2. General introduction :
Inflammatory bowel disease (IBD) is a chronic condition
that includes two major entities :
1- Crohn’s disease
2- ulcerative colitis
The distinction between ulcerative colitis
and Crohn disease is based, in large part, on:
1. the distribution of affected sites
2. the morphologic expression of disease at those sites
2
3. General introduction :
Ulcerative colitis is limited to the colon and
rectum and extends only into the mucosa and
submucosa.
Crohn’s disease may involve any area of the
gastrointestinal tract and frequently is
transmural
3
4. Causes
The exact cause of IBD is unknown, However,
most investigators believe that IBD results from a
combination of :
Genetic factors.
Mucosal immune responses.
Environmental factors
Bacteria( epithelial defect )
4
5. Genetic factors
Risk of disease is increased when there is an
affected family member.
In Crohn disease, the concordance rate for
monozygotic twins is approximately 50%.
In ulcerative colitis concordance rate for monozygotic
twins is only 16%.
5
6. Mucosal immune responses
Although the mechanisms by which mucosal
immunity contributes to the pathogenesis of
Ulcerative colitis and Crohn disease are still
being not completely understood. it is likely that
some combination of derangements that
activate mucosal immunity and suppress
immunoregulation contribute to the
development of both ulcerative colitis and
Crohn disease
6
9. Introduction
Is a disease in which extensive areas of the walls of the
large intestine become inflamed and ulcerated.
The motility of the ulcerated colon is often so great that
mass movements occur much of the day.
The colon’s secretions are greatly enhanced the
patient has repeated diarrheal bowel movements.
9
10. Introduction
Begins gradually and can become worse over time.
Is an autoimmune disease characterized by T-cells infiltrating
the colon.
Ulcerative colitis usually involves the rectum and is confined
to the colon, with occasional involvement of the ileum.
10
11. Signs and symptoms
The most common are diarrhea with blood or
pus and abdominal discomfort. Other signs and
symptoms include:
An urgent need to have a bowel movement.
Feeling tired.
Nausea or loss of appetite.
Weight loss.
Fever.
Anemia.
11
12. Complications
Rectal bleeding.
Dehydration and malabsorbtion.
Changes in bones.
Inflammation in other areas of the body.
Megacolon
12
14. Treatment - Medications
No medication cures ulcerative colitis, many
can reduce symptoms. The goals of medication
therapy are:
Inducing and maintaining remission.
Improving the person's quality of life.
Medications that best treat symptoms:
Aminosalicylates (Aspirin and Ibuprofen.).
Corticosteroids (prednisone).
Immunomodulators.
Other medications.
14
15. 15
Removal of the entire colon "cures" ulcerative colitis.
A surgeon can do that by two different types of
surgery :
Proctocolectomy and ileostomy.
Proctocolectomy and ileoanal reservoir.
Full recovery from both operations may take 4 to 6
weeks.
Treatment – Surgery
IleostomyIleoanal reservoir
22. 3-loss of normal mucosal folds ( linear mucosa )
in addition to ( cobblestone –shaped mucosa )
22
The characteristic of crohn's disease
23. 4- (creeping fat)
23
The characteristic of crohn's disease
24. 5- The microscopic features of active
Crohn disease include abundant
neutrophils that infiltrate and damage
crypt epithelium ,, Clusters of
neutrophils within a crypt are referred
to as a crypt abscess and often are
associated with crypt destruction.
24
The characteristic of crohn's disease
25. Clinical features :
1- In most patients, disease begins with:
-mild diarrhea
-fever and abdominal pain
2- Iron deficiency anemia may develop in persons with
colonic disease
3- extensive small bowel disease may result in :
-serum protein loss
-generalized nutrient malabsorption
(VB12 and bile salts )
25
26. Treatment :
1- Anti-inflammatory drugs ( reduces inflammation )
2- Immune system suppressors ( suppress immune
system that increases inflammation )
3- Antibiotics (reduce harmful intestinal bacteria )
4- Surgery
26
28. References
Robbins-basic pathology ,9th editiom
The National Institute of Diabetes and Digestive and
Kidney Diseases:
http://www.niddk.nih.gov/health-information/health-
topics/digestive-diseases/ulcerative-colitis/Pages/facts.aspx#what
Guyton and Hall Textbook of Medical Physiology, 12th edition.
Pathoma.
28
The exact cause of ulcerative colitis is unknown
Autoimmune disease.
Genetic factors.
Environment.
Bacteria.
but overall, it is likely that some combination of derangements that activate mucosal immunity and suppress immunoregulation contribute to the development of both ulcerative colitis and Crohn disease.
1- the large intestine become inflamed
2 The motility of the ulcerated colon is often so great
3-secretions are greatly enhanced has repeated diarrheal bowel movements
gradually
are diarrhea with blood or pus and abdominal discomfort
An urgent need to have a bowel movement.
Feeling tired.
Nausea or loss of appetite.
Weight loss.
Fever.
Anemia.
Rectal bleeding.
Dehydration and malabsorbtion.
Changes in bones.
Inflammation in other areas of the body.
Megacolon
3- bcs corticosteroid
megacolon Megacolon is a rare complication of ulcerative colitis.
No medication cures ulcerative colitis, many can reduce symptoms. The goals of medication therapy are:
inducing and maintaining remission.
improving the person's quality of life.
Medications that best treat symptoms:
Aminosalicylates (Aspirin and Ibuprofen.).
Corticosteroids (prednisone).
Immunomodulators.
Other medications.
Immunomodulators reduce immune system activity, resulting in less inflammation in the colon.
Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove a patient's entire colon and rectum.
An ileostomy The surgeon brings the end of the ileum through an opening in the skin. The stoma most often is located in the lower part of the patient's abdomen, just below the beltline.
A removable external collection pouch, connects to the stoma and collects intestinal contents outside the patient's body. The stoma has no muscle, so it cannot control the flow of intestinal contents, and the flow occurs whenever peristalsis occurs. Peristalsis is the movement of the organ walls that propels food and liquid through the GI tract.
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Proctocolectomy and ileoanal reservoir. An ileoanal reservior is an internal pouch made from the patient's ileum. The ileoanal reservior connects the ileum to the anus. The surgeon preserves the outer muscles of the patient's rectum during the proctocolectomy.
Next, the surgeon creates the ileal pouch and attaches it to the end of the rectum. Waste is stored in the pouch and passes through the anus.
After surgery, bowel movements may be more frequent and watery than before the procedure.