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Inflammatory Bowel Diseases (IBD)

Inflammatory Bowel Diseases (IBD). Dr: Gehan Mohamed Dr. Abdelaty Shawky. Learning objectives. Understand definition of IBD Discuss the etiology of IBD. Recognize the COMMMONest TWO types of IBD (Crohn’s disease ,Ulcerative colitis)

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Inflammatory Bowel Diseases (IBD)

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  1. Inflammatory Bowel Diseases(IBD) Dr: Gehan Mohamed Dr. Abdelaty Shawky

  2. Learning objectives • Understand definition of IBD • Discuss the etiology of IBD. • Recognize the COMMMONest TWO types of IBD (Crohn’s disease ,Ulcerative colitis) • Mention the clinical presentation,gross and microscopic characteristics for both crhon’s disease and ulcerative colitis.

  3. Inflammatory bowel disease * Definition: a chronic condition of intestinal inflammation and ulceration that has no identifiable cause

  4. Etiology Environment Triggers Genetic Factor Immunoregulatory Defects andMicrobial Exposure a)Westernization a)Dysfunctional immune host response to normalluminal components b)Infection with a specific pathogen e.g paramyxovirus, Listeria monocytogenes, and Helicobacter hepaticus b)Occupation (exposure to pollutants) c)Diet (fats, fast food) c)Defective barrier function e.g bacterial products are able to cross the mucosal barrier d)Tobacco smoking

  5. * Course of the IBD: The inflammatory bowel disease is a chronic disease (lasting a long time), show periods of exacerbations in which the disease flares up and causes symptoms. These periods are followed by remission, in which symptoms disappear or decrease and good health returns.

  6. Symptoms may range from mild to severe and generally depend upon the part of the intestinal tract involved. They include the following: • Abdominal cramps and pain • Bloody diarrhea • Severe urgency to have a bowel movement • Fever • Loss of appetite • Weight loss • Anemia (due to blood loss) • Extra-intestinal manifestations: arthritis, eye problems..

  7. * Two common types of IBD: • Crohn’s disease • Ulcerative colitis

  8. Ulcerative colitis

  9. Ulcerative colitis • It is a chronic disease of the lower gastrointestinal tract. • The hallmarks of ulcerative colitis are abdominal pain and bloody diarrhea due to inflammation and ulcerations in the large intestine (colon) and rectum.

  10. * Morphological features of UC: • Ulcerative colitis involves the rectum and extends proximally in a retrograde fashion to involve the entire colon ("pancolitis") in the more severe cases. • The affected segment shows; • Marked inflammatory cellular infiltrate of the mucosa by lymphocytes, plasma cells and neutrophils. • Ulcerations. • Psudopolyps formation: hyperplastic surface mucosal cells without fibrovascular cores. • Cryptitisand crypt abscess: presence of neutrophils inside colonic glands. • Dysplasia of the colonic glands: which is precancerous.

  11. Endoscopic image of a sigmoid colon with ulcerative colitis. Note the focal friability of the mucosa

  12. Colonic pseudopolyps

  13. Marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.

  14. Crypt abscess, a classic finding in ulcerative colitis

  15. * Complications of UC: 1. Bleeding:Rectal bleeding and bloody diarrhea are two of the hallmark symptoms of ulcerative colitis. 2. Anemia: In ulcerative colitis, this is usually the result of chronic blood loss. 3. Malnutrition: Symptoms such as diarrhea and rectal bleeding can lead to a loss of fluids and nutrients.

  16. 4. Osteoporosis:Ulcerative colitis patients are at risk for low bone density, chiefly due to long-term use of some medications, such as steroids. 5.Intestinal Stricture and obstruction:due to fibrosis. 6. Cancer colon:Ulcerative colitis patients have a higher risk of developing colon cancer. The risk increases when ulcerative colitis for a prolonged period of time.

  17. 7. Perforation:Extensive inflammation can lead to a tear in the intestinal wall, resulting in leakage of bowel contents outside the intestine. Categorized by sudden, severe abdominal pain, shock, and excessive abdominal tenderness. 8. Toxic megacolon:This serious complication may occur when inflammation spreads from the lining of the colon to involve the entire intestinal wall. Because this involvement temporarily stops the normal contractile movements of the intestine, the large intestine may greatly expand.

  18. Toxic megacolon.

  19. Crohn's disease(Regional enteritis)

  20. Crohn's disease can affect any area of the GI tract, from the mouth to the anus, including esophagus, stomach, small intestine, large intestine, and rectum. • It most commonly affects the ileum. • A classic feature of CD is the sharp demarcation of diseased bowel segments from adjacent uninvolved bowel.

  21. * Morphological features of Crohn's disease: • Crohn’s disease is characterized by: • The affected part of the intestine show skip areas i.e. areas free from the lesions. • The intestinal wall is thick and rubbery, caused by edema, inflammation, fibrosis, and hypertrophy of the muscularis propria. • Cobble stone appearance due to edema of the mucosa with interrupting fissuring ulcers.

  22. Fissuring of the wall with formation of fistulae. • Microscopically there is: transmural involvement of the bowel by mixed inflammatory cells and the presence of noncaseating granulomas.

  23. Gross appearance of Crohn's disease. There is a sharp demarcation between the involved and the uninvolved areas (skip areas).

  24. Fig. 2: Gross appearance of Crohn's disease. The combination of ulceration and elevated remnants of mucosa results in a typical cobblestone appearance. Fig. 3: Gross appearance of Crohn's disease. Another example of cobblestone appearance. Fig. 4: Gross appearance of Crohn's disease. Note the segmental nature of the inflammation, and rigidity of the wall, and flattening of the mucosa are characteristic.

  25. Section of colectomy showing transmural inflammation in crohn's disease

  26. Crohn's disease showing marked inflammatory changes and the formation of a fissure.

  27. * Complications of crohn’s disease: 1. Intestinal obstruction: Blockage occurs because the disease tends to thicken the intestinal wall by inflammation and finally fibrosis occurs. 2. Fistulas: intestino-intestinal, intestinoabdominal and perianal fistulae.

  28. 3. Malabsorption syndrome: deficiencies of proteins, calories, and vitamins deficiencies may be caused by intestinal loss of protein, or poor absorption. 4. Other complications: arthritis, skin problems, inflammation in the eyes or mouth, or other diseases of the liver and biliary system.

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