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inflammatory Bowel disease

Inflammatory Bowel Disease , case, signs and symptoms, diagnosis, investigations and treatment.

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inflammatory Bowel disease

  1. 1. Fahad Fayyaz Butt Resident R1
  2. 2. 6 year school going boy presented with Chronic diarrhea for 6 months associated with abdominal pain, Progressive weight loss and reduced appetite. • Continuous, 4-5x a day , with bleeding and mucusDiarrhea •Diffuse , Dull aching Abdominal pain
  3. 3. Past Medical History Anal fistulas since 2 years- taking medical therpay 1-1.5 years diarrhea on/off Took antibiotics multiple times but no effective improvement Family History One Sister have psoriasis Developmental History Normal development ,4th grader Vaccination History Completed Nutritional History Eats healthy normal diet, but reduced appetite since 1-1.5 years
  4. 4. Physical examination • Wasted, lethargicLook • presentPallor • absentLymph nodes • present ( MILD)Clubbing • absentCyanosis • DehydratedHydration
  5. 5. Physical examination CVS Normal Heart examination CNS No CNS Examination CHEST Normal Chest examination ENT Normal ENT examination ABDOMEN Diffuse tenderness, no distention, no masses palpable, no organomegaly, bowel sounds present. Anal fistulas and fissures are present
  6. 6. Initial Investigations LABS Results WBC 11 x 10^3 U/L mainly neutrophils HgB 10 g /dl ( LOW) MCV 70 fl ( LOW) RDW 16% ( Increased) PLT 500 x 10^3 U/L PT and PTT normal LFT normal CRP Raised ESR Raised
  7. 7. Mucus: present RBCs: 10-20 /HPF Pus cells: Numerous OVA and Parasites: not seen Rota and adeno virus : negative Stool for reducing substances: negative Culture: Normal C. Diff toxin : normal Fecal Calprotectin and Lactoferrin: Raised Stool Routine and culture
  8. 8. • No blood in stool • Positive for Anti-gliadin antibody IgACeliac disease • ova and parasites seen in series of stool examinations • No blood in stool Giardiasis • History of exposureG.I. T.B. • Reducing substances should be positive in stool • Hydrogen Breath test: positive Lactose Intolerance • Recurrent URTI and LRTI • Sweat chloride should be positive Cystic Fibrosis Differential diagnosis
  9. 9. Inflammatory Bowel disease:
  10. 10. •Mild erythema distal esophagus Esophagus •Patchy erythema ,mainly antrum Stomach •Patchy erythema and edema Colon Esophago- duodenoscopy Colonoscopy Endoscopic findings
  11. 11. Diagnosis: Crohn’s Disease
  12. 12. Inflammatory Bowel Disease Crohn’s Disease Ulcerative Colitis
  13. 13. Ulcerative ColitisCrohn’s Disease
  14. 14. • UnknownCause • Most common in Adolescents Age group • Family History • Mutations: Turner, Glycogen storage Diseases Risk Factors
  15. 15. Clinical Presentation 72 56 22 5862 74 84 31 0 20 40 60 80 100 abdominal pain diarrhea bleeding weight loss crohns disease ulcerative colitis
  16. 16. 74 35 20 20 18 0 20 40 60 80 100 Anemia Arthritis Erythema Nodosum Stomatitis Scleritis & Uveitis Inflammatory Bowel disease Extraintestinal Manifestation
  17. 17. Laboratory Crohn’s Disease Ulcerative Colitis CBC ESR CRP LFT Fecal Calprotectin or Lactoferrin P-ANCA ASCA Negative Positive Investigations ↓↓ Hemoglobin ↑↑ Platelets ↑ or normal ↑ or normal ↓ Albumin Positive Positive Negative
  18. 18. Crohn’s Disease Ulcerative Colitis Esopahgo- duodenoscopy edema, erythema, friability, granulation • StricturesColonoscopy Colonoscopy edema, erythema, friability, granulation • Pseudopolyps Macroscopic appearance
  19. 19. Cobble stoning In CROHN’S Pseudopolyps In Ulcerative Colitis
  20. 20. Microscopic appearance 0 20 40 60 80 100 Crypts distortion crypts abscess Granuloma Crohns Disease Ulcerative colitis
  21. 21. Steatorrhea Renal Stones Growth Retardation Sclerosing Cholangitis Colon Cancer Complications • Crohn’s disease = Biliary system or Ileum • Ulcerative Colitis = Biliary system • Excessive Oxalate absorption • Reduced appetite and/or decreased absorption • Fibrosis of intra and extra hepatic bile ducts • Long term inflammation and damage, >10 years
  22. 22. Crohn’s Complications
  23. 23. Fistula Strictures Perianal Abscess Enteroenteral Enterovesical Entervaginal
  24. 24. Strictures Constipation Mild Distention Abdominal pain
  25. 25. Ulcerative Colitis Complications
  26. 26. Toxic Megacolon Severe Abdominal pain Distention Fever
  27. 27. Medical Management
  28. 28. Diet Management Flares Small several Meals Low Fiber Low Fat Simple carbohydrate Protein rich Modulen Milk
  29. 29. Description: Modulen® IBD is a whole protein powdered formulation. It is 100% casein based and provides 25% of the fat as MCT
  30. 30. Induction Transition Maintenance Drug Management •Modulen milk •SteroidsInduction • 5-ASA • Azathipurine • 6-Mercaptopurine Maintenance
  31. 31. Modulen Milk Oral Budesonide IV methyl Prednisolone Induction THERAPY NON REMITTING SEVERE MILD
  32. 32. 5-ASA Azathiopruine 6-MP Methotrexate Infliximab Maintenance THERAPY TMPT TEST TUBERCULIN TEST NON-RESPONSIVE Start
  33. 33. Surgical Management Indication • Perforation • Strictures • Fistulas • Perianal abscess • Intractable Bleeding • TOXIC MEGACOLON Complications • Recurrence of strictures at site of surgery. • Leak at site of anastomosis
  34. 34. Prognosis Relapses Retarded Height Osteopenia Drug side effects Colon Cancer

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