Ulcerative Colitis - Crohn's Disease

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  • 1.Universidad de GuadalajaraCentro Universitario de Ciencias de la Salud INFLAMMATORY BOWEL DISEASE: Ulcerative Colitis Crohn s DiseaseTeachers: Dr. Hctor Manuel Virgen AyalaDr. Benjamn Robles MariscalExponent:Egua Ornelas Carlos EugenioOctubre 2011

2. Ulcerative Colitis(UC) 3. Ulcerative ColitisDifusse inflammatory disease, contiguous,initially confined to mucous. 4. Ulcerative ColitisILEUM 10% - 20% Reflux Ileitis 20% 30% - 40% 40% - 50%RECTUM 5. EpidemiologyAges 15-30 60-801:1Preventive 6. EtiologyUnknownExogen factors: Salmonella, Shigella,Campylobacter, Clostridium Difficile.Lack of immunitary regulationGenetics: IL-23RInheritance 7. Signs and SymptomsDiarreaRectorrhageTenesmusMucus secretionCrampy abdominal painFever 8. DiagnosisEndoscopy or proctoscopyBarium enemaLead tubeBarium contrast radiography.Contrast CT 9. www.gastrointestinalatlas.com 10. Disease Presentation LowModerate SevereDepositions 6 dayBlood in stool FewModerateIntenseFever NoMean 37.5Tachycardia No 90ESR30 mmEndoscopic aspect Erythema, decreaseIntense erythema,Spontaneus of vascular model,thick granularity,hemorrhage,fine granularity.absence of vascularulcerations.marks, contact hemorrhage, noulcerations. Fauci A. S. et al. (2009). Harrison. Principios de Medicina Interna. Mxico, D.F. Mc Graw Hill. Pag. 1889 11. Medical TreatmentLactose free dietSulfasalazineMesalamineOlzalazineBalsalazideCorticosteroids 12. Surgical TreatmentURGENT SURGERYFulminant colitisToxic Megacolon Total colectomy with terminal ileostomySELECTIVE SURGERY:Abdominal colectomy with ileorrectal anastomosisTotal Proctocolectomy with terminal ileostomyRestorative proctocolectomy with anal anastomosis and ileal bag 13. Crohns Disease (CD) 14. Crohns DiseaseAffects any part of digestive tube.Segmentary distribution Colon and Small Intestine 40% Small Intestine 30% Colon25% Anorrectal8% Ileocolic and Small Intestine CD Anal and Perianal CD Acute Inflammatory Crohn s JejunoileitisChronic Fibrous Crohns Colitis 15. EpidemiologyAges 15-30 60-80 1: 1.5 Increase probabilities 16. EtiologyUnknownExogen factors: Bacteroides, Clostridium,Escherichia.Lack of immunitary regulationGenetics: CARD 15, MHC, OCTN, DLG5, ATG16L1 17. Ileocolic and Small Intestine CDDiarreaRight upper and lower quadrant painPalpable massFever and leukocytosisInternal abscessesComplications FistulasObstruction 18. Crohn s JejunoileitisSteatorrheaDiarreaNutritional deficienciesAlbuminMgCa Vertebral FracturesVitamin DVitamin B12 19. Crohns ColitisFeverGeneral malaiseDiarreaCrampy abdominal painHematocheziaComplications: Stenosis, Fistulas, Intestinal Obstruction, Fulminant Colitis and Toxic Megacolon 20. Anal and Perianal CDAffects 35% of CD patientsIncontinenceBig hemorrhoidsAnal stenosisAnorrectal fistulasPerirrectal abscesses 21. CD DiagnosisEndoscopyBarium contrast radiography Rope SignCT EnterologyMRI 22. www.gastrointestinalatlas.com 23. Medical TreatmentGlucocorticoids5- aminosalicilates (Sulfasalazine,Mesalamine)Immunosuppressive (Azatioprine,Mercaptopurine)AntibioticsInfliximab 24. Surgical Treatment- Segmentary colectomy with primaryanastomosis.- Total colectomy with ileorrectal anastomosis- Proctocolectomy with ileostomy 25. Right Hemicolectomy - CD http://www.youtube.com/watch?v=Nkbhc7KyS68 26. Ulcerative Colitis and Crohns DiseaseUlcerative ColitisCrohns Disease DiarreaMarkedPresent, less severe Blood in stool Caracteristic Infrequent Perianal injuriesInfrequent, mildFrequent, complex Toxic dilatation Yes (3-10%) Yes (2-5%) Pain OccasionalFrequent Abdominal mass RareYes General Symptoms OccasionalFrequent Fistulas NoYes Intestinal Obstruction RareFrequent Fauci A. S. et al. (2009). Harrison. Principios de Medicina Interna. Mxico, D.F. Mc Graw Hill. Pag. 1890 27. Undetermined Colitis15% of IBDUC and CD characteristics and complications Total abdominal colectomy with terminalileostomy 28. Thanks! 29. Bibliography Doherty M. Gerard (2011). Diagnstico y TratamientoQuirrgicos. Mxico D.F.: Lange. Fauci A. S. et al. (2009). Harrison. Principios deMedicina Interna. Mxico, D.F.: Mc Graw Hill. Brunicardi. F. Charles. et al. (2006). Schwartz.Principios de Ciruga. Mxico, D.F.: Mc Graw Hill. http://www.youtube.com/watch?v=Nkbhc7KyS68