ia

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

by Dr. JAGJIT KHOSLA

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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

by Dr. JAGJIT KHOSLA

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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

by Dr. JAGJIT KHOSLA

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Barium Studies Crohns diseaseAphthous ulcers First signCobblestone appearance - due to deep fissuring ulcers around inflamed mucosa

by Dr. JAGJIT KHOSLA

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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

by Dr. JAGJIT KHOSLA

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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

by Dr. JAGJIT KHOSLA

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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