INFLAMATORY BOWEL DİSEASE
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Inflammatory bowel disease (IBD) can present with abdominal pain and bloody diarrhea. A thorough history, examination, blood tests, endoscopy, and imaging are used to diagnose IBD and distinguish between Crohn's disease and ulcerative colitis. Crohn's disease can affect any part of the gastrointestinal tract and is characterized by patchy inflammation and deeper ulcers, while ulcerative colitis causes continuous inflammation of the colon. Treatment involves medications to reduce inflammation and manage symptoms.
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Biliary colic is caused by gallstones forming in the gallbladder or bile ducts, which leads to severe cramping pain in the right upper abdomen. Risk factors include being overweight, high cholesterol, pregnancy, estrogen use, rapid weight loss, and certain medical conditions. The pain occurs after meals and lasts 1-6 hours, with nausea and tenderness in the right upper abdomen. Treatment involves laparoscopic cholecystectomy to remove the gallbladder, along with pain medications and antispasmodics. Nonsurgical options include oral bile acid therapy for patients who cannot undergo surgery.
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This document provides information about jaundice and obstruction of the biliary tract. It begins with an overview of the causes of yellow discoloration of the skin and mucous membranes, which is caused by bilirubin accumulation. It then describes the breakdown of red blood cells and how bilirubin is processed and excreted. The document outlines various causes of obstructive jaundice including gallstones, strictures, tumors, and external compression. Investigation methods and treatment approaches for different biliary obstructions are also summarized.
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Biliary colic
Biliary colic is caused by gallstones forming in the gallbladder or bile ducts, which leads to severe cramping pain in the right upper abdomen. Risk factors include being overweight, high cholesterol, pregnancy, estrogen use, rapid weight loss, and certain medical conditions. The pain occurs after meals and lasts 1-6 hours, with nausea and tenderness in the right upper abdomen. Treatment involves laparoscopic cholecystectomy to remove the gallbladder, along with pain medications and antispasmodics. Nonsurgical options include oral bile acid therapy for patients who cannot undergo surgery.
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This document contains information on various biliary diseases including gallstones, cholangiocarcinoma, pancreatic cancer, and biliary strictures. It discusses the clinical presentation, investigations, and management of biliary obstructions of different types including those caused by stones, tumors, strictures, and cysts. The diagnosis and treatment of choledochal cysts and sclerosing cholangitis are also covered.
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This document provides information about jaundice and obstruction of the biliary tract. It begins with an overview of the causes of yellow discoloration of the skin and mucous membranes, which is caused by bilirubin accumulation. It then describes the breakdown of red blood cells and how bilirubin is processed and excreted. The document outlines various causes of obstructive jaundice including gallstones, strictures, tumors, and external compression. Investigation methods and treatment approaches for different biliary obstructions are also summarized.
Obstructive jaundice
This document discusses obstructive jaundice, including its pathophysiology, workup, and management. It begins with definitions and descriptions of jaundice. Biochemical investigations that can help determine the level and cause of obstruction are outlined. Common etiologies of biliary obstruction include gallstones, strictures, tumors, and pancreatitis. Imaging modalities like ultrasound, MRCP, and EUS are described which can locate the obstruction and identify its cause. The document concludes with an algorithm for evaluating the specific clinical scenarios of ductal obstruction, cholangitis, or suspected cholelithiasis without cholangitis.
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The document discusses the acute abdomen, which refers to intra-abdominal disease that is often best treated surgically. It outlines characteristics of patients who need surgery versus those who do not, and provides potential non-surgical and metabolic causes of acute abdominal pain. The physiology of abdominal pain and patterns of referred pain are described. A history and physical exam are important for diagnosis, with differential diagnoses provided for various locations of abdominal pain. Immediate treatment of the acute abdomen includes IV fluids, pain medication, tubes, antibiotics, and definitive therapy based on diagnosis.
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This document discusses cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder). It covers the anatomy of the gallbladder and biliary tree. Common causes of gallstones include altered gallbladder function and supersaturated bile. Gallstones can be asymptomatic, cause biliary colic, or lead to complications like cholecystitis, pancreatitis and obstruction. Acute calculous cholecystitis is usually caused by a gallstone obstructing the cystic duct. Clinical features include right upper quadrant pain and tenderness. Investigations include ultrasound and blood tests. Treatment is usually laparoscopic cholecystectomy.
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This document summarizes several gastrointestinal emergencies, including upper GI bleeding, variceal bleeding, paracetamol overdose, severe ulcerative colitis, Crohn's colitis, and liver failure. For upper GI bleeding, it discusses causes, risk factors, management including resuscitation and endoscopy, and factors affecting prognosis. For variceal bleeding, it outlines treatment including banding, medical therapy, tamponade, TIPSS, and prevention. It also summarizes management of paracetamol overdose, criteria for severe colitis, and approaches to investigating and treating liver failure and associated complications like hepatorenal syndrome.
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1. Gallstone disease ranges from asymptomatic cholelithiasis to complications like acute cholecystitis, cholangitis, or pancreatitis. The pathophysiology involves cholesterol supersaturation in bile leading to stone formation over three stages.
2. Seven cases demonstrate the clinical presentations of symptomatic cholelithiasis, chronic cholecystitis, acute cholecystitis, acalculous cholecystitis, choledocholithiasis, cholangitis, and gallstone pancreatitis. Diagnosis involves the history, exam, labs, and imaging findings specific to each condition.
3. Treatment depends on the condition but may include antibiotics, endoscopic retrograde cholangiop
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The document provides information about abdominal anatomy and examination, as well as causes and presentations of common abdominal conditions. It discusses:
1. The abdominal regions and organs are outlined, including the liver, gallbladder, pancreas, and intestines.
2. Abdominal pain has somatic and visceral components and can be caused by inflammation, obstruction, ischemia, perforation, or rupture.
3. Acute appendicitis presents with initially vague pain that localizes to the right lower quadrant, along with nausea, fever, and rebound tenderness on exam.
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This document discusses gallstone disease (cholelithiasis). It describes gallstones as abnormal masses formed in the gallbladder or bile ducts that are a common cause of abdominal pain and dyspepsia. It identifies factors that increase risk of gallstones like gender, age, obesity, pregnancy, and rapid weight loss. It discusses the types of gallstones, pathogenesis, definitions of related conditions, clinical manifestations, complications, and risk factors in more detail over several pages.
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Gallstone Disease
Gallbladder is a small organ located under the liver. Its function is to aid in digestion of food by storing and secreting bile (a digestive juice) into the small intestine when food enters there. Gallstone Disease may develop when there is too much cholesterol or bilirubin inside gallbladder secreted by the liver. To know the signs & symptoms of Gallstone Disease. visit at http://gisurgery.info
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This document discusses the investigations and management of surgical jaundice. It outlines the various laboratory tests, imaging studies, and other diagnostic evaluations used to confirm the diagnosis and identify the underlying cause of obstructive jaundice. This includes liver function tests, ultrasound, CT, MRCP, ERCP, and in some cases biopsy or tumor markers. The document then reviews the treatment approaches for common causes like gallstones, pancreatic cancer, and bile duct cancers. These involve endoscopic or surgical procedures to relieve the obstruction like ERCP, cholecystectomy, bile duct exploration, bypass procedures, and resection when possible. Postoperative jaundice is also discussed.
Gallstone disease
This document discusses gallstone disease, including the pathogenesis of gallstones and definitions of various gallstone conditions such as symptomatic cholelithiasis, acute cholecystitis, and choledocholithiasis. It also provides details on the differential diagnosis of right upper quadrant pain and treatment approaches for different gallstone diseases and complications.
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2. The document discusses the pathophysiology, etiology, indications for referral to a gastroenterologist, initial evaluation, and recommendations for evaluating patients with chronic diarrhea.
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Git 4th 1st.
This document provides an overview of gastroenterology and hepatology. It discusses common GI diseases and symptoms, as well as various tests used to evaluate GI structure, infections, and function. These include imaging studies, endoscopy, biopsies, bacterial cultures, serology tests, breath tests, and radioisotope tests to assess conditions like gastric emptying, HP infection, Meckel's diverticulum, bleeding, and malabsorption. Therapeutic endoscopy is highlighted as a less invasive alternative to surgery for many GI conditions.
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Obstructive jaundice
This document discusses obstructive jaundice, including its pathophysiology, workup, and management. It begins with definitions and descriptions of jaundice. Biochemical investigations that can help determine the level and cause of obstruction are outlined. Common etiologies of biliary obstruction include gallstones, strictures, tumors, and pancreatitis. Imaging modalities like ultrasound, MRCP, and EUS are described which can locate the obstruction and identify its cause. The document concludes with an algorithm for evaluating the specific clinical scenarios of ductal obstruction, cholangitis, or suspected cholelithiasis without cholangitis.
Obstructive jaundice
1. Obstructive jaundice results from obstruction of bile flow from the liver to the duodenum, causing bilirubin levels to rise above 2.5mg/dL and resulting in jaundice.
2. The top 3 causes of obstructive jaundice are choledocholithiasis, strictures, and pancreatic cancer.
3. Evaluation involves clinical examination, blood tests of liver function and markers, ultrasound of the bile ducts, and CT or ERCP to visualize the biliary tree and determine the level and cause of obstruction.
Gallstone disease rufi
This document defines various gallstone diseases and provides information on their risk factors, presentations, diagnoses, and treatments. It discusses the definitions of cholelithiasis, cholecystitis, choledocholithiasis, and other conditions. The risk factors include factors like female gender, obesity, and hemolytic states. Imaging studies like ultrasound and CT are used for diagnosis, and treatments involve analgesics, antibiotics, ERCP, and cholecystectomy.
Biliary Disease
This document defines various components of the biliary system including bile, bile salts, and bile acids. It describes bile acid metabolism and the enterohepatic circulation. It discusses cholestasis, approaches to diagnosing a patient with cholestasis, and various causes of cholestasis including gallstones. It describes the pathophysiology, risk factors, clinical features, diagnosis, and treatment of gallstone disease. It also discusses other biliary diseases and conditions such as primary sclerosing cholangitis, biliary strictures, and biliary dyskinesia.
Gi Gallbladder & Pancreas
The document provides information on the anatomy, physiology, causes, symptoms, signs, and diagnostic criteria for acute pancreatitis. It describes the anatomy of the pancreas and discusses the hormones that stimulate pancreatic secretion such as secretin and cholecystokinin. Common causes of acute pancreatitis include alcohol, gallstones, trauma, drugs, infections, and hyperlipidemia. Symptoms include severe epigastric pain that radiates to the back while signs include fever, abdominal tenderness, and grey turner sign. Laboratory tests and criteria such as Ranson's are used to determine severity and prognosis.
Obstructive jaundice
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
Gallbladder Disease
1. The document discusses various gallbladder diseases including cholelithiasis, acute cholecystitis, ascending cholangitis, gallstone ileus, and porcelain gallbladder.
2. It provides details on the presentation, workup, diagnosis and management of these conditions including anatomy, imaging findings, medical and surgical treatment options.
3. Case examples are presented and summarized to demonstrate the clinical approach to patients with different gallbladder issues.
clinical course" Acute abdomen "
The document discusses the acute abdomen, which refers to intra-abdominal disease that is often best treated surgically. It outlines characteristics of patients who need surgery versus those who do not, and provides potential non-surgical and metabolic causes of acute abdominal pain. The physiology of abdominal pain and patterns of referred pain are described. A history and physical exam are important for diagnosis, with differential diagnoses provided for various locations of abdominal pain. Immediate treatment of the acute abdomen includes IV fluids, pain medication, tubes, antibiotics, and definitive therapy based on diagnosis.
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This document discusses cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder). It covers the anatomy of the gallbladder and biliary tree. Common causes of gallstones include altered gallbladder function and supersaturated bile. Gallstones can be asymptomatic, cause biliary colic, or lead to complications like cholecystitis, pancreatitis and obstruction. Acute calculous cholecystitis is usually caused by a gallstone obstructing the cystic duct. Clinical features include right upper quadrant pain and tenderness. Investigations include ultrasound and blood tests. Treatment is usually laparoscopic cholecystectomy.
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Acute pancreatitis is a condition where pancreatic enzymes leak into the pancreas and cause its auto-digestion. Common causes include gallstones, alcohol use, and idiopathic factors. Patients present with epigastric pain radiating to the back that is exacerbated by eating or lying down. Lab tests show elevated pancreatic enzymes and imaging shows changes to the pancreas. Treatment is supportive with NPO, IV fluids, pain control and monitoring for complications like necrosis, pseudocysts, shock and respiratory failure. Severe cases may require ERCP, surgery or drainage procedures.
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Gallstone disease is a common clinical problem that can present asymptomatically or with acute or chronic symptoms. Laparoscopic cholecystectomy is the standard treatment for uncomplicated gallstone disease, while complicated cases involving issues like gallbladder perforation or gangrene require more difficult surgery combined with endoscopic procedures. The document then describes two case studies, one involving an uncomplicated laparoscopic cholecystectomy, and one where the patient presented with gallbladder perforation requiring partial cholecystectomy and CBD stenting.
Gastrointestinalemergencies Richard
This document summarizes several gastrointestinal emergencies, including upper GI bleeding, variceal bleeding, paracetamol overdose, severe ulcerative colitis, Crohn's colitis, and liver failure. For upper GI bleeding, it discusses causes, risk factors, management including resuscitation and endoscopy, and factors affecting prognosis. For variceal bleeding, it outlines treatment including banding, medical therapy, tamponade, TIPSS, and prevention. It also summarizes management of paracetamol overdose, criteria for severe colitis, and approaches to investigating and treating liver failure and associated complications like hepatorenal syndrome.
Diverticulitis
Diverticulitis is an infection or inflammation of small pouches called diverticula that can form in the lining of the intestines. The sigmoid colon is the most common location. Risk factors include aging, obesity, smoking, lack of exercise, and a low-fiber diet. Symptoms include abdominal pain, changes in bowel habits, nausea, vomiting, fever, and urinary issues. Complications can include peritonitis, fistulas, obstruction, or abscess. Diagnosis involves tests like CT scan, ultrasound, and colonoscopy. Mild cases are treated with antibiotics and diet, while severe or complicated cases may require hospitalization, IV antibiotics, or surgery.
Gallstone+disease
1. Gallstone disease ranges from asymptomatic cholelithiasis to complications like acute cholecystitis, cholangitis, or pancreatitis. The pathophysiology involves cholesterol supersaturation in bile leading to stone formation over three stages.
2. Seven cases demonstrate the clinical presentations of symptomatic cholelithiasis, chronic cholecystitis, acute cholecystitis, acalculous cholecystitis, choledocholithiasis, cholangitis, and gallstone pancreatitis. Diagnosis involves the history, exam, labs, and imaging findings specific to each condition.
3. Treatment depends on the condition but may include antibiotics, endoscopic retrograde cholangiop
abdominal pain
The document provides information about abdominal anatomy and examination, as well as causes and presentations of common abdominal conditions. It discusses:
1. The abdominal regions and organs are outlined, including the liver, gallbladder, pancreas, and intestines.
2. Abdominal pain has somatic and visceral components and can be caused by inflammation, obstruction, ischemia, perforation, or rupture.
3. Acute appendicitis presents with initially vague pain that localizes to the right lower quadrant, along with nausea, fever, and rebound tenderness on exam.
4. Acute pancreatitis has causes including gallstones, alcohol, hyperlipidemia and drugs. It involves activation of pancreatic
Gall stone disease
This document discusses gallstone disease (cholelithiasis). It describes gallstones as abnormal masses formed in the gallbladder or bile ducts that are a common cause of abdominal pain and dyspepsia. It identifies factors that increase risk of gallstones like gender, age, obesity, pregnancy, and rapid weight loss. It discusses the types of gallstones, pathogenesis, definitions of related conditions, clinical manifestations, complications, and risk factors in more detail over several pages.
Ascites ppts
Ascites is the accumulation of fluid in the peritoneal cavity. The most common cause is portal hypertension due to liver cirrhosis. Clinical signs include abdominal swelling and distension. Diagnosis involves physical exam findings like shifting dullness and diagnostic imaging. Treatment involves restricting sodium intake, diuretics, and paracentesis to remove excess fluid. The nursing management focuses on pain management, fluid and electrolyte balance, preventing complications, and restoring normal gastrointestinal function.
Gallstone Disease
Gallbladder is a small organ located under the liver. Its function is to aid in digestion of food by storing and secreting bile (a digestive juice) into the small intestine when food enters there. Gallstone Disease may develop when there is too much cholesterol or bilirubin inside gallbladder secreted by the liver. To know the signs & symptoms of Gallstone Disease. visit at http://gisurgery.info
Surgical Jaundice investigations & management
This document discusses the investigations and management of surgical jaundice. It outlines the various laboratory tests, imaging studies, and other diagnostic evaluations used to confirm the diagnosis and identify the underlying cause of obstructive jaundice. This includes liver function tests, ultrasound, CT, MRCP, ERCP, and in some cases biopsy or tumor markers. The document then reviews the treatment approaches for common causes like gallstones, pancreatic cancer, and bile duct cancers. These involve endoscopic or surgical procedures to relieve the obstruction like ERCP, cholecystectomy, bile duct exploration, bypass procedures, and resection when possible. Postoperative jaundice is also discussed.
Gallstone disease
This document discusses gallstone disease, including the pathogenesis of gallstones and definitions of various gallstone conditions such as symptomatic cholelithiasis, acute cholecystitis, and choledocholithiasis. It also provides details on the differential diagnosis of right upper quadrant pain and treatment approaches for different gallstone diseases and complications.
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2. The document discusses the pathophysiology, etiology, indications for referral to a gastroenterologist, initial evaluation, and recommendations for evaluating patients with chronic diarrhea.
3. The differential diagnosis and workup of inflammatory bowel diseases like Crohn's disease and ulcerative colitis are outlined, including relevant history, physical exam findings, diagnostic studies, endoscopy, histopathology, and radiology findings.
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Lower GI Hemorrhage- introduction
LOWER GI HEMORRHAGE- Introduction
#surgicaleducator #babysurgeon
Dear Viewers,
Greetings from “Surgical Educator”
Today I have uploaded an introductory video on Lower GI haemorrhage. In this episode, I have talked about the various causes for lower GI bleeding, applied anatomy,History&Physical exam,investigations and management algorithm for lower GI bleeding. In the subsequent episodes in this series of videos, I will be talking about the individual causes elaborately- one in each video. You can watch this video in the following links:
surgicaleducator.blogspot.com
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Thank you for watching the video
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This document discusses various diagnostic procedures used to evaluate gastrointestinal diseases. It describes structural tests like radiography, endoscopy and biopsy that can examine the GI tract. Functional tests evaluate motility and pH levels. Special blood tests and stool exams can identify infections or biomarkers. Key endoscopic procedures discussed are upper and lower endoscopy, capsule endoscopy, and ERCP. Esophageal manometry and pH monitoring are described as functional motility tests.
Ascitis
This document discusses ascites, which is an accumulation of fluid in the peritoneal cavity. It defines ascites and lists its main causes as increased hydrostatic pressure, decreased colloid osmotic pressure, increased permeability of capillaries, and leakage of fluid. The document describes the pathophysiology and classification of ascites as transudative or exudative. It outlines the clinical signs and diagnostic workup of ascites including abdominal examination, imaging, and analysis of ascitic fluid. Treatment approaches include dietary changes, diuretics, therapeutic paracentesis, TIPS procedure, and liver transplantation.
Approach patient with juandice
This document provides guidance on approaching a patient presenting with jaundice. It defines jaundice and distinguishes it from carotenemia. The document outlines the causes of jaundice as pre-hepatic, hepatic, or post-hepatic. It recommends taking a thorough history, performing a physical exam, and ordering lab tests and imaging to determine the underlying cause and guide management, which may include stopping hepatotoxic drugs, medical treatment, or surgery.
GI Bleeding Kalesh
The document discusses the approach to GI hemorrhage. It begins with the clinical presentation of GI bleeding, including symptoms of upper and lower GI bleeding. It then discusses resuscitation of patients based on bleeding severity. The causes, symptoms, and approaches to treatment of upper and lower GI bleeding are described. Diagnostic tests including endoscopy are explained. Specific causes of upper GI bleeding like peptic ulcers and varices are elaborated. Causes of lower GI bleeding including diverticular disease, angiodysplasia, and ischemia are also summarized.
A.pptx
1) The 80-year-old male patient presented with 5 months of abdominal pain, weight loss, and recent vomiting. Imaging showed a pancreatic mass encasing the splenic artery and gastric outlet obstruction.
2) Laboratory tests showed elevated tumor markers consistent with a probable malignant pancreatic mass.
3) The pre-op diagnosis is a pancreatic mass likely malignant causing gastric outlet obstruction. The proposed surgical plan is a palliative double bypass surgery including gastrojejunostomy, jejunostomy, and cholecystojejunostomy.
Choledocholithiasis- obstructive jaundice
Choledocholithiasis is one of the main causes for Obstructive Jaundice.In this ppt presentation, I have discussed the etiology, clinical features, complications, investigations and management of Choledocholithiasis. I have also included a mindmap and 2 algorithms for Choledocholithiasis. I hope you will find it very useful and interesting.
Cholestasis
Neonatal cholestasis is defined as prolonged elevation of conjugated bilirubin beyond the first 14 days of life. It can be caused by defects in intrahepatic bile production, bile transport, or bile flow obstruction. The document discusses the etiology, clinical presentation, evaluation, and management of neonatal cholestasis. Key tests include liver enzymes, genetic testing, imaging, and liver biopsy. Biliary atresia and neonatal hepatitis are the most common causes and require different treatment approaches. The Kasai procedure is the surgical treatment for biliary atresia but transplantation may eventually be needed in most cases.
Jaundice general survey
This document provides an overview of jaundice, including definitions, causes, signs and symptoms, and approaches to evaluation and diagnosis. Key points include:
- Jaundice is defined as a yellowish discoloration of the skin and eyes caused by high bilirubin levels in the blood.
- It can be caused by pre-hepatic (hemolytic), hepatic, or post-hepatic (obstructive) conditions that disrupt bilirubin metabolism.
- Evaluation involves history, physical exam, and lab tests including liver enzymes and bilirubin levels to determine the type and cause of jaundice.
- Further imaging like ultrasound and MRCP may be needed to identify obstructions
Surgical jaundice
This document discusses surgical jaundice, including:
1. It defines jaundice and surgical jaundice, and classifies jaundice into pre-hepatic, hepatic, and post-hepatic types.
2. It describes the anatomy and physiology of the biliary tract and bilirubin metabolism.
3. Common causes of obstructive jaundice include gallstones, cancer, strictures, and inflammation. A thorough history and physical exam can help identify the cause.
4. Investigations include blood tests, imaging like ultrasound and MRCP, and procedures like ERCP. The goal is to determine the specific cause and level of obstruction.
5. Treatment depends on the
Jaundice
- Jaundice is caused by increased bilirubin in the blood due to excessive production, defective processing in the liver, or impaired passage of bilirubin from the liver to the gut.
- Obstructive jaundice, the most common cause, occurs when bilirubin fails to reach the gut due to blockages like gallstones or pancreatic cancer.
- Obstructive jaundice requires prompt diagnosis and treatment to remove the blockage to prevent complications like biliary cirrhosis.
Similar to INFLAMATORY BOWEL DİSEASE (20)
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INFLAMATORY BOWEL DİSEASE
- 2. An early features is aphthoid ulceration, usually seen at colonoscopy; later larger and deeper ulcers appears in a patchy distribution again producing a cobblestone appearance.
- 3. Diagnosis History and Examination Presenting complain:- insidious oracutelyabdominal pain. Non-bloody Diarrhea but sometimes it maybe bloodyand Steatorrhea systemic review is very important becauseof extra GI manifestations Family history is important because of genetic predisposition. Drug and social history due to NSAIDs and smoking which is said to exacerbate CD.
- 4. Examination:- Lossof weightand sign of malnutrition. aphthous ulcer in the mouth is often seen.
- 5. Abdominal examination:- • Maybe normal or shows tenderness and or right iliac fossa mass are occasionally found. The anus should be examined to look foredematous anal tags, fissures or perianal abscesses. And the presenceof extra GI features should not be forgotten. • •
- 6. Investigations Complete blood count (CBC):- for the presence of anemia either normocytic normochronic anemia of chronic diseases. However iron deficiency and or folate also occur. Erythrocyte sedimentation rate (ESR) & C-reactive protein (CRP) may raised, whitecells & plateletscount is also high. Hypoalbuminemia is present in severedisease oras partof an acute phase response to inflammation associated with raised CRP .
- 7. Liver function test (LFT) Blood culture forsuspected septicemia Serologic test:- anti-saccharomycescerevisiae antibodies (ASCA) often positive. Stool culture for C. difficile toxinassay should always be performed if diarrhea is present.
- 8. Endoscopy & radiological imaging Colonoscopy/sigmoidoscopy in patientwith severe disease. Upper GI endoscopy toexcludeesophageal & gastroduedenal involvement. Small bowel imaging is mandatory in patientwith CD Perianal MRI orendoanal ultrasound. Capsuleendoscopy in CD with normal radiological findings. Radionuclidescan.
- 9. MRI shows linear fluid-filled perianal fistula in the right ischioanal fossa Capsule endoscopy show ulceration & narrowing of the intestinal lumen
- 10. Examinations In general there are no specific sign in Ulcratıve Colıtıs but the abdomen maybe slightlydistended or tenderto palpation. Pyrexia, tachycardia, are sign of severecolitisand require urgent admission. Rectal examination will show presence blood. Rigid sigmoidoscopy is usuallyabnormal, showing an inf lamed, bleeding, friable mucosa.
- 11. Sigmoidoscopy
- 12. Investigations Complete blood count (CBC):- iron deficiency and raised WBC & platelet. ESR & CRP are often raised Liver function test (LFT) Serologic test:- perinuclearanti-neutrophil cytoplasmicantibodies (pANCA) often positive Stool culture for C.difficile toxin. Colonoscopywith mucosal biopsy is the gold standard X-ray
- 13. Differential diagnosis of IBD Causesof infectiousdiarrhea such as:- Clostridium difficile ,Amoebiasis, Ileocolonic tuberculosis. Others:- Celiacdisease Microscopiccolitis Lactose intolerance Irritable bowel syndrome (IBS) Functional diarrhea
- 14. Behcet disease AIDS Colorectal malignancy (e.g. adenocarcinoma and lymphoma) C1 esterasedeficiency, hereditary angioedema Ischemic colitis e.t.c
- 15. Listen to your patient he is telling you the diagnosis.