7/30/2019 Disease of the Colon,Dr Apen

1/10

DISEASE OF THE COLON &

RECTUM

7/30/2019 Disease of the Colon,Dr Apen

2/10

Inflamatory Bowel Disease

Ulcerative colitis

Chrons disease

7/30/2019 Disease of the Colon,Dr Apen

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Definition:group of chronic inflamatorydisorderof unknown cause involving GI

Disorder have no pathognomonic features or

spesifik diagnostic test, diagnosis of exclusion The same process may involve the buccal

mucosa, esophagus, stomach, duodenum,jejunum, ileum

Ulcerative colitis: is a chronic, recurent diseasecharacterized by difuse mucosal inflamationinvolving only the colon

7/30/2019 Disease of the Colon,Dr Apen

4/10

Crohns disease: is a chronic, recurent disease

characteristic by patchy transmural

inflamation involving any segment of the GI

from the mouth to the anus

7/30/2019 Disease of the Colon,Dr Apen

5/10

Pathologic and clinical feature of IBD

Features Ulcerative colitis Chrons disease

Pathological features

Segmental 0 ++

Transmural involvment +/- ++

Granulomatous 0 +/++

Fibrosis + ++

Fissuring/fistulas +/- ++

Mesenteric fat, lymp node 0 ++

Clinical features

Diarrrhea ++ ++

Rectal bleeding ++ ++

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Features Ulcerative colitis Chrons disease

Abdominal pain + ++

Palpable mass 0 ++

Fistulas +/- ++

Strictures + ++

Small bowel involvment +/- ++

Rectal involment ++ ++

Extraintestinal disease ++ ++

Toxic megacolon + +/-

7/30/2019 Disease of the Colon,Dr Apen

7/10

Diagnosis

Diarrhea or bloody diarrhea persistent

Abdominal pain

Persistent perianal sepsis Atypical sympton, fever, arthritis, liver disease

Intermittent intestinal obstruction

Abdominak fistulas All types of malabsorpsi syndrome

7/30/2019 Disease of the Colon,Dr Apen

8/10

Laboratory usually are nonspesific

Features malabsorption

Anemia (def fe, folic acid , B12) Abnormality electrolyte (hypokalemia,

hypomagnesemia, hypocalcemia),

hypoalbuminemia Mild abnormalities of liver fungtion (alkaline

phosphatase,jaundice)

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9/10

Endoscopic examination and biopsy(sigmoidoscopy, colonoscopy)loss of mucosalvascularity, diffuse erytema, friability of themucosa, exudate, blood, mucus, pus, apthous

erosions or deep, longitudinal fissures, mucosanot uniform, friability and diffuse granularity(hallmarks of UC), cobblestone appearance(characteristic of CD)

radiologis evaluation (stricture,pseudopolyposis,carcinoma, ulceration,narrowing of the bowel lumen)

7/30/2019 Disease of the Colon,Dr Apen

10/10

Drug therapies

5-aminosalicylic acid (5-ASA)

sulfasalazine

oral or topical mesalamine agentAzo compound (balsalazide and olsalazine)

Corticosteroid

Mercaptopurine and azathioprine