Inflammatory bowel disease and polypoid diseases in children
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
From the list of medications above, choose which one is the most appropriate treatment option for each of the clinical scenarios outlined below. Each option may be used once, more than once, or not at all. A 14-year-old girl with a history of weight loss, diarrhoea, loss of appetite and joint pains. Colonoscopy reveals colitis.A 14-year-old girl with a history of bloody diarrhoea for the last 2 months but no weight loss. She looked anaemic and blood investigations revealed low haemoglobin with normal inflammatory markers and liver function tests. Colonoscopy showed evidence of pancolitis.A 14-year-old girl with a history of weight loss, diarrhoea, loss of appetite and joint pains. She is being treated with 5-ASA and tapering doses of steroids. Colonoscopy revealed colitis.A 14-year-old girl with a history of bloody diarrhoea for the last 2 months with no weight loss. She looked anaemic and blood investigations revealed low haemoglobin with normal inflamma-tory markers and liver function tests. Colonoscopy revealed distal colitis.
Diagnosis of IBD
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
However, there are some exceptions to these principles. First, the terminal ileum may be superficially inflamed in the presence of pancolitis, a phenomenon which is described as ‘backwash ileitis’. It may be observed in up to 20% of patients with pancolitis. It is thought to be due to reflux (e.g. backwash) of caecal contents. It has been suggested that the presence of backwash ileitis points to a more refractory course of UC.6,46,47 Second, topical therapy (e.g. enemas) can lead to near-complete mucosal healing in distal colonic areas (e.g. the rectum and distal sigmoid colon) which result in areas of sparing48,49 or patchy inflammation. Rectal sparing has also been described even prior to treatment50 and it can be present in fulminant colitis (13%) as well.51 Third, up to 75% of patients with left-sided UC have periappendiceal inflammation (appendiceal skip lesions) in the colon and patchy inflammation in the caecum (caecal patch). Because of a discontinuous pattern of inflammation with skip lesions it can resemble CD.48,52 Appendiceal inflammation in the setting of distal colitis has been associated with better response to pharmacotherapy.53 All of these features can cause difficulties in differentiating UC from CD.
Lower GI surgery
Philip Stather, Helen Cheshire in Cases for Surgical Finals, 2012
A 28-year-old female presents to A&E with abdominal pain. She reports diarrhoea with 4−6 bowel movements per day. She is passing both blood and mucus with her stool. Her Hb is 9.8, MCV is normal. Her WCC is 13.5 and CRP is 104. She reports a long history of these symptoms, on and off for years. What is the most likely diagnosis? (1 mark)Patients with inflammatory bowel disease may have signs unrelated to the GI tract (GIT). Name three of these signs. (3 marks)Ulcerative colitis only affects the colon and rectum. It does not affect the bowel proximal to the ileo-caecal valve. What is it called when only the rectum is involved? (1 mark)Define pancolitis. (1 mark)What is found on rectal biopsy in a patient with ulcerative colitis? (1 mark)The medications used in the management of ulcerative colitis are the same as in Crohn’s disease. Surgery can also be performed. Why is surgery for ulcerative colitis more successful than in Crohn’s disease? (1 mark)
Inflammatory bowel disease in patients over the age of 70 y. Does the disease duration influence its behavior?
Published in Scandinavian Journal of Gastroenterology, 2018
Jose M. Huguet, Marisa Iborra, Marta Maia Bosca-Watts, Nuria Maroto, Rafael Gil, Xavier Cortes, David Hervás, Jose M. Paredes
Most patients studied were diagnosed between 60 and 70 y of age. The mean age at diagnosis was 63.4 y (SD 12.6 y), and the median age was 65 y. Thus, 69% of the patients (229/331) were younger than 70 years old at diagnosis, with the remaining patients (31%) being diagnosed at age 70 y or older. The mean duration of the disease was 13.4 y (SD 11.74 y and median 10.7 y). Forty-seven percent (149) were women, and the mean age at the time of the study was 77.34 y (±5.39). Ten patients (3.2%) had inflammatory bowel disease unclassified, 180 (57.3%) had Ulcerative colitis (UC) and 124 (39.5%) had Crohn's disease (CD). There was a similar proportion between pancolitis and distal colitis with a proximal progression of 1.9%. The demographic characteristics of patients are presented in Table 1.
Catastrophic antiphospholipid syndrome in a patient with systemic sclerosis and hereditary angioedema: case report and literature review
Published in Modern Rheumatology Case Reports, 2018
Jean Liew, Marcia Friedman, Sima Desai, Lindsay Taute, Nastaran Neishaboori, Peter Stenzel, Ajay Wanchu
On admission, she was afebrile, tachycardic, and hypotensive. Significant labs included leucocytosis (27 × 109 per L), serum creatinine of 2.96 mg/dL (prior baseline, 0.4–0.5 mg/dL), and serum lactate of 6.6 mg/dL. In the first 36 hours of admission, the acute kidney injury and lactic acidosis resolved with intravenous fluids and empiric broad spectrum antibiotics. However, she developed progressive thrombocytopenia, with platelet count declining from 299 × 109 per L to a nadir of 25 × 109 per L, and anaemia, with haemoglobin declining from 13.9 g/dL to 6.3 g/dL. On hospital day 4, she developed purpura on her hands and feet (Figure 1). Computed tomography (CT) of the abdomen and pelvis demonstrated pancolitis. Given the uncertainty of her case as well as the concern for thrombotic thrombocytopenic purpura (TTP), she was transferred to our facility on hospital day 5.
Tissue factor in ulcerative colitis, with and without concomitant primary sclerosing cholangitis
Published in Upsala Journal of Medical Sciences, 2019
Johan Vessby, Maria Lampinen, Mikael Åberg, Fredrik Rorsman, Agneta Siegbahn, Alkwin Wanders, Marie Carlson
Study participants (UC, n = 23; PSC-UC, n = 24; controls, n = 11) were recruited in connection to elective colonoscopy at the Department of Gastroenterology, Uppsala University Hospital, Uppsala, Sweden, between December 2011 and October 2015. All (non-PSC) UC patients included in the study had a medical history of pancolitis. In all PSC cases, the IBD was classified as UC. The IBD diagnoses were based on established clinical, endoscopical, and histological criteria (17). PSC patients were previously diagnosed based on the presence of typical biochemistry, cholangiographic findings, and/or histological abnormalities (18). Exclusion criteria were recent treatment with corticosteroids (within last 4 weeks), ongoing biological medication, or previous liver transplant. No patient had a history of thromboembolic events. Control subjects were patients without inflammatory bowel disease or colorectal neoplasia. PSC-UC subjects were younger than controls (p = 0.03), and the same tendency was found in the UC group (p = 0.06). There was no statistical difference between the number of patients on 5-aminosalicylic acid/sulphasalazine or immunomodulators (IM, azathioprine and mercaptopurine) between UC and PSC-UC. As expected, the hepatobiliary marker alkaline phosphatase (ALP) was higher in PSC-UC than both UC and controls (not shown). The levels of other investigated inflammatory markers were comparable between the groups. Relevant clinical characteristics are presented in Table 1.
Related Knowledge Centers
- Colonoscopy
- Colorectal Cancer
- Inflammatory Bowel Disease
- Large Intestine
- Ulcerative Colitis
- Rectum