Inflammatory Bowel Inflammatory Bowel DiseaseDisease
Immunologically-related Immunologically-related disorders that includedisorders that include– Crohn's diseaseCrohn's disease– Ulcerative colitisUlcerative colitis
Inflammatory Bowel Inflammatory Bowel DiseaseDisease
Characterized by chronic, Characterized by chronic, recurrent inflammation of the recurrent inflammation of the intestinal tractintestinal tract
Clinical manifestations are varied Clinical manifestations are varied for both conditionsfor both conditions– Long periods of remission Long periods of remission
interspersed with episodes of interspersed with episodes of acute inflammationacute inflammation
– Both diseases can be debilitatingBoth diseases can be debilitating
Inflammatory Bowel Inflammatory Bowel DiseaseDisease
Cause is unknownCause is unknown Possible causes:Possible causes:
– Infectious agent (virus, Infectious agent (virus, bacteria)bacteria)
– Autoimmune reactionAutoimmune reaction– Food allergiesFood allergies– HeredityHeredity
Ulcerative ColitisUlcerative ColitisDescriptionDescription
Characterized by inflammation Characterized by inflammation and ulceration of the colon and and ulceration of the colon and rectumrectum
May occur at any ageMay occur at any age Peaks between ages 15 and 25 Peaks between ages 15 and 25
yearsyears Equally affects both sexesEqually affects both sexes
Ulcerative ColitisUlcerative ColitisEtiology and Etiology and PathophysiologyPathophysiology
Diffuse inflammation Diffuse inflammation – Involves mucosa and Involves mucosa and
submucosasubmucosa– Alternate periods of Alternate periods of
exacerbations and exacerbations and remissionsremissions
Ulcerative ColitisUlcerative ColitisEtiology and Etiology and PathophysiologyPathophysiology
Usually begins in the rectum Usually begins in the rectum and sigmoid colon and spreads and sigmoid colon and spreads up the colon in a continuous up the colon in a continuous patternpattern
Mucosa is hyperaemic and Mucosa is hyperaemic and oedematous in the affected oedematous in the affected areaarea
Ulcerative ColitisUlcerative ColitisEtiology and Etiology and PathophysiologyPathophysiology
Multiple abscesses develop in Multiple abscesses develop in the intestinal glands the intestinal glands – Abscesses break through into Abscesses break through into
the submucosa, leaving the submucosa, leaving ulcerationsulcerations
Ulcerative ColitisUlcerative ColitisEtiology and Etiology and PathophysiologyPathophysiology
Ulcerations destroy the Ulcerations destroy the mucosal epithelium, causing mucosal epithelium, causing bleeding and diarrhoeableeding and diarrhoea– Fluid and electrolyte lossesFluid and electrolyte losses– Protein lossProtein loss– PseudopolypsPseudopolyps
Ulcerative ColitisUlcerative ColitisEtiology and Etiology and PathophysiologyPathophysiology
Granulation tissue developsGranulation tissue develops Mucosa musculature becomes Mucosa musculature becomes
thickened, shortening the thickened, shortening the coloncolon
Ulcerative ColitisUlcerative ColitisClinical ManifestationsClinical Manifestations
Most commonly presents as a Most commonly presents as a chronic disorder with mild-to-chronic disorder with mild-to-severe acute exacerbations severe acute exacerbations that occur at unpredictable that occur at unpredictable intervals over many yearsintervals over many years
Ulcerative ColitisUlcerative ColitisClinical ManifestationsClinical Manifestations
Major symptoms:Major symptoms:– Bloody diarrhoeaBloody diarrhoea– Abdominal painAbdominal pain
Ulcerative ColitisUlcerative ColitisComplicationsComplications
Complications may be Complications may be classified as:classified as:– IntestinalIntestinal– ExtraintestinalExtraintestinal
Ulcerative ColitisUlcerative ColitisComplicationsComplications
Intestinal complications:Intestinal complications:– HaemorrhageHaemorrhage– StricturesStrictures– PerforationPerforation– Toxic megacolonToxic megacolon– Colonic dilationColonic dilation
Ulcerative ColitisUlcerative ColitisComplicationsComplications
Toxic megacolonToxic megacolon– Dilation and paralysis of the Dilation and paralysis of the
coloncolon– Occurs in 5% of patients Occurs in 5% of patients – Associated with perforationAssociated with perforation
Ulcerative ColitisUlcerative ColitisComplicationsComplications
Extraintestinal complications:Extraintestinal complications:– May be directly related to May be directly related to
the colitis the colitis – May be nonspecific May be nonspecific
complications mediated by a complications mediated by a disturbance in the immune disturbance in the immune systemsystem
Crohn's DiseaseCrohn's DiseaseDescriptionDescription
A chronic, nonspecific A chronic, nonspecific inflammatory bowel disorder of inflammatory bowel disorder of unknown origin that can affect unknown origin that can affect any part of the GI tract from the any part of the GI tract from the mouth to the anusmouth to the anus
Crohn's DiseaseCrohn's DiseaseDescriptionDescription
Can occur at any ageCan occur at any age Most often between ages 15 and Most often between ages 15 and
30 years30 years Both genders are affectedBoth genders are affected Similar to ulcerative colitisSimilar to ulcerative colitis
Crohn's DiseaseCrohn's DiseaseEtiology and Etiology and PathophysiologyPathophysiology
Characterized by inflammation Characterized by inflammation of segments of the GI tractof segments of the GI tract
Can affect any part of the GI Can affect any part of the GI tract but is most often seen in tract but is most often seen in the terminal ileum, jejunum, and the terminal ileum, jejunum, and coloncolon
Crohn's DiseaseCrohn's DiseaseEtiology and Etiology and PathophysiologyPathophysiology
Inflammation involves all layers Inflammation involves all layers of the bowel wallof the bowel wall
Ulcerations are deep and Ulcerations are deep and longitudinal and penetrate longitudinal and penetrate between islands of inflamed between islands of inflamed oedematous mucosa, causing oedematous mucosa, causing the classic cobblestone the classic cobblestone appearanceappearance
Crohn's DiseaseCrohn's DiseaseEtiology and Etiology and PathophysiologyPathophysiology
Thickening of the bowel wallThickening of the bowel wall Narrowing of the lumen with Narrowing of the lumen with
stricture developmentstricture development
Crohn's DiseaseCrohn's DiseaseEtiology and Etiology and PathophysiologyPathophysiology
Abscesses or fistula tracts that Abscesses or fistula tracts that communicate with other loops communicate with other loops of bowel, skin, bladder, rectum, of bowel, skin, bladder, rectum, or vagina may developor vagina may develop
Crohn's DiseaseCrohn's DiseaseClinical ManifestationsClinical Manifestations
Manifestations depend on the Manifestations depend on the anatomic site of involvement, anatomic site of involvement, extent of the disease process, extent of the disease process, and presence or absence of and presence or absence of complicationscomplications
Crohn's DiseaseCrohn's DiseaseClinical ManifestationsClinical Manifestations
Onset is usually insidiousOnset is usually insidious Nonspecific complaints:Nonspecific complaints:
– DiarrhoeaDiarrhoea– FatigueFatigue– Abdominal painAbdominal pain– Weight lossWeight loss– FeverFever
Crohn's DiseaseCrohn's DiseaseClinical ManifestationsClinical Manifestations
Principal manifestations:Principal manifestations:– Diarrhoea (non-bloody)Diarrhoea (non-bloody)– Abdominal painAbdominal pain
Crohn's DiseaseCrohn's DiseaseClinical ManifestationsClinical Manifestations
Pain (severe and intermittent)Pain (severe and intermittent) Abdominal cramping and Abdominal cramping and
tendernesstenderness Abdominal distensionAbdominal distension ArthritisArthritis Finger clubbingFinger clubbing
Crohn's DiseaseCrohn's DiseaseComplicationsComplications
Strictures and obstruction from Strictures and obstruction from scar tissuescar tissue
FistulasFistulas PeritonitisPeritonitis Fat intoleranceFat intolerance Gluten intoleranceGluten intolerance
