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InflammatoryBowel DiseaseInvestigations
By Jagjit Khoslaby Dr. JAGJIT KHOSLA
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Routine Investigations Blood examination C - reactive Protein Platelet count ESR TLC Hemoglobin S. Albumin
Due to InflammationDue to blood loss & Malabsorption
by Dr. JAGJIT KHOSLA
Specific Investigations Barium enema CT Scan
Colonoscopy
Stool specimenRadioimagingBiopsyCulture and SenstivityHistopathology
Ova and parasites, Cl. difficile toxin
by Dr. JAGJIT KHOSLA
Specific Investigations
Calprotectin in feces is a well-documented marker of gastrointestinal inflammation. Indicates disease intensity--normalization of values predict mucosal healingLakartidningen.2010 Oct 27-Nov 2;107(43):2645-9, PMID: 21137533 [PubMed - indexed for MEDLINE]
by Dr. JAGJIT KHOSLA
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Barium enema Ulcerative colitisAcute stageFine mucosal granularity - First signNarrowing of lumen
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Barium enema Ulcerative colitisAcute stageFine mucosal granularity - First signNarrowing of lumenCollar button ulcers
Intestinal LumenWide and deep BaseNarrow neckby Dr. JAGJIT KHOSLA
Barium enema Ulcerative colitisAcute stageFine mucosal granularity - First signNarrowing of lumenCollar button ulcersPseudopolyps - 'island' of preserved colonic mucosa, surrounded by 'sea' of ulcerated hemorrhagic mucosa
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Barium enema Ulcerative colitisChronic stageLoss of haustrationsShortened and narrowed colon due to spasm or fibrosis (Lead-pipe colon)
by Dr. JAGJIT KHOSLA
Barium Studies Crohns diseaseAphthous ulcers First sign
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Barium Studies Crohns diseaseAphthous ulcers First signCobblestone appearance - due to deep fissuring ulcers around inflamed mucosa
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Barium Studies Crohns diseaseAphthous ulcers First signCobblestone appearanceString sign due to spasm or fibrosis of intestinal wall
by Dr. JAGJIT KHOSLA
Barium Studies Crohns diseaseAphthous ulcers First signCobblestone appearanceString sign Fistulas, strictures, abscesses
Ileo-Ileal Fistulaby Dr. JAGJIT KHOSLA
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Colonoscopic differencesUlcerative colitis
Rectum involved in 95%Continuous disease
No cobblestoningBiopsy Never granulomaCrohns Disease
Rectal sparingSegmental involvement with intervening normal areaCobblestone appearanceBiopsy Granulomatous inflammation
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Colonoscopy
Severe ulcerative ColitisContinuous marked ulcerations White patchesby Dr. JAGJIT KHOSLA
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Colonoscopy
Biopsy forcepsBiopsy during colonoscopyby Dr. JAGJIT KHOSLA
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Histopathology Ulcerative colitisInflammation Acute and chronic mixedLimited to mucosal layerCrypt atrophy or distortionAbsence of goblet cellsAbscess formationby Dr. JAGJIT KHOSLA
Histopathology Crohns Disease
Inflammation Acute and chronic mixedInflammation extending into submucosaCrypt atrophy or distortionMultiple small Non-necrotizing epitheloid granulomas in mucosaby Dr. JAGJIT KHOSLA
Indeterminate colitis
In approximately 5% of inflammatory bowel disease cases, a definite diagnosis of ulcerative colitis or Crohn's disease cannot be established, in which case the term "indeterminate" colitis is used. Most cases of indeterminate colitis are related to fulminant colitis, a condition in which the classic features of ulcerative colitis or Crohn's disease may be obscured by severe ulceration with early superficial fissuring ulceration, transmural lymphoid aggregates, and relative rectal sparing.Diagnostic Problems and Advances in Inflammatory Bowel Disease, Robert Odze M.D., F.R.C.P.C.1, Mod Pathol 2003;16(4):347358
by Dr. JAGJIT KHOSLA
Infectious
InflammatoryNeoplasticIBD
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Infectious diseases Bacterial
Mycobacterial Parasitic
Viral
FungalSalmonella, Shigella, E. Coli, Campylobacter, Yersinia, Clostridium difficile, Gonorrhea, ChlamydiaTuberculosisE. hystolytica, Isospora belli, Trichuris trichura, Hookworm, Strongyloides stercoralisCMV, HSV, HIVCandida, Aspergillus, Histoplasmosis
by Dr. JAGJIT KHOSLA
Infectious diseases Bacterial
Mycobacterial Parasitic
Viral
Fungal
Stool SpecimenCulture & SenstivityCl. Difficile Toxin analysisby Dr. JAGJIT KHOSLA
Infectious diseases Bacterial
Mycobacterial Parasitic
Viral
Fungal
ColonoscopyCulture & SenstivityAcid- Fast smear
Biopsyby Dr. JAGJIT KHOSLA
Infectious diseases Bacterial
Mycobacterial Parasitic
Viral
FungalStool Specimen Ova and parasites
Biopsyby Dr. JAGJIT KHOSLA
Inflammatory diseases Diverticulitis Appendicitis Ischemic colitis Radiation colitis NSAID related colitisColonoscopy & BiopsyH/o RadiotherapyH/o NSAIDS intakeby Dr. JAGJIT KHOSLA
Neoplastic diseases Lymphoma Colonic carcinomaColonoscopy & Biopsyby Dr. JAGJIT KHOSLA
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Bibliography
Harrisons Principles of Internal medicine, 17th Edition Davidsons Principles & Practice of Medicine, 21st Edition Lakartidningen.2010 Oct 27-Nov 2;107(43):2645-9, PMID: 21137533 [PubMed - indexed for MEDLINE]ABDOMINAL IMAGING, Volume 4, Number 1, 79-84, DOI: 10.1007/BF01887501, Joel E. Lichtenstein, John E. Madewell and David S. FeiginK. Ramakrishnan & D.C. Scheid : Opening Pandora's Box: The Role Of Contrast Enemas In Abdominal Imaging . The Internet Journal of Gastroenterology. 2003, Volume 2 Number 1Diagnostic Problems and Advances in Inflammatory Bowel Disease, Robert Odze M.D., F.R.C.P.C.1, Mod Pathol 2003;16(4):347358Learning radiology
by Dr. JAGJIT KHOSLA
Thanks for patienceby Dr. JAGJIT KHOSLA