
Management of Bowel Obstruction
Written by Dr Hyerim Suh References – Di Saverio, Salomone & Tugnoli, Gregorio & Orlandi, Paolo & Casali, Marco & Catena, Fausto & Biscardi, Andrea & Pillay, Omeshnie & Baldoni, […]
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Management of Inflammatory Bowel Disease
Dr Swapnil Pawar
Crohn’s Disease vs. Ulcerative Colitis
Crohn’s | Ulcerative Colitis | |
Location | Anywhere in the GIT including the mouth, resulting in oral ulcers. Skip lesions possible | Only affects the large colon up to the ileocaecal valve (may involve distal ileum if backwash ileitis present). Progression is continuous, beginning in the rectum and moving retrograde. |
Layer Involvement | Transmural inflammation affecting all layers | Only affects mucosa and submucosal layers |
Clinical Presentation | More likely to present with mucousy diarrhea with crampy abdominal pain. Worsened by smoking | More likely to present with bloody diarrhea. Smoking is protective and helps prevent disease |
Macroscopic Pathology | Pseudopolyps due to regenerating mucosa popping out of areas of ulceration | Cobblestone appearance due to the formation of linear ulcers with normal/inflamed tissue between forming “cobblestones” |
Microscopic Pathology | Non-caseating granulomas. Goblet cells present with few crypt abscesses | Crypt abscesses with loss of mucin and loss of goblet cells |
Extra-Intestinal Manifestations
Dermatological
– Erythema Nodosum
– Pyoderma Gangrenosum
Ocular
– Episcleritis
– Scleritis
– Iritis
– Conjunctivits
– Uveitis
Rheumtological
– Enteropathic Arthritis (Asymmetrical Oligo-arthritis)
– Ankylosing Spondylitis
Gastrointestinal
– Primary sclerosing cholangitis
– Autoimmune hepatitis
– Cholesterol stones (Decreased bile resorption resulting in precipitation of cholesterol)
Renal
– Renal calculi (uric acid and calcium oxalate stones from dehydration, steatorrhea and diarrhea)
– Renal amyloidosis
Pulmonary
– Bronchiectasis
– Interstitial lung disease
– Bronchiolitis obliterans
– Sarcoidosis
Musculoskeletal
– Osteopenia/Osteoporosis (Can be secondary to steroid use or Calcium/Vit D deficiency)
Haematological
– Anaemia (Secondary to Folate/B12 deficiency, iron deficiency, anaemia of chronic disease)
Complications of Inflammatory Bowel Disease
References:
Peppercorn, M.A., Kane, S.V. (2020). Clinical manifestations, diagnosis and prognosis of Crohn Disease in adults. UpToDate. Retrieved November 8, 2020, from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-diagnosis-and-prognosis-of-crohn-disease-in-adults
Peppercorn, M.A., Kane, S.V. (2020). Clinical manifestations, diagnosis and prognosis of ulcerative colitis in adults. UpToDate. Retrieved November 8, 2020, from https://www.uptodate.com.acs.hcn.com.au/contents/clinical-manifestations-diagnosis-and-prognosis-of-ulcerative-colitis-in-adults
Dr Swapnil Pawar November 16, 2020
Written by Dr Hyerim Suh References – Di Saverio, Salomone & Tugnoli, Gregorio & Orlandi, Paolo & Casali, Marco & Catena, Fausto & Biscardi, Andrea & Pillay, Omeshnie & Baldoni, […]
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