3 Suspicion of IBD Diarrhoea for more than 4 weeks Opening the bowels more than twice a daywet/fluid-like stoolAbdominal painStool containing blood, mucus or pus
4 Ulcerative colitisChronic inflammatory bowel disease that is only localised in the mucus membrane of the colon/rectum.There are ulcers and signs of inflammation in the rectum and the colon. It is a recurrent disease.Diarrhoea, bloody stool, crampy abdominal pain, weight loss, loss of appetiteDiffuse ulceration in colon mucus membrane, crypt abscess, infiltration.
5 Crohn’s diseaseChronic, segmental or multy-segmental. All the layers of the intestine is affectedBoth small intestines and the colon might be affectedCramp-like abdominal pain, weight loss, diarrhoea, feverLocal inflammation, micro-erosions, fissures, granuloma, fistulas , infiltrations, lymphatic vessel enlargement
9 Localisation Ulcerative Colitis Sigmoid-rectum 54% Left colon 27% Pancolitis %Crohn’s diseaseSmall intestine and colon 50%Ileitis %Colitis %Anorectal %
10 Distribution of gastrointestinal Crohn's disease.
11 EpidemiologyYoung ageIncidence has not changed in the recent yearsCrohn’s disease: 6/100000Ulcerative Colitis: 2-3/ in the developped countries10-20 x frequent in afected familiesgenetical predisposition: In1996-ban Hugot et al found IBD1 locus on the 16 chromosome, which predispose for CD, IBD2 that predispose for CU
21 Crohn's disease can mimic ulcerative colitis on endoscopy Crohn's disease can mimic ulcerative colitis on endoscopy. This endoscopic image is of Crohn's colitis showing diffuse loss of mucosal architecture, friability of mucosa in sigmoid colon and exudate on wall, all of which can be found with ulcerative colitis.
22 Endoscopic image of colon cancer identified in the sigmoid colon (anatomy) on screening colonoscopy for Crohn's disease.
26 Endoscopic image of a sigmoid colon afflicted with ulcerative colitis Endoscopic image of a sigmoid colon afflicted with ulcerative colitis. Note the vascular pattern of the colon granularity and focal friability of the mucosa.
27 Colonic pseudopolyps of a patient with intractable ulcerative colitis Colonic pseudopolyps of a patient with intractable ulcerative colitis. Colectomy specimen.
28 Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynx
29 Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.
30 Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.
31 H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis