Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Zulfachmi Wahab
Dept. of Internal Medicine
Dr. Adhyatma Hospital
Semarang
Peak incidence between 10-30 yrs & then a second peak between
6th/7th decade
AETIOLOGY
UNKNOWN
Genetics- approximately 10-15% have a family history of
eg: Ashkanazi jews
Smoking- CD -Yes, Aggrevates
UC- Protective
Developed countries- extreme Hygiene may predispose
(insufficient exposure and challenge of Gut immune
system that makes them susceptible)
Clinical Manifestations- UC
UC typically involves rectum and extends proximally.
At presentation 40 % have proctitis, 40% have left sided, 20% present
with Pancolitis
So Bloody diarrhea, urgency are presenting symptoms
Severe cases i.e. Toxic megacolon can present with fever, weight loss,
tachycardia, failure to thrive, Growth failures and symptoms of systemic
inflamation
Occasionally severe proctitis cases can present with constipation
Clinical Manifestations- CD
Can involve entire GI tract and so symptoms vary
depending on site of involvement
Approximately 30% have SB disease, 40% have ileo-colitis,
30% have colitis and 5% have UGI disease or Anorectal
presentation
Abd pain, Diarrhea, weight loss, Failure to thrive, Growth
retardation- small bowel Disease
Hematochezia, diarrhea in Large bowel disease
Upto 20% have extraintestinal manifestations
Pyoderma_gangrenos um_cribri.lnk
CROHNS DISEASE
FEATURES UC vs CD
Feature
Depth of inflamation
Pattern of disease
Location
Rectal involvement
Ileal disease
Fistulas
Perianal Disease
Granulomas
Overt Bleeding
Malnutrition
Cancer Risk
Tobacco use
UC
Mucosal
Contiguous
Colorectal
Usual
Backwash 10-15%
Rare
Rare
Unlikely
Usual
Unlikely
CRC, Cholangio
Protective
CD
Transmural
Skip areas
Mouth-Anus
less common
Common
Common
Common
10-30% pts
less common
more common
CRC,Sm Bwl
Harmful
Peripheral
Ophtholmologic
Primary
Gallstones
LAB FINDINGS
In mild cases Lab findings are NORMAL
Anemia is a common finding from Iron deficiency of Blood loss or B12/
Folate malabsorption in CD
Hypoalbuminemia, metabolic bone disease from malabsorption are
common in CD
Hypokalemia , Metabolic acidosis from severe diarrhea
Acute Phase reactants- ESR, CRP
UC
p ANCA +/ ASCA -
CD
p ANCA -/ ASCA +
PPV 63%
PPV 80%
ENDOSCOPIC HALLMARKS
Disease Invariably of RECTUMUC
Disease in Perineum- fistula/ inflammation- CD
Ileal disease- CD
Skip lesions Vs Continuous disease
Oral involvement- more common in CD
UGI involvement - CD
CROHNS vs PM COLITIS
ULCERATIVE COLITIS
CONTINUOUS INVOLVEMENT
Ch Ulc COLITIS
PSEUDOPOLYPS,
Collagenous/Lymphocytic colitis
Diverticular Dis Associated Colitis
Medication related Colitis--- NSAIDs , Gold
Ischemic Colitis
Radiation Colitis
Appendicitis
Diverticulitis
Neutropenic Enterocolitis/ Typhilitis
Solitary Rectal Ulcer syndrome
Malignancies- Carcinoma/ lymphoma/ leukemia
Microscopic Colitis
Histopathology features
Crypt Abscess, crypt distortion in UC
Crypt abscess- depth of involvement in CD
Granulomas are found in 30% of CD
Inflamatory infiltrates in MC- NO crypt
distortion noted in MC
Treatment of IBD- UC
Active Disease
Topical therapy for distal disease ie enemas/ suppositoriesASA / Steroid
disease treated with oral mesalamine
Mild
Treatment of IBD- UC
Maintenance of Remission
Mild distal disease may not need
maintenance
Severe disease will do better with a low
dose maintenance with ASA
or with
AZA/6MP
Steroids do not have a roll in maitenance
Treatment of IBD- CD
Similar to UC with following exceptions
Smokers should be counselled to stop
5ASA is less effective than in UC
Metronidazole in an option in induction
Steroids for acute flares
Infliximab/ Adalimumab for induction/ maintenance
AZA/ 6MP for maintenance
Surgery fo complications of disease
Thanks 4 U attention