Inflammatory Bowel Disease: Clinical

Inflammatory Bowel Disease CLINICAL History CD with gastroduodenal involvement may mimic: peptic ulcer disease and can progress to gastric outlet obstruction

Inflammatory Bowel Disease CLINICAL History Many patients with inflammatory bowel disease (IBD) have irritable bowel syndrome, which can produce occasional: Cramping irregular bowel habits and passage of mucus without blood or pus

Inflammatory Bowel Disease CLINICAL History Weight loss is observed more commonly in CD than in UC because of the malabsorption associated with small bowel disease

Inflammatory Bowel Disease

Physical Fever Tachycardia Dehydration and Pallor may be noted, reflecting anemia The magnitude of these factors is related directly to the severity of the attack

► Evaluate for signs of localized peritonitis

Inflammatory Bowel Disease CLINICAL Physical ► Patients with toxic megacolon appear septic. They have: high fever lethargy chills tachycardia increasing abdominal pain tenderness and distention

Inflammatory Bowel Disease CLINICAL Physical Patients with CD may develop a mass in the right lower quadrant The rectal examination often reveals bloody stool on: gross or hemoccult examination

Inflammatory Bowel Disease CLINICAL Physical Complications e.g.: perianal fissures or fistulas abscesses rectal prolapse may be observed in up to 90% of patients with CD

Inflammatory Bowel Disease CLINICAL Physical Include in the examination a search for extraintestinal manifestations, such as: iritis episcleritis arthritis and dermatologic involvement

Inflammatory Bowel Disease Illustration (episcleritis)

Inflammatory Bowel Disease Causes The etiology of IBD is unknown Environmental smoking infectious genetic autoimmune and host factors have been suspected Interactions among these factors may be more important

Inflammatory Bowel Disease Causes The risk of developing UC is higher in nonsmokers and former smokers than in current smokers On the contrary, patients with CD have a higher incidence of smoking than the general population, and those patients with CD who continue to smoke appear to be less likely to respond to medical therapy

Inflammatory Bowel Disease Differential diagnosis Appendicitis, Acute Diverticular Disease Endometriosis Pelvic Inflammatory Disease

Lab Studies CBC with differential Anemia may result from: 1) acute or chronic blood loss 2) or malabsorption ▼ Iron Folate vitamin B-12 3) or may reflect the chronic disease state

Inflammatory Bowel Disease Lab Studies CBC with differential

► Leukocytosis, anemia, and thrombocytosis are common A modestly elevated WBC is observed in active disease but a marked elevation suggests the presence of an abscess or other suppurative complication

Inflammatory Bowel Disease

Lab Studies Serum chemistry Hypokalemia reflects the severity of the diarrhea ►Abnormal liver function test results may represent: pericholangitis or sclerosing cholangitis

Lab Studies Serum chemistry Hypoalbuminemia resulting from protein-losing enteropathy, suggests extensive colitis Decreased serum calcium may reflect reduced serum albumin Erythrocyte sedimentation rate is typically elevated

Inflammatory Bowel Disease

Imaging Studies Upright chest radiography and abdominal series Evaluate for an edematous irregular colon with "thumb printing." Occasionally, there may be pneumatosis coli (air in the colonic wall)

Inflammatory Bowel Disease Imaging Studies ► Upright chest radiography and abdominal series. Associated findings include: nephrolithiasis cholelithiasis arthritis of the:▼ spine or the sacroiliac joints

Inflammatory Bowel Disease Barium enema In UC, a barium enema (BE) may reveal: 1) a shortened colon 2) with loss of haustrations and 3) destruction of the mucosal pattern lead-pipe colon

Inflammatory Bowel Disease Barium enema Skip areas and rectal sparing are noted in CD BE is contraindicated in patients with moderate-tosevere colitis because it risks: perforation or precipitation of a toxic megacolon

Inflammatory Bowel Disease • Endoscopic differentiation: UC Distribution Inflammation Skip areas Granularity, friability

rectum always diffuse and uniform continuous diffuse disease ++++

Ulceration

small ulcers in a diffuse inflamed mucosa

Stricture Cobblestoning

uncommon uncommon

CD rectal sparing asymmetrical, focal yes + aphthoid ulcer

common common

Inflammatory Bowel Disease • Illustration: cobblestone street and in CD

Inflammatory Bowel Disease • Illustration: aphthoid ulcer (ulcer over a lymphoid follicle)

(earliest radiographic sign in Crohn,s colitis)

Inflammatory Bowel Disease Complications Pseudopolyps Stricture Cancer Perianal complications

Inflammatory Bowel Disease TREATMENT Initiate supportive care with: bowel rest nasogastric suction and intravenous (IV) fluids containing electrolytes

Inflammatory Bowel Disease TREATMENT Admit for:▼ toxicity Obstruction hemorrhage or localized peritonitis

► Laparatomy

TREATMENT

► Monitor severe cases for fat malabsorption Treat perirectal disease Sitz baths Soap and water after stooling Surgical drainage of perirectal abscesses Surgical treatment of recurrent fistulas if medical management fails

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