Inflammatory Bowel Disease Clinical features

Clinical features of

Inflammatory Bowel Disease

Crohn’s Disease• Fibrostenotic Obstructive pattern• Penetrating Fistulous pattern

The site of disease influences the clinical manifestations.

Ileocoltis

• Low grade fever• recurrent episodes of right lower quadrant pain• Prolonged diarrhea not grossly bloody and is

intermittent.• Leukocytosis• Weight loss• High spiking fever s/o intra abdominal abscess

formation • Palpable mass composed of inflamed bowel,

adherent and indurated mesentery, and enlarged abdominal lymph nodes.

• Dysuria and fever – extension of mass

causing obstruction of right ureter

and bladder inflammation• Bowel obstruction features – early stages produce

intermittent obstructive manifestations and increasing symptoms of postprandial pain.

• Enterovesical fistulas typically present as

dysuria or recurrent bladder infections• Enterovaginal fistulas are rare and present

as dyspareunia or as a feculent or foul-smelling,

often painful vaginal discharge.

jejunoileitis• Malabsorption and steatorrhea – due to loss of

digestive and absorptive surface.• Vertebral fractures – vit.D deficiency, hypocalcemia,

and prolonged glucocorticoid use.• Pellagra from niacin deficiency.• Megaloblastic anemia – vit.B12 deficiency• Diarrhea:• (1) bacterial overgrowth in obstructive stasis or

fistulization, • (2) bile-acid malabsorption due to a diseased or

resected terminal ileum, and • (3) intestinal inflammation with decreased water

absorption and increased

ColitisLow-grade feversMalaise DiarrheaCrampy abdominal pain, and Sometimes hematochezia

• Incontinence • Debilitatng rectal pain - hemorrhoids• Malodorous discharge from fistula• Disfiguring scars from active disease and of previous abdominal surgery.

Perianal disease

Gastroduodenal Disease

• nausea, vomiting, and epigastric pain.• H. pylori–negative gastritis• Patients with advanced gastroduodenal CD may

develop a chronic gastric outlet obstruction.

Extraintestinal manifestations1.Musculoskeletal disease: in 9-53% Arthritis- seronegative, transient and non deforming, asymmetric distribution involves large jts of lower extremities.2.Dermatologic disease: 2-34% Erythema nodosum – raised,red,tender nodules appear primarily on ant.surface of lower leg.3.Oral lesions: Apthous ulcers4.Opthalmologic disease: Primary episcleritis Anterior uveitis

5. Urologic disease: Nephrolithiasis Hydronephrosis Enterovescical fistulae6. Hepatobiliary disease: cirrhosis portal vein thrombosis cholangocarcinoma pancreatitis7. Thromboembolic disease: Deep vein thrombsis Pulmonary embolism8. Hematologic manifestations: Iron deficiency anemia, megaloblasrtc anemia Autoimmune hemolytic anemia

Laboratory, Endoscopic,and Radiographic Features

• Elevated ESR and CRP. • In more severe disease - hypoalbuminemia, anemia, and leukocytosis.

Laboratory abnormalities:

Endoscopic features:

rectal sparingaphthous ulcerations, fistulas, and skip lesions.“Cobble stone” appearance.

Radiographic features:

String sign - represents long areas of circumferential inflammation and fibrosis, resulting in long segments of luminal narrowingFilling defects seen on barium enema

CT Enterography:

depicts the smallbowel inflammation associated with CD by displaying mural hyperenhancement, stratification, and thickening; engorged vasa recta; and perienteric inflammatory Changes.

Ulcerative colitis:• Diarrhea - Liquid stools containing blood, pus, often nocturnal and/or postprandial. rectal bleeding, passage of mucus.• Tenesmus• Crampy abdominal pain.• In moderate to severe disease:• anorexia• nausea • vomiting • fever• weight loss

Proctitis - usually pass fresh blood or bloodstained mucus. tenesmus. physical signs – tender anal canal blood on rectal examinationToxic colitis – severe pain and bleedingMegacolon - hepatic tympany

Mild Moderate Severe

Bowel movements

<4 per day 4–6 per day >6 per day

Blood in stool Small Moderate Severe

Fever None <37.5C mean >37.5C mean

Tachycardia None <90 mean pulse >90 mean pulse

Anemia Mild >75% 75%

Sedimentation rate

<30 mm >30 mm

Endoscopic appearance

Erythema, decreased, Vascular pattern, Fine granularity

Marked erythema, Coarse granularity, Absent vascular markings, Contact bleeding No ulcerations

Spontaneous bleeding, Ulcerations

Extracolonic manifestations

• Uveitis – most common• Primary sclerosing cholangitis• Ankylosing spondylitis• Erythema nodosum• Pyoderma gangrenosum • Pleuritis• Spondyloarthropathies

Laboratory abnormalities:

• Elevated ESR , CRP, platelet count.• In more severe disease - hypoalbuminemia, anemia, and leukocytosis.

Radiographic features :

The earliest radiologic change is fine mucosal granularity.When severe – “collar-button” ulcers - Haustral folds become edematous and thickened - the colon becomes shortened and narrowed. - Polyps in the colon may be postinflammatory polyps or pseudopolyps, adenomatous polyps, or carcinoma.

CT findings:

• mild mural thickening (<1.5 cm),• inhomogeneous wall density, absence of small-

bowel• thickening, increased perirectal and presacral fat,• Target appearance of the rectum and adenopathy.

Clinical Features of UC vs CD

Endoscopic and Radiographic Features of UC vs CD