1. DISEASES OF LARGE INTESTINE
Lykhatska G.V.

2. IRRITABLE BOWEL SYNDROME

3. IRRITABLE BOWEL SYNDROME
-functional disorders,which characterized by abdominal pain, defecation disorders without specific organic pathology which last more than 12 weeks per year

4. Risk factors Violations on diet gynecological diseases
violation intestinal microbiocenosis
In the pathogenesis, the main role –
intestinal dysmotility and visceral hypersensitivity

5. Clinical features of IBS

6. Rome criteria for the diagnosis of IBS

7. IBS: SUMMARY

8. Treatment IBS Diet 4 and regimen
Antidepressants(amitriptyline mg at bedtime)
Spasmolytic drugs (dyspatalin 200mg 2 times a day;ditsetel mg 3 times per day during 2-4 weeks or more
Laxatives(mukofalk,laktuloza,forlaks)individually
Antidiarrhea drugs(loperamyd,smekta)individually
Psychotherapy(hypnotherapy,acupuncture)
Correction of bowel microflore injuries(probiotics-bifi-form,linex,symbiter)

9. IBS treatment scheme (with prevailing diarrhea)
Antidiarrhea drugs (loperamid 2-12 mg daily,
Cytoprotective drugs (smekta 1-2 packs 3 times),
Enterosorbents(enterosgel,poliferan 1spoon 3 times a day)
psychotherapy

10. IBS treatment scheme (with prevailing constipation)
Osmotic laxatives (laktuloza ml 1-2 times a day, mukofalk 1-2 packs 1-3 times a day during meals)
Prokinetic drugs(domperidon,primer 10mg 3 times a day)
Antidepressants or antagonists (5-HT4 receptors 1 tab(6mg)2 times a day before meals)

11. IBS treatment scheme (with pain syndrom prevailing)
Spasmolytic drugs(duspatalin 200mg 2 times a day,ditsetel mg 3 times a day);
Antidehressants(amitryptylin 25-50mg before sleep,fluoksetyn 20mg once a day)

12. ULCERATIVE COLITIS

13. Etiology
The cause of ulcerative colitis is unknown

14. Definition
ULCERATIVE COLITIS - A chronic, inflammatory, and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea

15. ULCERATIVE COLITIS Clinical picture
Bloody diarrhea
The stools may be watery, may contain mucus, and frequently consist almost entirely of blood and pus
Abdominal pain
Fever
Anorexia
Weight loss
Malaise

16. The endoscopic spectrum of ULCERATIVE COLITIS includes a) mucosal edema, erythema, loss of vasculature; b) granular mucosa with pinpoint ulceration and friability; c) regenerated (i.e., healed) mucosa with distorted mucosal vasculature; d) regenerated mucosa with typical postinflammatory pseudopolyps

17. It’s air-contrast radiograph of ULCERATIVE COLITIS, the mucosal pattern is granular with loss of normal haustrations in a diffuse, continuous pattern

18. ULCERATIVE COLITIS

19. ULCERATIVE COLITIS Extracolonic problems
Peripheral arthritis
Ankylosing spondylitis
Sacroiliitis
Anterior uveitis
Erythema nodosum
Pyoderma gangrenosum
Episcleritis
Primary sclerosing cholangitis

20. Erythema nodosum on the skin

21. Pyоderma gangrenosum seen in UC

22. Episcleritis in UC

23. CLASSIFICATION OF ULCERATIVE COLITIS according to the degree of expressiveness of clinical manifestations

24. Defecation frequency <4 >6 >10 Bleeding mild profuse
COURSE
MODERATE
SEVERE
Defecation frequency
<4
>6
>10
Bleeding
mild
profuse
Continuous
Fever -
>37,5 ˚C
>38,8 ˚C
Hemoglobin g/l
>100
<100
<80
ESR, mm/hour
<30
>30
>50
Albumin, g/l
Norm
30-40

25. DIFFERENTIAL DIAGNOSIS
Crohn's Disease
Ulcerative Colitis
Small bowel is involved in 80% of cases
Disease is confined to the colon.
Rectosigmoid is often spared; colonic involvement is usually right-sided.
Rectosigmoid is invariably involved; colonic involvement is usually left-sided.
Gross rectal bleeding is absent in 15-25% of cases.
Gross rectal bleeding is always present.
Fistula, mass, and abscess development is common.
Fistulas do not occur.
Perianal lesions are significant in 25-35%.
Significant perianal lesions never occur.

26. DIFFERENTIAL DIAGNOSIS
Crohn's Disease
Ulcerative Colitis
On x-ray, bowel wall is affected asymmetrically and segmentally, with "skip areas" between diseased segments.
Bowel wall is affected symmetrically and uninterruptedly from rectum proximally (ahaustral Colon).
Endoscopic appearance is patchy, with discrete ulcerations separated by segments of normal-appearing mucosa.
Inflammation is uniform and diffuse (continuous superficial inflammation
with granular)

27. DIFFERENTIAL DIAGNOSIS
Crohn's Disease
Ulcerative Colitis
Microscopic inflammation and fissuring extend transmurally; lesions are often highly focal in distribution.
Inflammation is confined to mucosa (diffuse, continuous, superficial inflammation) except In severe cases.
Epithelioid (sarcoid-like) granulomas detected in bowel wall or lymph nodes in 25-50% of cases (pathognomonic).
Typical epithelial granulomas do not occur.

28. ULCERATIVE COLITIS Treatment
Diet № 4
Aminosalicilates (Sulfasalazine, Salofalk)
Corticosteroid therapy (Budesonid, Prednizolon)
Immunosuppressive drugs (Azathioprine)
Antidiarrheal drugs - loperamide, Anticholinergics, digestive enzymes, transfusions, vitamin therapy

29. DISEASES OF SMALL INTESTINE

30. CROHN’S DISEASE

31. Definition
CROHN’S DISEASE A nonspecific chronic transmural inflammatory disease that most commonly affects the distal ileum and colon but may occur in any part of the GI tract.

32. PLAN CROHN’S DISEASE (CD) Etiology and Epidemiology of CROHN’S DISEASE
Pathology of CROHN’S DISEASE
Clinical picture of CROHN’S DISEASE
Diagnosis of CROHN’S DISEASE
Differential Diagnosis of CROHN’S DISEASE
Prognosis of CROHN’S DISEASE
Treatment of CROHN’S DISEASE

33. Etiology
The fundamental cause of Crohn's disease is unknown

34. DISEASES OF SMALL INTESTINE

35. The spectrum of CROHN DISEASE presentations includes gastroduodenitis, jejunoileitis and ileitis, ileocolitis, colitis 7%
33%
45%
15%

36. CROHN’S DISEASE Clinical picture
Abdominal pain (77%)
Chronic diarrhea (73%)
Bleeding (22%)
Anal Fistulas (16%)
Anorexia
A right lower quadrant mass or fullness

37. CROHN’S DISEASE Extraintestinal manifestations
Weight loss (54%)
Fever (35%)
Anemia (27%)
Peripheral arthritis (16%)
Ophtalmic diseases (Episcleritis, 10%)
Aphthous stomatitis
Erythema nodosum (2%)
Pyoderma gangrenosum

38. Endoscopic spectrum of CD includes a) aphthous ulcerations amid normal colonic mucosal vasculature; b) deeper, punched-out ulcers in ileal mucosa; c) a single colonic linear ulcer; d) deep colonic ulcerations forming a stricture.

39. CROHN’S DISEASE DIAGNOSIS
x-ray: Barium enema x-ray may show reflux of barium into the terminal ileum with irregularity, nodularity, stiffness, wall thickening, and a narrowed lumen. A small-bowel series with spot x-rays of the terminal ileum usually most clearly shows the nature and extent of the lesion. An upper GI series without small-bowel follow-through usually misses the diagnosis.

40. X-ray showing abnormal terminal ileum in Crohn's disease

41. Laboratory findings Laboratory findings are nonspecific: -anemia,
-leukocytosis,
-hypoalbuminemia,
- ↑ ESR, C-reactive proteins.
Elevated alkaline phosphatase and γ-glutamyltranspeptidase accompanying colonic disease often reflect primary sclerosing cholangitis.

42. CROHN’S DISEASE DIFFERENTIAL DIAGNOSIS
Ulcerative colitis
Acute appendicitis
Pelvic inflammatory disease
Ectopic pregnancy
Ovarian cysts
Cancer of the cecum
Lymphosarcoma
Systemic vasculitis
Radiation enteritis
Ileocecal TB
AIDS-related oppor­tunistic infections (cytomegalovirus)

43. DIFFERENTIAL DIAGNOSIS
Crohn's Disease
Ulcerative Colitis
Small bowel is involved in 80% of cases
Disease is confined to the colon.
Rectosigmoid is often spared; colonic involvement is usually right-sided.
Rectosigmoid is invariably involved; colonic involvement is usually left-sided.
Gross rectal bleeding is absent in 15-25% of cases.
Gross rectal bleeding is always present.
Fistula, mass, and abscess development is common.
Fistulas do not occur.
Perianal lesions are significant in 25-35%.
Significant perianal lesions never occur.

44. The typical perianal skin tag of Crohn's Disease

45. DIFFERENTIAL DIAGNOSIS
Crohn's Disease
Ulcerative Colitis
On x-ray, bowel wall is affected asymmetrically and segmentally, with "skip areas" between diseased segments.
Bowel wall is affected symmetrically and uninterruptedly from rectum proximally (ahaustral Colon).
Endoscopic appearance is patchy, with discrete ulcerations separated by segments of normal-appearing mucosa.
Inflammation is uniform and diffuse (continuous superficial inflammation
with granular)

46. DIFFERENTIAL DIAGNOSIS
Crohn's Disease
Ulcerative Colitis
Microscopic inflammation and fissuring extend transmurally; lesions are often highly focal in distribution.
Inflammation is confined to mucosa (diffuse, continuous, superficial inflammation) except In severe cases.
Epithelioid (sarcoid-like) granulomas detected in bowel wall or lymph nodes in 25-50% of cases (pathognomonic).
Typical epithelial granulomas do not occur.

47. Enterocutaneous fistulae in Chrohn's disease

48. CROHN’S DISEASE Treatment
Diet № 4
Aminosalicilates (Sulfasalazine, Salofalk)
Corticosteroid therapy (Budesonid, Prednizolon)
Immunosuppressive drugs (Azathioprine)
Antibacterial drugs (metronidazole, Nifuroxazide
Symptomatic treatment (antidiarrheal drugs - loperamide, Anticholinergics)

49. THANK YOU FOR ATTENTION !