IBD
Inflammatory Bowel Disease
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Inflammatory Bowel Disease
, Autoimmune Bowel Disorder
See Also
Chronic Diarrhea
Epidemiology
Age: 10 to 40 years old
First degree relative with Inflammatory Bowel Disease increases risk 10 fold
Differential Diagnosis
Lower GI Bleed
ing
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
Hemorrhoid
s
Anal Fissure
s
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)
Pseudomembranous colitis
of
Clostridium difficile
(recent antibiotic use)
Entamoeba histolytica
Tuberculosis
Cytomegalovirus
Yersinia
Strongyloides
History
Travel
Contaminated intake
Foodborne Illness
Waterborne Illness
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
Stool
Blood
Grossly bloody stool in
Ulcerative Colitis
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
Bowel
Tissue affected
Ulcerative Colitis
: Mucosal disease (no granuloma)
Crohn's Disease
: Transmural disease (granulomas)
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%
Menees (2015) Am J Gastroenterol 110(3):444-54 [PubMed]
Gene
ral
Stool
studies
Stool Culture
Stool
for
Ova and Parasite
s
Giardia
Antigen
Clostridium difficile Toxin
and culture
Fecal Leukocytes
Additional
Stool
studies
Yersinia enterocolitica
culture
Toxigenic
Escherichia coli
isolation
Entamoeba histolytica
serologic titers
Labs
Immunocompromised Patient Evaluation
Chlamydia trachomatis
Cryptosporidium
Antigen
Neisseria gonorrhoeae
Herpes Simplex Virus
(HSV)
Cytomegalovirus
(CMV)
Isospora belli
Mycobacterium tuberculosis
Labs
Underlying Nutrition and Disease Severity
C-Reactive Protein
or
Erythrocyte Sedimentation Rate
Correlates with severity
Serum Protein
level
Serum Albumin
Serum
Transferrin
Serum Prealbumin
Hemoglobin
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
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
http://www.ccfa.org
Cedars-Sinai Inflammatory Bowel Disease Center
http://www.csmc.edu/ibd
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