Inflammatory Bowel Disease (IBD) Idiopathic IBD is comprised of CD+UC and is characterized by chronic bowel inflammation. Idiopathic IBD is comprised of CD+UC and is characterized by chronic bowel inflammation. Significant overlap between CD+UC but each has characteristic Significant overlap between CD+UC but each has characteristic clinical clinical endoscopic findings. endoscopic findings. histologic histologic

Macroscobic colitis Macroscobic colitis CROHN’S DISEASE ULCERATIVE COLITIS ULCERATIVE COLITIS Microscobic colitis Microscobic colitis Collagenous colitis Collagenous colitis (Lymphocytic colitis) (Lymphocytic colitis) Eozinofilic colitis Eozinofilic colitis

Histological Difference CD CDTransmural Epitheloid cell Epitheloid cellGranuloma Fibrosis Fibrosis UC UC Mucosa + submucosa Mucosa + submucosa Crypt abcess Crypt abcess Atrophy Atrophy

Crohn’s Disease Colon Colon Mucosa ulceration Mucosa ulceration Submucosal edema Submucosal edema Noduli Noduli Chr. Inf. Cells Chr. Inf. Cells Serosa congested Serosa congested

UC UC Colon mucosa Colon mucosa Surface purulent exudate Surface purulent exudate Center ulceration Center ulceration Diffuse inflammation Diffuse inflammation Cript abcess Cript abcess

Intestinal Manifestations ANATOMIC DISTRIBUTION Ulcerative Colitis Target organ:COLON 40-50%:Rectum + Sigmoid Sigmoid + Left side Left side 30%:Proctitis 20%:Pancolitis

Intestinal Manifestations Crohn’s Disease TARGET ORGAN:GI Tractus - All – - All – 50%:Ileocolitis 30-40%:Jejunitis- Ileitis Ileitis 10%:Gastroduodenitis 15%:Colitis

Extraintestinal symptoms + Manifestations I UC – 15-25% - CD SKIN : Erythema nodosum SKIN : Erythema nodosum 1-10% pyoderma angrenosum EYES : Iridocyclitis EYES : Iridocyclitis 5-8% Uveitis JOINTS : Polyarthritis JOINTS : Polyarthritis 15% Monoarthritis Sacroileitis

Extraintestinal symptoms + Manifestations II BLOOD : Thrombophilia BLOOD : Thrombophilia 10% Autoimmun Hemolytic Anemia, Leucocytosis LUNG: Alveolitis LUNG: Alveolitis2% KIDNEY : Amyloidosis, stones KIDNEY : Amyloidosis, stones5% LIVER :PS.C. LIVER :PS.C.3% HEART : Peri-myocarditis HEART : Peri-myocarditis4%

Clinical features UCAnatomical CDDistributions CD  from MOUTH to ANUS CD  from MOUTH to ANUS UC  mainly COLON UC  mainly COLON

Clinical Features (UC) Typically  Bloody mucotic + Diarrhoea Abdominal pain Proctitis Rectal bleeding + Left sidedtenesmus Colitis Fulminant Severe bloody diarrhoea ColitisFever, hypovolemia Anemia

Clinical features I (CD) 1. Abdominal pain 2. Palpable right lower quadrant 3. Fistulas: bowel skinbladder 4. Infection + Abcess 5. Diarrhoea:Intestinal Inflammation Bile Salt malabsorbtion bacterial overgrowth Short-bowel Syndrome Fistulas

Clinical features II (CD) 6. Growth Retardation 7.Gallstone:impaired reabsorbtion of bile salts 8. Stricture formation : colicy pain DistensionAnorexiaVomiting

Complications CD CDMalabsorbtion Kidney stones Gall bladder stones Stenosis  Ileus PerforationAbcessFissuraFistula Colorectal Ca (rare) UC UC Toxic Megacolon PeritonitisPerforation Massive Bleeding Colo-rectal Ca (often)

Complications UC Toxic Megacolon PeritonitisPerforation Massive Bleeding Colo-rectal Ca (often)

Diagnosis Clinical Symptoms + Signs+ Laboratory Signs+ Laboratory + investigation Radiographicİnvestigation+ Endoscopy + Biopsy

Laboratory Investigation  ESR   CRP   CBC Anemia Leucocytosis  Signs of MALABSORBTION