1. Universidad de Guadalajara
Centro Universitario de Ciencias de la Salud
INFLAMMATORY BOWEL DISEASE:
• Ulcerative Colitis
• Crohn s Disease
Teachers:
Dr. Héctor Manuel Virgen Ayala
Dr. Benjamín Robles Mariscal
Exponent:
Eguía Ornelas Carlos Eugenio Octubre 2011

2. Ulcerative Colitis
(UC)

3. Ulcerative Colitis
Difusse inflammatory disease, contiguous,
initially confined to mucous.

4. Ulcerative Colitis
ILEUM
10% - 20% Reflux Ileitis
20%
30% - 40%
40% - 50%
RECTUM

5. Epidemiology
Ages 15-30
60-80 1:1
Preventive

6. Etiology
Unknown
Exogen factors: Salmonella, Shigella,
Campylobacter, Clostridium Difficile.
Lack of immunitary regulation
Genetics: IL-23R
Inheritance

7. Signs and Symptoms
Diarrea
Rectorrhage
Tenesmus
Mucus secretion
Crampy abdominal pain
Fever

8. Diagnosis
Endoscopy or proctoscopy
Barium enema “Lead tube”
Barium contrast radiography.
Contrast CT

9. www.gastrointestinalatlas.com

10. Disease Presentation
Low Moderate Severe
Depositions <4/day 4-6 day >6 day
Blood in stool Few Moderate Intense
Fever No Mean <37.5°C Mean > 37.5°
Tachycardia No <90 >90
ESR <30 mm >30 mm
Endoscopic aspect Erythema, decrease Intense erythema, Spontaneus
of vascular model, thick granularity, hemorrhage,
fine granularity. absence of vascular ulcerations.
marks, contact
hemorrhage, no
ulcerations.
Fauci A. S. et al. (2009). Harrison. Principios de
Medicina Interna. México, D.F. Mc Graw Hill. Pag. 1889

11. Medical Treatment
Lactose free diet
Sulfasalazine
Mesalamine
Olzalazine
Balsalazide
Corticosteroids

12. Surgical Treatment
URGENT SURGERY Fulminant colitis
Toxic Megacolon
Total colectomy with terminal ileostomy
SELECTIVE SURGERY:
Abdominal colectomy with ileorrectal anastomosis
Total Proctocolectomy with terminal ileostomy
Restorative proctocolectomy with anal anastomosis and ileal
bag

13. Crohn’s Disease
(CD)

14. Crohn’s Disease
Affects any part of digestive tube.
Segmentary distribution
Colon and Small Intestine 40%
Small Intestine 30%
Colon 25%
Anorrectal 8%
Ileocolic and Small Intestine CD
Anal and Perianal CD Acute Inflammatory
Crohn s Jejunoileitis Chronic Fibrous
Crohn’s Colitis

15. Epidemiology
Ages 15-30
60-80
1: 1.5
Increase
probabilities

16. Etiology
Unknown
Exogen factors: Bacteroides, Clostridium,
Escherichia.
Lack of immunitary regulation
Genetics: CARD 15, MHC, OCTN, DLG5, ATG16L1

17. Ileocolic and Small Intestine CD
Diarrea
Right upper and lower quadrant pain
Palpable mass
Fever and leukocytosis
Internal abscesses
Complications Fistulas
Obstruction

18. Crohn s Jejunoileitis
Steatorrhea
Diarrea
Nutritional deficiencies
Albumin
Mg
Ca
Vertebral Fractures
Vitamin D
Vitamin B12

19. Crohn’s Colitis
Fever
General malaise
Diarrea
Crampy abdominal pain
Hematochezia
Complications: Stenosis, Fistulas, Intestinal
Obstruction, Fulminant Colitis and Toxic
Megacolon

20. Anal and Perianal CD
Affects 35% of CD patients
Incontinence
Big hemorrhoids
Anal stenosis
Anorrectal fistulas
Perirrectal abscesses

21. CD Diagnosis
Endoscopy
Barium contrast radiography “Rope Sign”
CT Enterology
MRI

22. www.gastrointestinalatlas.com

23. Medical Treatment
Glucocorticoids
5- aminosalicilates (Sulfasalazine,
Mesalamine)
Immunosuppressive (Azatioprine,
Mercaptopurine)
Antibiotics
Infliximab

24. Surgical Treatment
- Segmentary colectomy with primary
anastomosis.
- Total colectomy with ileorrectal anastomosis
- Proctocolectomy with ileostomy

25. Right Hemicolectomy - CD
• http://www.youtube.com/watch?v=Nkbhc7Ky
S68

26. Ulcerative Colitis and Crohn’s Disease
Ulcerative Colitis Crohn’s Disease
Diarrea Marked Present, less severe
Blood in stool Caracteristic Infrequent
Perianal injuries Infrequent, mild Frequent, complex
Toxic dilatation Yes (3-10%) Yes (2-5%)
Pain Occasional Frequent
Abdominal mass Rare Yes
General Symptoms Occasional Frequent
Fistulas No Yes
Intestinal Obstruction Rare Frequent
Fauci A. S. et al. (2009). Harrison. Principios de
Medicina Interna. México, D.F. Mc Graw Hill. Pag. 1890

27. Undetermined Colitis
15% of IBD
UC and CD characteristics and complications
Total abdominal colectomy with terminal
ileostomy

28. Thanks!

29. Bibliography
• Doherty M. Gerard (2011). Diagnóstico y Tratamiento
Quirúrgicos. México D.F.: Lange.
• Fauci A. S. et al. (2009). Harrison. Principios de
Medicina Interna. México, D.F.: Mc Graw Hill.
• Brunicardi. F. Charles. et al. (2006). Schwartz.
Principios de Cirugía. México, D.F.: Mc Graw Hill.
• http://www.youtube.com/watch?v=Nkbhc7KyS68