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Inflammatory Bowel

disease IBD

Crohn’s Ulcerative
disease colitis
General introduction :

Inflammatory bowel disease (IBD) is a chronic condition

that includes two major entities :
1- Crohn’s disease
2- ulcerative colitis

The distinction between ulcerative colitis

and Crohn disease is based, in large part, on:
1. the distribution of affected sites
2. the morphologic expression of disease at those sites
General introduction :

colitis is limited to the colon and

rectum and extends only into the mucosa and

Crohn’s disease may involve any area of the

gastrointestinal tract and frequently is

exact cause of IBD is unknown, However,

most investigators believe that IBD results from a
combination of :
Genetic factors.
Mucosal immune responses.
Environmental factors
Bacteria( epithelial defect )
Genetic factors

Risk of disease is increased when there is an

affected family member.
In Crohn disease, the concordance rate for
monozygotic twins is approximately 50%.

In ulcerative colitis concordance rate for monozygotic

twins is only 16%.
Ulcerative colitis

Is a disease in which extensive areas of the walls of the

large intestine become inflamed and ulcerated.

The motility of the ulcerated colon is often so great that

mass movements occur much of the day.

The colon’s secretions are greatly enhanced  the

patient has repeated diarrheal bowel movements.

Begins gradually and can become worse over time.

Is an autoimmune disease characterized by T-cells infiltrating

the colon.

Ulcerative colitis usually involves the rectum and is confined

to the colon, with occasional involvement of the ileum.
Signs and symptoms

Themost common are diarrhea with blood or

pus and abdominal discomfort. Other signs and
symptoms include:
An urgent need to have a bowel movement.
Feeling tired.
Nausea or loss of appetite.
Weight loss.


Rectal bleeding.
Dehydration and malabsorbtion.
Changes in bones.
Inflammation in other areas of the body.
Treatment - Medications

No medication cures ulcerative colitis, many

can reduce symptoms. The goals of medication
therapy are:
Inducing and maintaining remission.
Improving the person's quality of life.

Medications that best treat symptoms:

Aminosalicylates (Aspirin and Ibuprofen.).
Corticosteroids (prednisone).

Other medications.
Treatment – Surgery

Removal of the entire colon "cures" ulcerative colitis.

A surgeon can do that by two different types of
surgery :
Proctocolectomy and ileostomy.
Proctocolectomy and ileoanal reservoir.
Full recovery from both operations may take 4 to 6
weeks. Ileoanal reservoir Ileostomy
Crohn’s disease:

also known as regional

enteritis, may occur in any
area of the gastrointestinal
American Gastroenterologist:
Burrill Bernard Crohn
The most common sites involved by
Crohn’s disease at presentation are:

1-terminal ileum.
2-ileocecal valve.
The characteristic of crohn's disease

1 -skip lesion :
The characteristic of crohn's disease

2 - Strictures (stenosis )
The characteristic of crohn's disease

3-loss of normal mucosal folds ( linear mucosa )

in addition to ( cobblestone –shaped mucosa )
The characteristic of crohn's disease

4- (creeping fat)

The characteristic of crohn's disease

5- The microscopic features of active

Crohn disease include abundant
neutrophils that infiltrate and damage
crypt epithelium ,, Clusters of
neutrophils within a crypt are referred
to as a crypt abscess and often are
associated with crypt destruction.
Clinical features :

1- In most patients, disease begins with:

-mild diarrhea
-fever and abdominal pain
2- Iron deficiency anemia may develop in persons with
colonic disease

3- extensive small bowel disease may result in :

-serum protein loss
-generalized nutrient malabsorption
(VB12 and bile salts )
Treatment :

1- Anti-inflammatory drugs ( reduces inflammation )

2- Immune system suppressors ( suppress immune

system that increases inflammation )

3- Antibiotics (reduce harmful intestinal bacteria )

4- Surgery