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Inflammatory Bowel Disease

Inflammatory Bowel Disease. Professor Ravi Kant FRCS (England), FRCS ( Edin ), FRCS ( Glasg ),FRCS ( Irel ), FAMS, MS, DNB, FACS, FICS Professor of Surgery. Professor Ravi Kant. Fellow Mayo Clinic, USA Fellow NCI Milan, Italy Fellow Univ. College of London (UCL), UK

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Inflammatory Bowel Disease

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  1. Inflammatory Bowel Disease Professor Ravi Kant FRCS (England), FRCS (Edin), FRCS (Glasg),FRCS (Irel), FAMS, MS, DNB, FACS, FICS Professor of Surgery

  2. Professor Ravi Kant • Fellow Mayo Clinic, USA • Fellow NCI Milan, Italy • Fellow Univ. College of London (UCL), UK • Fellow NCI, Tokyo, Japan • Award of Excellence by Govt. of Delhi 1995 • Award: Japan Surgical Society (1992) • Award: American Society of Lasers 1991 • Award by Association of Surgeons of India

  3. Professor Ravi Kant • Professor since 1995 • Faculty member since 1984 • Post graduation: 1981 • WHO Fellow • Commonwealth Fellow • Married to Bina since 1982 • Daughter Tina, dentist in USA, married.

  4. Inflammatory bowel disease

  5. 1932 • Crohn BB, Ginzburg L, Oppenheimer GD "Regional ileitis: a pathologic and clinical entity. 1932". Mt. Sinai J. Med.67 (3): 263–8. PMID10828911

  6. H2S (Hydrogen Sulfide) theory Roediger WE, Moore J, Babidge W (1997). "Colonic sulfide in pathogenesis and treatment of ulcerative colitis". Dig. Dis. Sci.42 (8): 1571-9.   doi:10.1023/A:1018851723920. PMID9286219. Levine J, Ellis CJ, Furne JK, Springfield J, Levitt MD (1998). "Fecal hydrogen sulfide production in ulcerative colitis". Am. J. Gastroenterol.93 (1): 83– 7.  doi:10.1111/j.1572-0241.1998.083_c.x. PMID9448181.

  7. NOD gene in Crohn’ (Ogura 2000 in Nature)

  8. NOD Gene & Crohn’s • Ogura. Nature 2000 (411): 603-6. • Cuthbert A. Gastroenterology 2002 • Kaser. Cell 2008

  9. Crohn’s (Am GI Asso)

  10. Transmural Colon involvement in Crohn’s

  11. Pseudopolyps in UC

  12. Pyoderma gangrenosum

  13. Primary Sclerosing Cholangitis in UC • 40-60% UC: Primary Sclerosing Cholangitis • Colectomy will NOT reverse PSC • RxTransplant • CA @ 20y < N • Dvorchik J. Hepatology 2002 35:380

  14. Post Colectomy in UC

  15. Arthritis in UC • Improves after Colectomy. • 20 X N

  16. Sacroiliatis & Ankylosing Spondylitis in UC • RX of UC- No change in Symptoms • 20 X N

  17. N

  18. UC

  19. CD

  20. Ulcerative colitis. Double-contrast barium enema study shows pseudopolyposis of the descending colon Crohn’s disease (regional ileitis)

  21. Stricture

  22. Multiple strictures

  23. Abscess

  24. Contrast • String sign of Kantor • Sterlien’s sign • Fleischner’s sign

  25. Imaging • MRI > CT • CT enteroclysis • Capsule endoscopy

  26. Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture Crohn's disease (regional ileitis)

  27. Peri-nuclear staining

  28. Granular cytoplasmic stain

  29. Iowa hypothesis • Helminthic therapy using the whipwormTrichuris suis • fecal bacteriotherapy ►Th2 white cell response in the diseased area • Summers RW, Elliott DE, Urban JF, Thompson RA, Weinstock JV (2005). "Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial". Gastroenterology128 (4): 825–32

  30. Bristol & Bath hypothesis • ▲ Immunity • CB1 & CB 2 receptors (Cannabis) • Wright K, Rooney N, Feeney M. "Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing". Gastroenterology2005129 (2): 437–53. doi:10.1053 /j.gastro.2005.05.026.  PMID16083701

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