Inflammatory Bowel Disease Ulcerative Colitis, Crohn’s.pptVIP

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2017-12-23 发布于江西
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Inflammatory Bowel Disease Ulcerative Colitis, Crohn’s.ppt

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Inflammatory Bowel Disease Ulcerative Colitis, Crohn’s

Inflammatory Bowel Disease Ulcerative Colitis, Crohn’s Chetan Irwin December 22, 2010 Inflammatory Bowel Disease Ulcerative colitis - nonspecific inflammatory bowel disease of unknown etiology that effects the mucosa of the colon and rectum Crohn’s disease - nonspecific inflammatory bowel disease that may affect any segment of the gastrointestinal tract Indeterminate colitis 15% patients with IBD impossible to differentiate Ulcerative Colitis Epidemiology 8-15 per 100,000 in US and Northern Europe where incidence is greatest 7,000 to 46,000 new cases in US each year Peak incidence 3rd (20’s), 7th (60’s) decades Slight male predominance Crohn’s disease - nonspecific inflammatory bowel disease that may affect any segment of the gastrointestinal tract Risk Factors for UC Diet, oral contraceptive use, breastfeeding, measles infection/vaccination and other widely discussed factors are not yet proven Cigarrette smoking Smokers are 40% as likely as non-smokers to develop UC; primarily sclerosing cholangitis and pouchitis are both also decreased in smokers Active smokers are half as likely to be hospitalized as nonsmokers, and former smokers are 50% more likely to be hospitalized and twice as likely as current smokers or those who have never smoked to require colectomy Appendectomy Protective effect of nearly 70% of appendectomy for the development of UC Pts who developed UC after appendectomy were less likely to develop recurrent sx than those with colitis and an intact appendix and less likely to require colectomy Genetics 5-10% of those affected have positive family hx pANCA - UC; ASCA, OmpC, Cbir1 - Crohn’s (Prometheus labs) UC Pathology Macroscopic Appearance Limited to mucosa and submucosa of rectum (nearly always) and colon Starts distally, continuous involvement of varied amount of colon proximally Pancolitis may include backwash ileitis (10%) - notably the ileum will appear dilated on radiography as opposed to the frequently narrow, fibrosed ileum in Crohn