inflammatory bowel diseases (ibd)
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Inflammatory Bowel Diseases (IBD). Dr: Gehan Mohamed Dr. Abdelaty Shawky. Learning objectives. Understand definition of IBD Discuss the etiology of IBD. Recognize the COMMMONest TWO types of IBD (Crohn’s disease ,Ulcerative colitis) - PowerPoint PPT PresentationTRANSCRIPT
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Inflammatory Bowel DiseasesInflammatory Bowel Diseases(IBD)(IBD)
Dr: Gehan Mohamed Dr. Abdelaty ShawkyDr: Gehan Mohamed Dr. Abdelaty Shawky
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Learning objectives
• Understand definition of IBD• Discuss the etiology of IBD.• Recognize the COMMMONest TWO types of
IBD (Crohn’s disease ,Ulcerative colitis)• Mention the clinical presentation,gross and
microscopic characteristics for both crhon’s disease and ulcerative colitis.
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Inflammatory bowel disease Inflammatory bowel disease
* Definition: a chronic condition of intestinal inflammation and ulceration that has no identifiable cause
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Environment Triggers
Immunoregulatory Defects and
Microbial ExposureGenetic Factor
b)Occupation (exposure to pollutants)
a)Dysfunctional immune host response to normalluminal components
a)Westernization
c)Diet (fats, fast food)
c)Defective barrier function e.g bacterial products are able to cross the mucosal barrier
d)Tobacco smoking
b)Infection with a specific pathogen e.g paramyxovirus, Listeria monocytogenes, and Helicobacter hepaticus
Etiology
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* Course of the IBD:
The inflammatory bowel disease is a chronic disease (lasting a long time), show periods of exacerbations in which the disease flares up and causes symptoms. These periods are followed by remission, in which symptoms disappear or decrease and good health returns.
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Symptoms may range from mild to severe and generally depend upon the part of the intestinal tract involved. They include the following:
•Abdominal cramps and pain •Bloody diarrhea•Severe urgency to have a bowel movement •Fever •Loss of appetite •Weight loss •Anemia (due to blood loss)•Extra-intestinal manifestations: arthritis, eye problems..
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* Two common types of IBD:
• Crohn’s disease• Ulcerative colitis
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Ulcerative colitisUlcerative colitis
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Ulcerative colitis
• It is a chronic disease of the lower gastrointestinal tract.
• The hallmarks of ulcerative colitis are abdominal pain and bloody diarrhea due to inflammation and ulcerations in the large intestine (colon) and rectum.
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* Morphological features of UC:• Ulcerative colitis involves the rectum and extends proximally
in a retrograde fashion to involve the entire colon ("pancolitis") in the more severe cases.
• The affected segment shows;– Marked inflammatory cellular infiltrate of the mucosa by
lymphocytes, plasma cells and neutrophils. – Ulcerations.– Psudopolyps formation: hyperplastic surface mucosal
cells without fibrovascular cores. – Cryptitis and crypt abscess: presence of neutrophils inside
colonic glands.– Dysplasia of the colonic glands: which is precancerous.
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Endoscopic image of a sigmoid colon with ulcerative colitis. Note the focal friability of the mucosa
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Colonic pseudopolyps
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Marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.
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Crypt abscess, a classic finding in ulcerative colitis
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* Complications of UC:1. Bleeding: Rectal bleeding and bloody diarrhea are two of the hallmark symptoms of ulcerative colitis.2. Anemia: In ulcerative colitis, this is usually the result of chronic blood loss. 3. Malnutrition: Symptoms such as diarrhea and rectal bleeding can lead to a loss of fluids and nutrients.
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4. Osteoporosis: Ulcerative colitis patients are at risk for low bone density, chiefly due to long-term use of some medications, such as steroids.5.Intestinal Stricture and obstruction: due to fibrosis.6. Cancer colon: Ulcerative colitis patients have a higher risk of developing colon cancer. The risk increases when ulcerative colitis for a prolonged period of time.
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7. Perforation: Extensive inflammation can lead to a tear in the intestinal wall, resulting in leakage of bowel contents outside the intestine. Categorized by sudden, severe abdominal pain, shock, and excessive abdominal tenderness.8. Toxic megacolon: This serious complication may occur when inflammation spreads from the lining of the colon to involve the entire intestinal wall. Because this involvement temporarily stops the normal contractile movements of the intestine, the large intestine may greatly expand.
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Toxic megacolon.
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Crohn's diseaseCrohn's disease(Regional enteritis)(Regional enteritis)
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• Crohn's disease can affect any area of the GI
tract, from the mouth to the anus, including
esophagus, stomach, small intestine, large
intestine, and rectum.
• It most commonly affects the ileum.
• A classic feature of CD is the sharp demarcation
of diseased bowel segments from adjacent
uninvolved bowel.
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* Morphological features of Crohn's disease:
• Crohn’s disease is characterized by: The affected part of the intestine show skip areas i.e.
areas free from the lesions.
The intestinal wall is thick and rubbery, caused by
edema, inflammation, fibrosis, and hypertrophy of the
muscularis propria.
Cobble stone appearance due to edema of the mucosa
with interrupting fissuring ulcers.
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Fissuring of the wall with formation of fistulae.
Microscopically there is: transmural involvement of the
bowel by mixed inflammatory cells and the presence of
noncaseating granulomas.
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Gross appearance of Crohn's disease. There is a sharp demarcation between the involved and the uninvolved areas
(skip areas).
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Fig. 2: Gross appearance of Crohn's disease. The
combination of ulceration and elevated remnants of mucosa results in a typical cobblestone appearance.
Fig. 3: Gross appearance of Crohn's disease. Another example of cobblestone appearance.
Fig. 4: Gross appearance of Crohn's disease. Note the segmental nature of the inflammation, and rigidity of the wall, and flattening of the mucosa are characteristic.
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Section of colectomy showing transmural inflammation in crohn's disease
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Crohn's disease showing marked inflammatory changes and the formation of a fissure.
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* Complications of crohn’s disease:
1. Intestinal obstruction: Blockage occurs because the disease tends to thicken the intestinal wall by inflammation and finally fibrosis occurs.2. Fistulas: intestino-intestinal, intestinoabdominal and perianal fistulae.
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3. Malabsorption syndrome: deficiencies of proteins, calories, and vitamins deficiencies may be caused by intestinal loss of protein, or poor absorption.4. Other complications: arthritis, skin problems, inflammation in the eyes or mouth, or other diseases of the liver and biliary system.
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Findings in diagnostic workup in Crohn's disease vs. ulcerative colitis
Sign Crohn's disease Ulcerative colitis
Terminal ileum involvement Commonly Seldom
Colon involvement Usually Always
Rectum involvement Seldom Usually
Involvement aroundthe anus Common Seldom
Bile duct involvement No increase in rate of primary sclerosing cholangitis Higher rate
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Distribution of Disease Patchy areas of inflammation (Skip lesions)
Continuous area of inflammation
EndoscopyDeep geographic and
serpiginous (snake-like) ulcers
Continuous ulcer
Depth of inflammation May be transmural, deep into tissues Shallow, mucosal
Stenosis Common Seldom
Granulomas on biopsy May have non-necrotizing granulomas crypt granulomas not seen
Sign Crohn's disease Ulcerative colitis