Ulcerative colitis , crohn's disease and inflammatory bowel disease

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By : Khaled Hani. naji. Alkhodari Sadi yehia el-NakhalaSupervisor : dr. omar Saleh ferwana

1General introduction : Inflammatory bowel disease (IBD) is a chronic condition that includes two major entities : 1- Crohns disease 2- ulcerative colitis

The distinction between ulcerative colitis and Crohn disease is based, in large part, on:the distribution of affected sites the morphologic expression of disease at those sites

22General introduction : Ulcerative colitis is limited to the colon and rectum and extends only into the mucosa and submucosa.

Crohns disease may involve any area of the gastrointestinal tract and frequently is transmural33

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 factorsBacteria( epithelial defect ) 4The exact cause of ulcerative colitis is unknownAutoimmune disease.Genetic factors.Environment.Bacteria.

4Genetic 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%.

55Mucosal 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 disease6but 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.

6Epithelial defectsVariety of epithelial defects have been described in Crohn disease & ulcerative colitis.

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7Ulcerative colitisBy : Khaled H. Alkhodari

8Introduction 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 colons secretions are greatly enhanced the patient has repeated diarrheal bowel movements.91- 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 movementsgradually 9Introduction 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.

1010Signs and symptomsThe 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.11are diarrhea with blood or pus and abdominal discomfortAn urgent need to have a bowel movement.Feeling tired.Nausea or loss of appetite.Weight loss.Fever.Anemia.

11ComplicationsRectal bleeding.Dehydration and malabsorbtion.Changes in bones.Inflammation in other areas of the body.Megacolon12Rectal bleeding.Dehydration and malabsorbtion.Changes in bones.Inflammation in other areas of the body.Megacolon

3- bcs corticosteroidmegacolon Megacolon is a rare complication of ulcerative colitis. 1213

13Treatment - MedicationsNo 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.14No 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.

1415Removal 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 reservoirProctocolectomy 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.*****************************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.

15CROHN DISEASE

BY : SADI NAKHALA

16Crohns disease: also known as regional enteritis, may occur in any area of the gastrointestinal tract !!

1717AmericanGastroenterologist: Burrill Bernard Crohn

1818The most common sites involved by Crohns disease at presentation are:

1-terminal ileum.2-ileocecal valve.3-cecum.

19191-skip lesion :

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The characteristic of crohn's disease

20The characteristic of crohn's disease

2- Strictures (stenosis )

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213-loss of normal mucosal folds ( linear mucosa ) in addition to ( cobblestone shaped mucosa )

22

The characteristic of crohn's disease

224- (creeping fat)

23

The characteristic of crohn's disease

235- 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.24The characteristic of crohn's disease

24Clinical 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 )

2525Treatment : 1- Anti-inflammatory drugs ( reduces inflammation )

2- Immune system suppressors ( suppress immune system that increases inflammation )

3- Antibiotics (reduce harmful intestinal bacteria) 4- Surgery

2626COMPARISON 27

27References Robbins-basic pathology ,9th editiomThe 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#whatGuyton and Hall Textbook of Medical Physiology, 12th edition.Pathoma.

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28Thank you 29

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