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Inflammatory Bowel Disease
Aka: Inflammatory Bowel Disease, Autoimmune Bowel Disorder- See Also
- Epidemiology
- Age: 10 to 40 years old
- First degree relative with Inflammatory Bowel Disease increases risk 10 fold
- Differential Diagnosis
- Lower GI Bleeding
- Diverticulitis (most common cause)
- Angiodysplasia (Arteriovenous Malformation)
- Neoplasm
- Ulcerative Colitis (Blood Diarrhea distinguishes from Crohn's Disease)
- Ischemic Colitis (Older patients with sudden onset pain)
- Anorectal Disease
- Diarrhea
- Non-Infectious Osmotic Diarrhea
- Non-Infectious Secretory Diarrhea
- Ulcerative Colitis (bloody Diarrhea)
- Crohn's Disease
- Irritable Bowel Syndrome (diagnosis of exclusion)
- Fecal Impaction (with leakage)
- Infectious Diarrhea (Sudden onset and often painful)
- Lower GI Bleeding
- History
- Travel
- Contaminated intake
- Immunodeficiency risk
- High risk sexual behavior
- Family History of Gastrointestinal disease
- Medications in the last 6 months (e.g. antibiotics)
- Symptoms
- Chronic Inflammatory Diarrhea
- Crohn Disease may also cause Secretory Diarrhea (Chronic Watery Diarrhea)
- Pain
- Ulcerative Colitis
- Lower abdominal cramps
- Relieved with Bowel Movement
- Crohn's Disease
- Constant pain often in right lower quadrant
- Not relieved with Bowel Movement
- Ulcerative Colitis
- Stool Blood
- Grossly bloody stool in Ulcerative Colitis
- Chronic Inflammatory Diarrhea
- Signs
- Abdominal Mass
- Ulcerative Colitis: No abdominal mass
- Crohn's Disease: Mass often at Right lower quadrant
- Gastrointestinal Tract Affected
- Ulcerative Colitis
- Affects only colon
- Continuous from Rectum
- Crohn's Disease
- Mouth to anus potentially affected
- Discontinuous, "Skip" lesions
- Ulcerative Colitis
- Bowel Tissue affected
- Ulcerative Colitis: Mucosal disease (no Granuloma)
- Crohn's Disease: Transmural disease (Granulomas)
- Abdominal Mass
- Labs: Stool Studies
- Fecal Calprotectin
- Newer test with high Test Sensitivity and Test Specificity for Inflammatory Bowel Disease
- Fecal Calprotectin <40 mcg/g and CRP <0.5 reduce Inflammatory Bowel Disease likelihood to<1%
- General Stool studies
- Additional Stool studies
- Yersinia enterocolitica culture
- Toxigenic Escherichia coli isolation
- Entamoeba histolytica serologic titers
- Fecal Calprotectin
- Labs: Immunocompromised Patient Evaluation
- Labs: Underlying Nutrition and Disease Severity
- C-Reactive Protein or Erythrocyte Sedimentation Rate
- Correlates with severity
- Serum Protein level
- Hemoglobin
- C-Reactive Protein or Erythrocyte Sedimentation Rate
- Differential Diagnosis: Distinguishing Crohn's Disease from Ulcerative Colitis
- Location
- Crohn's Disease can involve any area of Gastrointestinal Tract
- Ulcerative Colitis is typically limited to colon, and has onset at the Rectum
- Thickness
- Crohn's Disease involves the entire bowel wall
- Ulcerative Colitis is limited to the mucosa and submucosa
- Colonoscopy
- Crohn's Disease demonstrates skip lesions, cobblestoning, ulcerations and strictures
- Ulcerative Colitis demonstrates pseudopolyps, continuous areas of inflammation
- Other discriminating factors
- Anemia is more common in Ulcerative Colitis
- Abdominal Pain is more common in Crohn's Disease
- Rectal Bleeding is more common in Ulcerative Colitis
- Colon Cancer is much more common in Ulcerative Colitis
- Location
- Diagnosis
- Colonoscopy with mucosal biopsy
- Imaging
- CT Abdomen and Pelvis (or MRI Abdomen)
- Abdominal XRay findings (if done for other reasons)
- Perforation signs (i.e. Free air in peritoneum)
- Toxic Megacolon
- Thumb-printing
- Pattern of multiple locations where bowel wall appears indented (as if by a thumbs)
- Resources
- Crohn's and Colitis Foundation of America
- Cedars-Sinai Inflammatory Bowel Disease Center