DISEASES OF SMALL INTESTINE

Small Intestine DiseasesDiarrheaIntolerance to specific foodsAcute food poisoningViral infections

Small Intestine DiseasesMalabsorptionMaldigestion problemsIntestinal mucosal changesGenetic diseaseIntestinal enzyme deficiencyCancer and its treatmentMetabolic defects

Small Intestine DiseasesCeliac sprueHypersensitivity to the protein gluten in certain grainsSteatorrhea and progressive malnutrition are secondary effects to gluten reactionNutrition management controls dietary gluten intake and prevents malnutrition

Small Intestine Diseases

Cystic fibrosisGenetic disease of childhoodInhibits movement of chloride and sodium ions in the body tissue fluids

Small Intestine DiseasesCystic fibrosisTreated with pancreatic replacement productsChildren with CF require 105% - 150% of recommended nutrients for their ageNutritionally adequate high-protein, normal-to-high fat diet recommended

Small Intestine DiseasesInflammatory bowel diseaseApplies to both ulcerative colitis and Crohns diseaseShort-bowel syndrome results from repeated surgical removal of parts of the small intestine as disease progressesReduces absorption of nutrients

Large Intestine DiseasesDiverticular diseaseDiverticulosis: formation of many small pouches (diverticula) along muscular mucosal liningDiverticulitis caused by pockets becoming infected

Inflammatory bowel disease..Inflammatory bowel diseases (IBD) include a group of chronic disorders that cause inflammation or ulceration in the small and large intestines. Most often IBD is classified as:Ulcerative colitisUlcerative colitis--causes ulceration and inflammation of the inner lining of the colon and rectum.Crohn'sCrohn'sdiseasedisease--an inflammation that extends into the deeper layers of the intestinal wall, and also may affect other parts olayers of the f digestive tract, including the mouth, esophagus, stomach, and smdigestive small all intestine.

Ulcerative colitis and Crohn's disease cause similar symptoms that often resemble other conditions, such as irritable bowel syndrome. The correct diagnosis may take some time. Inflammatory bowel disease may also be referred to as colitis, enteritis, ileitis, and proctitis

PLANCROHNS DISEASE (CD)Etiology and Epidemiology of CROHNS DISEASE Pathology of CROHNS DISEASE Clinical picture of CROHNS DISEASE Diagnosis of CROHNS DISEASE Differential Diagnosis of CROHNS DISEASE Prognosis of CROHNS DISEASE Treatment of CROHNS DISEASE

Traditional viewCrohns diseaseis characterized by acute and chronic inflammation of the small and large intestine and structures apart from the bowel (BA Lashner in Inflammatory Bowel Diseases, J Kirsner ed. 5the ed WB Saunders, 2000) Ulcerative colitisis an inflammatory disease of the colon of unknown etiology (PB Miner in Inflammatory Bowel Diseases, J Kirsner ed. 5the ed WB Saunders, 2000)Exceptionsbackwash ileitisPostcolectomy pouchitis

Porto criteria for the diagnosis of Pediatric IBDIndeterminate colitis can only be diagnosed after a full diagnostic work-up. This must include colonoscopy with intubation of the terminal ileum, upper gastrointestinal endoscopy and small bowel follow through. Diagnosis of indeterminate colitis is suggested by histology showing acute and chronic inflammation with architectural changes confined to the colon, absence of abnormalities suggesting lymphocytic or allergic colitis, or CD, a normal small bowel follow through or enteroclysis and no definite classification of CD or UC possible with histology. (IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition.. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis--the Porto criteria. J Ped Gastroenterol Nutr 2005; 41: 1-7)

Upper GI involvement and IBDThe difference in distribution between CD and UC is a feature which is used for the differential diagnosis!Upper GI Involvement is considered as an argument against a diagnosis of UC But? Is UC confined to the colon

Ulcerative colitis and upper GI diseaseUlcerative small bowel lesions in pts with ulcerative colitisDiffuse, confined to mucosa, no granulomas

Ulcerative colitis and Upper GI involvementEctors N, Rutgeerts P, Geboes K, Penninckx F, Desmet V. Ulcerative jejunitis in patients with established ulcerative colitis. Gastroenterology 1994; 106: A676.Sasaki M et al; Ulcerative colitis complicated by gastroduodenal lesions. J Gastroenterol 1996; 31: 585Annese V et al Fatal ulcerative panenteritis following colectomy in a patient with ulcerative colitis. Dig Dis Sci 1999; 44: 1189Valdez et al. Diffuse duodenitis associated with ulcerative colitis. Am J Surg Pathol 2000; 24: 1407Terashima et al. Ulcerative duodenitis accompanying ulcerative colitis. J Clin Gastroenterol 2001; 32: 172Rubenstein J et al; Ulcerative colitis associated enteritis : is ulcerative colitis always confied to the colon J Clin Gastroenterol 2004; 38: 46

Upper GI involvement and ulcerative colitis Duodenum : Friability

Upper GI involvement and ulcerative colitis Duodenum : Friability & Granularity

Gastritis and Ulcerative colitis B -1390258

Gastritis and Ulcerative colitis B -1390258

Focally Enhanced gastritis B-1412032

Focally Enhanced gastritis

Upper GI involvement and ulcerative colitisAphthous gastritis : Crohn or UC

ConclusionsUpper GI lesions in ulcerative colitis are different in children and adultsGastritis is common in children with ulcerative colitisThe diagnostic value of gastritis in ulcerative colitis has not yet been established; the predictive value is low in adultsTwo patterns have been recognizedDiffuse gastritisFocally enhanced gastritisSevere upper small intestinal inflammation can complicate severe ulcerative colitis

Definition

CROHNS 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.

EtiologyThe fundamental cause of Crohn's disease is unknown

The spectrum of CROHN DISEASE presentations includes gastroduodenitis, jejunoileitis and ileitis, ileocolitis, colitis7%33%45%15%

CROHNS DISEASE Clinical pictureAbdominal pain (77%)Chronic diarrhea (73%)Bleeding (22%) Anal Fistulas (16%)Anorexia A right lower quadrant mass or fullness

CROHNS DISEASE Extraintestinal manifestations Weight loss (54%)Fever (35%)Anemia (27%)Peripheral arthritis (16%)Ophtalmic diseases (Episcleritis, 10%)Aphthous stomatitisErythema nodosum (2%)Pyoderma gangrenosum

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.

CROHNS DISEASEDIAGNOSISx-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.

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

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

Sigmoidoscopy An internal examination of the rectum, distal sigmoidcolon, and large bowel using a type of small camera(flexible sigmoidoscope sigmoidoscope). ). This test can help diagnose:1.Inflammatory bowel disease2.Bowel obstruction3.Colon cancer4.Colon polyps5.Diverticulosis6.Causes of diarrhea7.causes of abdominal pain This test can also be used to:1.Determine the cause of blood, mucus, or pus in the stool2.Confirm findings of another test or X-rays3.Take a biopsy of a growth

Sigmoidoscopy with biopsy showed:- Non Non-specific inflammation of the rectal mucosa withsome granulomas but without necrosis.Differential diagnosis of Granulomas Granulomas:- Crohn Crohns disease Mycobacterial Tuberculosis On the suspicion of tuberculosis anti anti-tuberculousmedication was given for four months

CROHNS DISEASEDIFFERENTIAL DIAGNOSISUlcerative colitis Acute appendicitis Pelvic inflammatory disease Ectopic pregnancyOvarian cysts

Cancer of the cecumLymphosarcomaSystemic vasculitisRadiation enteritisIleocecal TB AIDS-related opportunistic infections (cytomegalovirus)

DIFFERENTIAL DIAGNOSIS

The typical perianal skin tag of Crohn's Disease

DIFFERENTIAL DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

Enterocutaneous fistulae in Chrohn'sdisease

CROHNS DISEASETreatmentDiet 4 Aminosalicilates (Sulfasalazine, Salofalk) Corticosteroid therapy (Budesonid, Prednizolon)Immunosuppressive drugs (Azathioprine)Symptomatic treatment (antidiarrheal drugs - loperamide, Anticholinergics)

Diarrhealoose, watery stools occurring more than three times in one dayWhat is the main complication associated with diarrhea? (dehydration)Chronic diarrhea can be life-threatening to young children or adults with weak immune systems.Until diarrhea subsides, patients should avoid milk products and foods that are greasy, high-fiber, or very sweet. These foods tend to aggravate diarrhea.Health professional may recommend the BRAT diet (bananas, rice, apples, toast).Can cause many problems, from diarrhea to malnutrition.Celiac sprue, cystic fibrosis, and inflammatory bowel disease are three diseases that cause malabsorption.Celiac disease damages the small intestine and interferes with absorption of nutrients from food.The only treatment for celiac disease is to follow a gluten-free diet.What are some foods that contain gluten? (foods prepared with wheat, rye, oat, or barley; luncheon meats)More info: http://www.celiac.org/Thick mucus in the lungs leads to damaged airways, difficulty breathing, and lung infections.Thick secretions also obstruct the pancreas, preventing digestive enzymes from reaching the intestines to help break down and absorb food.Causes malabsorption of undigested foods, liver disease, and increased salt concentration in the tissues.

More than 90% of CF patients take supplemental pancreatic enzymes.Supplement salt by adding salt and salty snacks.Use foods that are high in calories to promote weight gain. Additional nutrition resources at: http://www.cff.org/home/

Diet gradually advanced to restore nutrient intake:High protein (100 g/day)High-energy (2500-3000 kcal/day)Increased vitamins and minerals (supplements)The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea.Patients should avoid foods that upset the intestines, such as highly seasoned foods, raw fruits and vegetables, or milk sugar (lactose). Check out: http://www.ccfa.org/ (Crohns & Colitis Foundation of America)Diverticulosis is caused by progressive increase in pressure within the bowel; affects About 10% of Americans over the age of 40. The condition becomes more common as people age. About half of all people over the age of 60 have diverticulosis.Chronic diverticular disease is managed with increased dietary fiber. Dominant theory is that a low-fiber diet is the main cause of diverticular disease.What foods should be avoided with diverticular disease?