This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida, Chairman of the Department of Medicine. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.

Inflammatory Bowel Disease Presented by: Ahmad Abdallah Alshaer Medical Student February 2009

1.Introduction 2.Pathogenesis 3.Clinical feature 4.Complication 5.Investigation 6.Management 7.IBD in special circumstances

1- Introduction Chronic inflammatory disease extending to several years affecting GI Presents as CD or UC Unknown etiology, environmental, genetics &immunological Uncontrolled immune response within the intestine Incidence 1 - 2/10000

2-pathogenesis CD Affect any part from mouth to anus Ulcer is deep Cobble stone appearance Complication include granuloma and fistula Has malignant potential Th-1 immune response Most common site: ileal or ileaocolonic 45%, small intestine 35%, colon 20% UC Colon only Ulcer is superficial Crypititis appearance Less probably to develop malignant potential Th-2 immune response Most common site: proctitis or proctosigmoiditis 50%, left sided 35%, pancolitis 20%

CD

UC

CD &UC

3- Clinical features CD Depends on the site of the lesion Ileocecal: abdominal pain & weight loss Colonic: bleeding, diarrhea, pain related to defection Perianal: tags, fissures, fistula UC Bloody diarrhea & mucus The first attack the most severe one Followed by relapse & remission Minority have chronic unremitting symptoms

Severity assessment of UC mildsevere Daily bowel frequency < 4>6 Blood in stool+/-+++ Stool volume<200>400 Pulse<90>90 Temperaturenormal>37.2 SigmoidoscopyNormal or granularBlood in lumen Abdominal X raynormalDilated bowel Hgbnormal<100 ESRNormal>30 Serum albumin (g/l) >35<30

Extra intestinal manifestation Eyes: uveitis, episcleoritis, conjunctivitis Joints: arthralgia, arthritis Skin: erythema nodosum, pyoderma gangrenosum Liver: primary sclerosing cholingitis jaundice

4- complication  Severe life threatening inflammation of the colon  Perforation  Toxic megacolon  Acute hemorrhage  Fistula & perianal disease  Cancer development

5- Investigation  CBC  Bacteriology  Endoscopy & biopsies  Barium study

CD & UC

Terminal ileum crohn`s

Fistulae

6- Management Medical o Aminosalicylate sulfasalazine o Corticosteroids prednisolone o Methotrexate o Ciclosporin o Infliximab o Antidiarrheal agents codeine, loperamide

surgical 1.Failure to medical therapy 2.Fulminant colitis 3.Colon cancer 4.Impaired quality of life 5.Dealing with fistula, fissures & perianal abscess

7- IBD in special circumstances  Childhood  Pregnancy  Metabolic bone disease

Thank you