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Inflammatory Bowel Disease


Inflammatory Bowel Disease overview and Definition

The inflammatory bowel disease refers to the several long term conditions that involves inflammation of the digestive tract or gut. It is caused by the dysregulation of the immune responses to host intestinal microflora. The two major types of inflammatory bowel disease includes Ulcertaive colitis and crohn’s disease which can affect any sight of the gastrointestinal tract from the mouth to the anus involves skin lesions. The patient with this condition is more prone for malignancy.


Clinical signs & symptoms

Abdominal cramping

Irregular bowel habits and passage of mucus without blood or pus.

Fever, sweats

 

Malaise, fatigue

 

Arthralgias

 

Growth retardation and delayed or failed sexual maturation in children

 

Extraintestinal manifestations such as Arthritis, uveitis, or liver disease

 

Bloody stools and Tenesmus might occur

 

Perianal disease (eg, fistulas, abscesses)

 

Diarrhea: Possible presence of mucus/blood in stool; occurs at night; incontinence

Constipation: May be the primary symptom in UC limited to the rectum; obstipation may occur; may proceed to bowel obstruction

 

Bowel movement abnormalities: Possible presence of pain or rectal bleeding, severe urgency, tenesmus

 

Abdominal cramping and pain: Commonly present in the right lower quadrant in CD. Occur in the periumbilical or in the left lower quadrant in moderate to severe UC.

 

Nausea and vomiting: More often in CD than in UC

 

  • Diarrhea
  • Fatigue
  • Abdominal pain and cramping
  • Blood in your stool
  • Reduced appetite
  • Unintended weight loss
  • Feeling of Tenesmus that is feeling of defaecating inspite of being empty stomach

 


Differential Diagnosis

Diagnosis:

Colonoscopy:

The patient is sedated and physician looks for an abnormality in the intestine with a computer aided device.

Biopsy:

It is the removal of a small amppount of tissue for examination under the microscope. A biopsy is the confirmatory test for colorectal cancer or colonal cancer.

Biomarketing testing of the tumour:

The colorectal cancer should be tested for problems in mismatch repair proteins called mismatch repair defect.

Blood test:

Patient with the colorectal cancer may tends to bleed through rectum. This results in the aneamia in patients. Complete blood count might reveal whether the bleeding is occurring or not.

Other levels of protein such as the carcinoembryonic antigen which detects if the cancer has spread to other regions or not.

Fecal immunochemical test:(FIT0

This test reveals if the blood is present in the stool or not

Guaiac based feacl occult blood test(gFOBT):

It is similar to the FIT but it reveals the occult blood in stool.

Fecal DNA test:

It tests the genetic mutations and presence of cancer cells in the stool.

Computed tomography:

A CT scan takes three dimensional pictures of the abnormal tissues from different angles.

Magnetic Resonance Imaging:

A MRI scan uses the combination of the magnetic and radiowave frequency to view the abnormal tissues.

An dye is injected in the vein or the patient is asked to swallow the dye and the results are observed.

Ultrasound:

A sound waves to create the picture of the internal organs to find out if the cancer is spread or not.

Abdominal ultrasound:  with the patient symptoms it can be used to view the pancreas. But it cannot reveal the spread of pancreas.

Endoscopic ultrasound: in this method the doctor uses an ultrasound probe, and with the guidance of endoscope it is passed in to the small intestine and then into the pancreas to view the structures.

Barium Swallow:

The patient is asked to swallow the liquid Barium. Barium gets deposited in the lining of the stomach ,

esophagus and small intestine.

If X rays are taken at this time it might show some blockages in the stomach and other areas clearly.

Positron emission tomography (PET) or PET-CT scan.:

A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body

Liver function test:

              The bilirubin levels and the level of other digestive enzymes and liver enzymes such as Alanine transaminase, Aspartate transaminase and Alkaline phosphatase should be checked.


Prognosis

 The prognosis is excellent when the treatment is started the earlier stages.


Prevention

Take lots of fiber containing food

Maintain healthy lifestyle

Practice exercise regularly

Avoid alcohol and smoking