery rates
3 - Ciprofloxacin +/- Metronidazole
Effectiveness arguable but often seen used anyway
71. 4 - IV Cyclosporine 2-4 mg/kg
Effective for induction of remission but not long-term
maintenance
Patients who did not respond to I.V. steroid
If no improvement within 4 to 5 days or if complete
remission is not achieved by 10 to 14 days, surgical
treatment is advised. (32)
5 - Infliximab is currently approved for use in IBD
Induction- 3 separate infusions of 5 mg/kg for
moderate to severe IBD at weeks 0, 2, and 6
Maintenance- infusions every 8 weeks
75. Indications for surgery in ulcerative colitis
Urgent Surgery Elective Surgery
Ongoing hemorrhage Failure of medical therapy
Toxic megacolon Intolerable side effect of
medical therapy
Colonic perforation Development of dysplasia
Fulminant ulcerative colitis Carcinoma
Colonic stricture
Growth retardation in
children
*Current Surgical Therapy 9th Edition
76. Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,
www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.
77. Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource
Center,
78. Indications for surgery in Crohn’s Disease
Urgent Surgery Elective Surgery
Perforation Stricture
Abscess Fistula
Uncontrollable
hemorrhage
Malignancy
Toxic megacolon Malnutrition
Bowel obstruction Poorly controlled despite
management
Extra-intestinal manifestations
*Medical Management of the Surgical Patient: A Textbook of Perioperative Medicine
*ASCRS – American Society of Colon and Rectal Surgeons
80. Artwork is reproduced, with permission, from the Johns Hopkins Gastroenterology and Hepatology Resource Center,
www.hopkins-gi.org,copyright 2006, Johns Hopkins University, all rights reserved.