IBD for 5th 2011.

1. Inflammatory Bowel Disease Dr. Mohammad Shaikhani CABM,FRCP. Updated:2/2011

14. UC

15. Distinguishing characteristics of CD and UC UC CD Feature Only colon (rarely “ backwash ileitis ” SB or colon Location Continuous, begins distally Skip lesions Anatomic distribution Involved in >90% Rectal spare Rectal involvement Universal Only 25% Gross bleeding Rare 75% Peri-anal disease No Yes Fistulization No 50-75% Granulomas

16. Endoscopic features of CD and UC UC CD Feature Continuous Discontinuous Mucosal involvement Rare Common Aphthous ulcers Abnormal Relatively normal Surrounding mucosa Rare Common Longitudinal ulcer No In severe cases Cobble stoning Common Uncommon Mucosal friability distorted Normal Vascular pattern

17. Pathologic features of CD and UC UC CD Feature Uncommon Yes Transmural inflammation No 50-75% Granulomas Rare Common Fissures No Common Fibrosis Uncommon Common Submucosal inflammation

18. Radiologic features of CD and UC UC CD Feature Collar button ulcers Nodularity granularity cobble stoning string sign of SB

19. Comparison of Features in Ulcerative Colitis and Crohn's Disease Crohn's Disease Ulcerative Colitis Feature Transmural Mucosal Depth of inflammation Skip areas Contiguous Pattern of disease Mouth to anus Colorectum Location Less common Usual Rectal involvement Common Backwash ileitis (15%–20% of patients ) Ileal disease Common Rare Fistulas Common Rare Perianal disease 10%–30% of patients Unlikely Granulomas Less common Usual Overt bleeding More common Unlikely Malnutrition Colorectal cancer, small bowel cancer (depending on disease location ) Colorectal cancer, cholangiocarcinoma (if primary sclerosing cholangitis is present ) Cancer risk Harmful Protective Tobacco use

20. UC

21. CD

37. Complications of IBD

55. Treatment : 5-ASA (sulfasalazine, olsalazine, balsalazide, mesalamine: oral, rectal UC: induction/maintenance CD (weak): induction/maintenance Inters nephritis (rare Diarrhea (olsalazine) Medication Indication Side Effects

56. Treatment : Antibiotics: Metronidazole, Ciprofloxacin CD: perianal/ colonic disease Metronidazole:PN , metallic taste, antabuse effect Ciprofloxacin: arthropathy, seizure) Medication Indication Side Effects

57. Treatment : CS (oral, IV, rectal) UC/CD: induction, not maintenance Acne, moon facies, truncal obesity, osteoporosis, osteonecrosis, DM, hypertension, cataracts, inf Budesonide CD (ileal/R colon): induction Minimal CS effects Medication Indication Side Effects

58. Treatment : Methotrexate CD: induction/maintenance Bone marrow suppression, hepatotoxicity, pulmonitis 6-MP, Azathioprine UC/CD: steroid withdrawal, maintenance Pancreatitis, fever, infection, leukopenia, hepatotoxicity, lymphoma Anti–TNF-α: Infliximab UC/CD: induction/maintenance Infusion reaction, tuberculosis reactivation, demyelination, infection,HF,Lymphoma. Adalimumab UC/CD: induction/maintenance Cyclosporine UC: steroid refractory Hypertension, nephro &neurotoxicity Medication Indication Side Effects

69. Infliximab - mucosal healing Baseline Week 10 Week 54 Rutgeerts et al. DDW 2002: [abstract] W1367.