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IBD Inflammatory Bowel Disease IBD Inflammatory Bowel Disease Dr. László Orosz Surgical Department University Of Debrecen.

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Presentation on theme: "IBD Inflammatory Bowel Disease IBD Inflammatory Bowel Disease Dr. László Orosz Surgical Department University Of Debrecen."— Presentation transcript:

1 IBD Inflammatory Bowel Disease IBD Inflammatory Bowel Disease Dr. László Orosz Surgical Department University Of Debrecen

2 IBD Crohn’s Disease Crohn’s Disease Ulcerative colitis Ulcerative colitis

3 Suspicion of IBD Diarrhoea for more than 4 weeks Diarrhoea for more than 4 weeks Opening the bowels more than twice a day Opening the bowels more than twice a day wet/fluid-like stool wet/fluid-like stool Abdominal pain Abdominal pain Stool containing blood, mucus or pus Stool containing blood, mucus or pus

4 Ulcerative colitis Chronic inflammatory bowel disease that is only localised in the mucus membrane of the colon/rectum. Chronic 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. 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 appetite Diarrhoea, bloody stool, crampy abdominal pain, weight loss, loss of appetite Diffuse ulceration in colon mucus membrane, crypt abscess, infiltration. Diffuse ulceration in colon mucus membrane, crypt abscess, infiltration.

5 Crohn’s disease Chronic, segmental or multy-segmental. All the layers of the intestine is affected Chronic, segmental or multy-segmental. All the layers of the intestine is affected Both small intestines and the colon might be affected Both small intestines and the colon might be affected Cramp-like abdominal pain, weight loss, diarrhoea, fever Cramp-like abdominal pain, weight loss, diarrhoea, fever Local inflammation, micro-erosions, fissures, granuloma, fistulas, infiltrations, lymphatic vessel enlargement Local inflammation, micro-erosions, fissures, granuloma, fistulas, infiltrations, lymphatic vessel enlargement

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9 Localisation Ulcerative Colitis Ulcerative Colitis Sigmoid-rectum 54% Left colon 27% Pancolitis 19% Crohn’s disease Crohn’s disease Small intestine and colon 50% Ileitis 29% Colitis 19% Anorectal 2%

10 Distribution of gastrointestinal Crohn's disease.

11 Epidemiology Young age Young age Incidence has not changed in the recent years Incidence has not changed in the recent years Crohn’s disease: 6/ Crohn’s disease: 6/ Ulcerative Colitis: 2-3/ in the developped countries Ulcerative Colitis: 2-3/ in the developped countries x frequent in afected families x frequent in afected families genetical predisposition: In1996-ban Hugot et al found IBD1 locus on the 16 chromosome, which predispose for CD, IBD2 that predispose for CU genetical predisposition: In1996-ban Hugot et al found IBD1 locus on the 16 chromosome, which predispose for CD, IBD2 that predispose for CU

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13 Ethiology Unknown!! Unknown!! Infective: herpes, measeles, E. coli, M. paratuberculosis Infective: herpes, measeles, E. coli, M. paratuberculosis Genetic background: familiar disposition Genetic background: familiar disposition Diet? Diet? Immune system: autoimmune? Immune system: autoimmune? Emmotional status Emmotional status

14 Symptoms Ulcerative Coilits Crohn’ disease Ulcerative Coilits Crohn’ disease Bleeding 80% 22% Bleeding 80% 22% Diarrhoea 52% 73% Diarrhoea 52% 73% Abdominal pain 47% 77% Abdominal pain 47% 77% Fistulas 0% 16% Fistulas 0% 16% Weight-loss 5% 54% Weight-loss 5% 54% Fever 1% 35% Fever 1% 35% Anaemia 15% 27% Anaemia 15% 27% Joint pain 13% 16% Joint pain 13% 16% Eye symptoms 11% 10% Eye symptoms 11% 10%

15 Extraintestinal symptoms Arthritis, polyarthritis 26% Arthritis, polyarthritis 26% Erythema nod., Pyoderma gangr. 19% Erythema nod., Pyoderma gangr. 19% Fatty liver, Chr. Active hepatitis, PSC 7% Fatty liver, Chr. Active hepatitis, PSC 7% Iridocyclitis, Uveitis 4% Iridocyclitis, Uveitis 4% Oral, stomatitis aphtosa 4% Oral, stomatitis aphtosa 4% Alveolitis, lung fibrosis <1% Alveolitis, lung fibrosis <1%

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17 Diagnostics: Crohn’s disease Colonscopy, (biopsy) capsule-endoscopy Colonscopy, (biopsy) capsule-endoscopy X-ray, Barium anema and meal X-ray, Barium anema and meal UH, CT UH, CT Laboratory (blood) tests ( Sedimentation, WBC, CRP, liver enzymes, stool culture ) Laboratory (blood) tests ( Sedimentation, WBC, CRP, liver enzymes, stool culture )

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19 Endoscopy image of colon showing serpiginous ulcer, a classic finding in Crohn's diseasecolonserpiginous

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21 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.ulcerative colitisendoscopicmucosalfriability

22 EndoscopicEndoscopic image of colon cancer identified in the sigmoid colon (anatomy) on screening colonoscopy for Crohn's disease.colon (anatomy)colonoscopy

23 Diagnostics: Ulcerative colitis Colonscopy, (biopsy) capsule-endoscopy Colonscopy, (biopsy) capsule-endoscopy X-ray, Barium anema and meal X-ray, Barium anema and meal UH, CT UH, CT Laboratory (blood) tests ( Sedimentation, WBC, CRP, liver enzymes, stool culture ) Laboratory (blood) tests ( Sedimentation, WBC, CRP, liver enzymes, stool culture )

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26 EndoscopicEndoscopic image of a sigmoid colon afflicted with ulcerative colitis. Note the vascular pattern of the colon granularity and focal friability of the mucosa.sigmoid colonmucosa

27 ColonicColonic pseudopolyps of a patient with intractable ulcerative colitis. Colectomy specimen.Colectomy

28 Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynxaphthous ulcerstonguelipspalatepharynx

29 EndoscopicEndoscopic 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.colon

30 Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.H&E stainlymphocyticintestinal mucosa

31 H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis

32 Medical therapy Pentasa Pentasa Steroids, imuran, (budesonid) Steroids, imuran, (budesonid) Anti-TNF-alfa (Remicade) Anti-TNF-alfa (Remicade) Ciprofloxacin, metronidazol Ciprofloxacin, metronidazol Nutritional advices Nutritional advices

33 Crohn’s disease: Therapy Acute fulminate: exclusion of abscess than Steroid mg, wide spectrum antibiotics Acute fulminate: exclusion of abscess than Steroid mg, wide spectrum antibiotics Subacute disease: Steroid in decreasing dosage Budenofalk, sulfasalazin, Pentasa, Salofalk, metronidasol Subacute disease: Steroid in decreasing dosage Budenofalk, sulfasalazin, Pentasa, Salofalk, metronidasol Chronic: constant low dose steroid, Imuran, 5- aminosalicyl Chronic: constant low dose steroid, Imuran, 5- aminosalicyl

34 Ulcerative colitis :Therapy Acute inflammation: Steroid, antibioticum, 5- ASA Acute inflammation: Steroid, antibioticum, 5- ASA Chronic : 5-ASA, Imuran Chronic : 5-ASA, Imuran

35 Crohn’s disease: complications Stenosis, ileus (bowel obstruction) Stenosis, ileus (bowel obstruction) Fistula formation Fistula formation Abscess formation Abscess formation Bleeding Bleeding Toxic megacolon Toxic megacolon Malignant transformation Malignant transformation

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37 Ulcerative colitis: complications Stenosis, ileus (bowel obstruction) Stenosis, ileus (bowel obstruction) bleeding bleeding Perforation, abscess formation, peritonitis Perforation, abscess formation, peritonitis Toxic megacolon Toxic megacolon Malignant transformation Malignant transformation

38 Crohn’disease: Surgical therapy Maximally conservative !!! Maximally conservative !!! Resection (preserving as much small intestine as possible!) Resection (preserving as much small intestine as possible!) Srticturopalsty (small intestine) Srticturopalsty (small intestine)

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47 Toxic megacolon

48 Ulcerative colitis: Surgical treatment In acute case: In acute case: Hartmann procedure Hartmann procedure Proctocolectomy Proctocolectomy Elective operation: Elective operation: Proctocolectomy with ileostomy Proctocolectomy with ileostomy Total colectomy with ileo-rectal anastomosis Total colectomy with ileo-rectal anastomosis Proctocolectomia, ileo-analis anastomisis with ileum pauch Proctocolectomia, ileo-analis anastomisis with ileum pauch Proctocolectomia, Koch-reservoir Proctocolectomia, Koch-reservoir

49 Colon J-pouch

50 J-pouch

51 IPAA

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