Inflammatory bowel disease is characterized by ulcerations in small or large intestine. Two common inflammatory bowel diseases are Ulcerative colitis and Crohn’s disease.
Ulcerative colitis
Ulcerative colitis is disease characterized by ulcerations in large intestine
Common symptoms are
Diarrhoea
Blood in stool
Urgency (patient has to rush to toilet)
Incontinence (passage of stool in cloths)
Pain abdomen
Weight loss
Diagnosis
Diagnosis is confirmed by colonoscopy and biopsy
Treatment
Treatment depends upon severity of disease
Mild disease is treated by Mesalamines
Moderated and severe disease is treated by Steroids, antimetabolites, and Infliximab
Severe cases may require surgery
Crohn's disease Crohn’s disease is characterized by ulceration in small and large bowel.
Symptoms of Crohn’s disease are
Pain in umbilical region
Diarrhea
Blood in stool
Vomiting and upper abdominal pain
Weight loss
Fever
Abdominal lump
Diagnosis Following tests are required for the diagnosis and evaluation of extent of the disease
Colonoscopy and biopsy
CT enterography
Barium study
Double balloon enteroscopy
Capsule endoscopy
Tratement
Treatment depends upon the severity and extent of disease
Mild disease is treated by mesalamine
Moderate disease is treated by oral steroids and antimetabolites
Severe disease activity may require steroids, antimetabolites and Infliximab
Surgery is reserved for severe but localized disease, and stricturing disease
Crohn's Disease
Ulcerative colitis
Celiac disease
Celiac diseases is the disease of mucosa of small intestine.
It is characterized by small bowel dysfunction after ingestion of gluten in wheat.
Symptoms of celiac disease are
Diarrhea
Stunted growth
Bloating
Anemia
Amenorrhea, infertility and impotence
Diagnosis
Serological testing
IgA anti tissue transglutaminase
IgAantiendomysial antibodies
Antigliadin antibodies
UGI endoscopy and small intestinal biopsy which reveals villous atrophy
Treatment of celiac disease
Withdrawal of wheat/oat/barley/rye containing food items from the diet
Dietary supplements
Steroids may be helpful in severely ill patients with crisis
Colonic Polyps and cancer
Colonic polyp
Polyp is discrete mass of the tissue, that protrude into the lumen of the bowel
Polyps are categorized as non neoplastic polyps and neoplastic polyps
Neoplastic polyps
Adenoma
Non neoplastic polyps
Hyperplastic polyps
Juvenile polyps
PeutzJeghers polyps
Inflammatory polyps
Adenoma
Adenoma are benign neoplastic polyps, and are of two types, tubular and villous adenomas. Polyps which are larger than 2 cms and with villous morphology are more likely to have transformation to malignancy
Polyps less than 5 mm are called diminutive polyp, these polyps are highly unlikely to have malignant potential
Risk factors
Inherited susceptibility
Excessive dietary intake of fat and low fiber
Clinical features
Most of the polyps are clinically silent
Pain abdomen
Rectal bleeding
Diarrhea and constipation
Colonic obstruction
Detection of colonic polyps
Most of the polyps are diagnosed during colonoscopy.
Treatment
Adenomas without deeper invasion can be taken out endoscopically, resected polyp should be submitted for histopathology to confirm the complete resection
Polyp with invasion of deeper layers should be taken out surgically
Colon cancer
Colon cancer is a major cause of morbidity and mortality
Risk factors
High fat low fiber diet
Smoking
Colorectal adenomas polyposis syndromes
Family history of colorectal cancer
Ulcerative colitis and Crohn’s disease
Symptoms
Tumor on the right side of the colon, are larger in size and present with chronic bleed and there may be palpable mass also
Tumor on the left side of the colon present with change in bowel habits, pain abdomen, anemia and chronic bleed
Diagnosis
Colonoscopy is done for confirmation of diagnosis, biopsy is taken from abnormal areas for histopathological confirmation
Staging
CECT abdomen and chest are done to r/o distant metastasis
Treatment
Surgery is the treatment of choice for colon cancer
Patients with advanced disease (disease beyond serosa/lymph node positive cases patients with liver metastasis) should be offered chemotherapy
Irritable bowel syndrome
Irritable bowel syndrome (IBS) is very common cause of abdominal discomfort.
Symptoms are
Abdominal pain eased after defecation
Looser stool at onset of pain
More frequent stool at onset of pain
Abdominal distension
Feeling of incomplete emptying
Mucus per rectum
Alarming features
Presence of these features are uncommon in IBS and suggest alternate pathology
Blood in stool
Family history of Inflammatory bowel disease/colon cancer
Fever
Onset after the age of 50
Weight loss
Chronic diarrhea
Progressive dysphagia
Diagnosis
Presence of symptoms of IBS and absence of alarming symptoms are suggestive of diagnosis of IBS
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