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Definition:
-Inflammatory disease of the GI tract. The two inflammatory bowel diseases
include
Aphthous ulcers
Pyoderma Gangrenosum (necrotic tissue that causes ulcers in the leg)
Iritis (painful inflammation of the iris)
Erythema nodosum (Inflammation of the fact cells under the skin
resulting in red lumps or nodules)
Sclerosing cholangitis (destruction of the bile duct)
Arthritis, Ankylosin spondylitis (inflammatory disease of the axial
skeleton)
Clubbing of fingers
Kidney (amyloid deposits, nephrotic syndrome)
History:
Differential diagnosis:
IBD
Incidence
Ulcerative colitis
More common 10/100000
Crohn's disease
Less common 3-6/100000
Sex
Female> male
Distribution
Bimodal: 20 to 35y - 50 to 65
Bimodal: 25 to 40 - 50 to
65
Initial symptoms
Bloody diarrhea
(hallmark), fever, weight
loss
Anatomic
distribution
COLON ONLY
Route of spread
Mouth to anus:
small bowel (20%)
Small bowel and colon
(40%)
Colon only (30%)
Small bowel, colon, or both
with Skip areas of normal
bowel
Bowel
involvement
Anal
involvement
Uncommon
Full thickness
Common (fistulae,
abscess, fissures, ulcers)
Rectal
involvement
100%
Rare
Mucosal findings
1.
2.
3.
4.
1.
2.
3.
4.
5.
6.
Diagnostic tests
1. Colonoscopy
2. Barium enema (lead
pipe appearance)
3. UGI with small bowel
follow through (R/O
crohn's)
4. stool cultures
1.
1.
2.
3.
4.
5.
6.
1. fistula/abscess
(fistulas because
crohn's is
transmural)
2. perforation
3. stricture
4. toxic megacolon
5. Obstruction
6. cancer risk
Complications
Cancer
toxic megacolon
colonic perforation
hemorrhage
obstruction
cancer risk
2.
3.
4.
Aphtoid ulcers
Granulomas
Linear ulcers
Transverse fissures
Swollen mucosa
Full thickness wall
involvement
Colonoscopy with
biopsy
(cobblestoning)
Barium enema
UGI with small bowel
follow through
stool cultures
- During bowel resection for Crohn's disease we only need grossly negative
margins.
-CD: Surgery (not curative) most commonly performed in cases of disease
complications of the disease; generally consists of conservative resection
(eg, potential stricturoplasty vs resective surgery) to preserve bowel length
in case future additional surgery needed