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Inflammatory Bowel Disease

Inflammatory Bowel Disease. Myra Lalas Pitt.

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Inflammatory Bowel Disease

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  1. Inflammatory Bowel Disease Myra Lalas Pitt

  2. A  NASOGASTRIC  TUBE  IS  SEEN  COURSING  THE  ESOPHAGUS  WITH  ITS  TIP  OVER  THE  GASTRIC  ANTRUM.    SCATTERED  AIR-FLUID  LEVELS  ARE  DEMONSTRATED  IN  THE  UPRIGHT  IMAGE.    SMALL  AMOUNT  OF  AIR  IS  SEEN  WITHIN  THE  LARGE  BOWEL.    CONTRAST  IS  DEMONSTRATED  WITHIN  THE  BLADDER.    THE  VISUALIZED  BONY  STRUCTURES  APPEAR  GROSSLY  UNREMARKABLE.    THERE  IS  NO  EVIDENCE  FOR  PNEUMOPERITONEUM.

  3. MULTIPLE  DILATED  LOOPS  OF  SMALL  BOWEL  WITH  ILEUM  PREDOMINANCE  ASSOCIATED  WITH  AIR-FLUID  LEVELS  AND  A  TRANSITIONAL  POINT.    ORAL  CONTRAST  IS  LIMITED  TO  THE  STOMACH.    DIFFUSE  ABDOMINAL  ASCITES  IS  NOTED.    FINDINGS  LIKELY  REPRESENT  PARTIAL  SMALL  BOWEL  OBSTRUCTION.    EARLY  COMPLETE  SMALL  BOWEL  OBSTRUCTION  CANNOT  BE  EXCLUDED.    REPEAT  IMAGING  IS  RECOMMENDED.    GIVEN  THE  PREDOMINANTLY  DISTAL  SMALL  BOWEL  INVOLVEMENT  WITH  WALL  THICKENING,  INFLAMMATORY  BOWEL  DISEASE  WITH  STRICTURE  IS  A  POSSIBLE  ETIOLOGY  FOR  THE  SMALL  BOWEL  OBSTRUCTION.

  4. Definition • Comprised of 2 major disorders: Crohn’s Disease and Ulcerative Colitis

  5. Epidemiology

  6. Pathophysiology • Pathogenesis is multifactorial. • The most widely accepted theory of pathogenesis is that in genetically susceptible individuals: environmental trigger (can be normal gut flora or a ubiquitous environmental agent) ↓activates chronic, dysregulated immune response.

  7. Signs and Symptoms

  8. Extraintestinal Manifestations Skeletal Arthritis, arthralgia, ankylosingspondylitis, digital clubbing (hypertrophic osteoarthropathy), osteopenia, osteoporosis, aseptic necrosis CutaneousErythemanodosum, pyodermagangrenosum, aphthous ulcers, vesiculopustular eruption, necrotizing vasculitis OcularUveitis, episcleritis, corneal ulceration, retinal vascular disease Hepatic Primary sclerosingcholangitis, bile duct carcinoma, autoimmune chronic active hepatitis, fatty liver disease, cholelithiasis Endocrine Growth failure, pubertal delay Hematologic Autoimmune hemolytic anemia, thrombocytopenic purpura, thrombocytosis, thrombophlebitis, thromboembolism, arteritis RenalNephrolithiasis (classically oxalate stones) CardiacPericarditis, myocarditis, heart block Pancreatic Acute pancreatitis (Crohn disease > ulcerative colitis) Neurologic Peripheral neuropathy, myelopathy, myasthenia gravis

  9. Erythema Nodosum

  10. Pyoderma Gangrenosum

  11. Differential Diagnosis • Infectious    Bacterial (salmonella, shigella, campylobacter, Escherichia coli 0157/h7, yersinia, mycobacteria)     Parasitic (Amebiasis, giardia)    Viral (cytomegalovirus [CMV], herpes)    Clostridium difficilepseudomembranous colitis  AIDS TB • Rheumatologic/ Autoimmune Bechet disease    Chronic Granulomatous Disease SLE

  12. Vascular disorders  Hemolytic uremic syndrome    Henoch-Schönlein purpura    Polyarteritis nodosa • Obstetric and gynecologic    Pelvic inflammatory disease    Ectopic pregnancy    Endometriosis

  13. GI Tumors Eosinophilic Colitis Hirschsprung disease/enterocolitis Irritable Bowel Syndome PUD

  14. Work- up • CBC • CMP • ESR, CRP • Stool cultures • Stool for O&P • Stool for C. diff • UGIS • CT Scan • Endoscopy • Colonoscopy

  15. Abdominal computerized tomography (CT) scan showing thickened bowel wall due to Crohn disease.

  16. Ulceration of the ileum in a patient with Crohn disease

  17. Colonoscopic image from a patient with ulcerative colitis demonstrating diffuse erythema with ulcerations.

  18. Treatment Primary goals of therapy: 1. Induction and maintenance of remission 2. Prevention of disease complications (such as fistula, stricture, abscess, and cancer) 3. Control of postoperative disease recurrence 4. Maintenance of normal growth and development 5. Maximization of quality of life. From Peds in Review

  19. References Glick, S. and R. Carvalho. “Inflammatory Bowel Disease:” Pediatrics in Review Vol. 32 No. 1 January 1, 2011 pp. 14 -25 (doi: 10.1542/pir.32-1-14) Lowry AW, Bhakta KY, Nag PK, "Chapter 16. Gastroenterology" (Chapter). Lowry AW, Bhakta KY, Nag PK: Texas Children's Hospital Handbook of Pediatrics and Neonatology:http://www.accesspediatrics.com/content/7437895. Silverstein, Stu. Laughing Your Way to Passing the Pediatric Boards. 2008, Medhumor Medical Publications: USA Stephens Michael C, KugathasanSubra, Sato Thomas T, "Chapter 410. Inflammatory Bowel Disease" (Chapter). Colin D. Rudolph, Abraham M. Rudolph, George E. Lister, Lewis R. First, Anne A. Gershon: Rudolph's Pediatrics, 22e: http://www.accesspediatrics.com/content/7037639. www.uptodate.com

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