Universidad de GuadalajaraCentro Universitario de Ciencias de la Salud

INFLAMMATORY BOWEL DISEASE:• Ulcerative Colitis• Crohn´s Disease

Exponent:Eguía Ornelas Carlos Eugenio Octubre 2011

Teachers:Dr. Héctor Manuel Virgen Ayala

Dr. Benjamín Robles Mariscal

Ulcerative Colitis (UC)

Ulcerative Colitis

Difusse inflammatory disease, contiguous, initially confined to mucous.

Ulcerative Colitis

RECTUM

ILEUM

10% - 20% Reflux Ileitis20%30% - 40% 40% - 50%

Epidemiology

Ages 15-30

60-80

1:1

Preventive

Etiology

Unknown

Exogen factors: Salmonella, Shigella, Campylobacter, Clostridium Difficile.

Lack of immunitary regulation

Genetics: IL-23R

Inheritance

Signs and Symptoms

Diarrea

Rectorrhage

Tenesmus

Mucus secretion

Crampy abdominal pain

Fever

Diagnosis

Endoscopy or proctoscopy

Barium enema “Lead tube”

Barium contrast radiography.

Contrast CT

www.gastrointestinalatlas.com

Disease PresentationLow Moderate Severe

Depositions <4/day 4-6 day >6 day

Blood in stool Few Moderate Intense

Fever No Mean <37.5°C Mean > 37.5°

Tachycardia No <90 >90

ESR <30 mm >30 mm

Endoscopic aspect Erythema, decrease of vascular model,

fine granularity.

Intense erythema, thick granularity,

absence of vascular marks, contact

hemorrhage, no ulcerations.

Spontaneus hemorrhage, ulcerations.

Fauci A. S. et al. (2009). Harrison. Principios de Medicina Interna. México, D.F. Mc Graw Hill. Pag. 1889

Medical Treatment

Lactose free diet

Sulfasalazine

Mesalamine

Olzalazine

Balsalazide

Corticosteroids

Surgical Treatment

URGENT SURGERY Fulminant colitis

Toxic Megacolon

Total colectomy with terminal ileostomy

SELECTIVE SURGERY: Abdominal colectomy with ileorrectal anastomosis

Total Proctocolectomy with terminal ileostomy

Restorative proctocolectomy with anal anastomosis and ileal bag

Crohn’s Disease(CD)

Crohn’s Disease

Affects any part of digestive tube.

Segmentary distribution

Colon and Small Intestine 40%

Small Intestine 30%Colon 25%Anorrectal 8%

Ileocolic and Small Intestine CDAnal and Perianal CDCrohn´s Jejunoileitis Crohn’s Colitis

Acute InflammatoryChronic Fibrous

Epidemiology

Ages 15-30

60-80

1: 1.5

Increase probabilities

Etiology

Unknown

Exogen factors: Bacteroides, Clostridium, Escherichia.

Lack of immunitary regulation

Genetics: CARD 15, MHC, OCTN, DLG5, ATG16L1

Ileocolic and Small Intestine CD

Diarrea

Right upper and lower quadrant pain

Palpable mass

Fever and leukocytosis

Internal abscesses

Complications Fistulas

Obstruction

Crohn´s Jejunoileitis

Steatorrhea

Diarrea

Nutritional deficiencies

Albumin

Mg

Ca

Vitamin D

Vitamin B12

Vertebral Fractures

Crohn’s Colitis

Fever

General malaise

Diarrea

Crampy abdominal pain

Hematochezia

Complications: Stenosis, Fistulas, Intestinal Obstruction, Fulminant Colitis and Toxic Megacolon

Anal and Perianal CD

Affects 35% of CD patients

Incontinence

Big hemorrhoids

Anal stenosis

Anorrectal fistulas

Perirrectal abscesses

CD Diagnosis

Endoscopy

Barium contrast radiography “Rope Sign”

CT Enterology

MRI

www.gastrointestinalatlas.com

Medical Treatment

Glucocorticoids

5- aminosalicilates (Sulfasalazine, Mesalamine)

Immunosuppressive (Azatioprine, Mercaptopurine)

Antibiotics

Infliximab

Surgical Treatment

- Segmentary colectomy with primary anastomosis.

- Total colectomy with ileorrectal anastomosis

- Proctocolectomy with ileostomy

Right Hemicolectomy - CD

• http://www.youtube.com/watch?v=Nkbhc7KyS68

Ulcerative Colitis Crohn’s Disease

Diarrea Marked Present, less severe

Blood in stool Caracteristic Infrequent

Perianal injuries Infrequent, mild Frequent, complex

Toxic dilatation Yes (3-10%) Yes (2-5%)

Pain Occasional Frequent

Abdominal mass Rare Yes

General Symptoms Occasional Frequent

Fistulas No Yes

Intestinal Obstruction Rare Frequent

Ulcerative Colitis and Crohn’s Disease

Fauci A. S. et al. (2009). Harrison. Principios de Medicina Interna. México, D.F. Mc Graw Hill. Pag. 1890

Undetermined Colitis

15% of IBD

UC and CD characteristics and complications

Total abdominal colectomy with terminal ileostomy

Thanks!

Bibliography

• Doherty M. Gerard (2011). Diagnóstico y Tratamiento Quirúrgicos. México D.F.: Lange.

• Fauci A. S. et al. (2009). Harrison. Principios de Medicina Interna. México, D.F.: Mc Graw Hill.

• Brunicardi. F. Charles. et al. (2006). Schwartz. Principios de Cirugía. México, D.F.: Mc Graw Hill.

• http://www.youtube.com/watch?v=Nkbhc7KyS68