Inflammatory Bowel Disease :
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Inflammatory Bowel Disease
The risk of developing colon cancer is 20 times higher for patients with IBD than it is for the general population. The association with colon cancer is more clearly established in ulcerative colitis than in Crohn's disease. An increased risk most likely also exists, however, for patients with Crohn's disease that affects the colon. In ulcerative colitis, the risk of acquiring colon cancer increases according to how much of the colon is involved and the duration of colitis. Thus, after about 8 to 10 years of ulcerative colitis, especially if the entire colon is involved, the risk of developing colon cancer substantially increases. Other risk factors for colon cancer in IBD patients include a liver disease called primary sclerosing cholangitis (PSC), a family history of colon cancer, and a history of liver transplantation. Additional possible risk factors include the use of concurrent immunosuppressive medications and a deficiency of the vitamin, folic acid.
Diverticular Inflammatory Bowel Disease is an unusual condition. Please review the information on diverticulosis first, so you know what diverticuli are. Inflammatory bowel disease is a chronic inflammation of the bowel lining. It may be called either ulcerative colitis or Crohn's disease. A third type of inflammation can occur with severe diverticulosis. The lining can become very reddened and then bleed. In these cases, the inflammation remains localized in the area with diverticulosis and never extends further. Treatment is usually the same as for ulcerative colitis or Crohn's disease. Here you see two images of the sigmoid colon. Image 1 a shows small black opening of a diverticuli on the left. Above it is the markedly reddened and inflamed fold. Image 2 shows scattered areas of inflammation.
The most common symptoms of Ulcerative Colitis are stomach cramping and bloody Diarrhea.
The stools may be either firm or loose, and can be either blood-tinged (slightly bloody) or have a large amount of blood and mucus present.
Many people also have fecal urgency, which means that they have to go to the bathroom immediately. Some have pain around the rectum when they have bowel movements. Both of these symptoms are because of an inflammation in the last part of the colon.
In some patients, stomach pain, either throughout the stomach or in the lower left section, may get better after they have a bowel movement.
Some people with the disease may be anemic (low blood count), dehydrated, malnourished, and may even have a fever.
The amount and type of symptoms can be used to divide the disease into mild, moderate, and severe forms.
Arthritis and joint problems (effusion and pain)
Spondylitis inflammation of the spine
Eye complications such as Cataracts, Uveitis, corneal ulcerations, and other problems could occur
Aphthous Ulcers (shallow irritating mouth ulcers) may be seen.
Changes in the liver (e.g., Cirrhosis), skin (e.g., erythema nodosum), and heart (e.g., Pericarditis), are rare complications.
Thromboembolic events and gallbladder involvement (e.g., primary sclerosing Cholangitis) are rare complications of Ulcerative Colitis.
Mild disease -- people have fewer than 5 stools per day, with only occasional bleeding. Usually, there is not much pain or tenderness in the stomach.
Moderate disease -- more frequent bowel movements, usually with blood in their stools. There may be some abdominal pain and tenderness.
Severe disease -- more than 6 to 12 bloody stool per day, along with stomach pain and tenderness. Patients with severe disease may be dehydrated and anemic.
- Anal fissure
An anal fissure is a cleft in the anus or in the skin around the anus where infection may occur. This is commonly associated with painful bowel movements.
Ulcers may extend through the intestinal wall, creating a fistula (an abnormal opening). If an internal fistula develops, food may not reach the area of the intestine involved in absorption. External fistulas may result in continuous bowel drainage onto the skin. Fistulas may also become infected, a condition that can be life threatening, if left untreated.
Diarrhea, abdominal pain and cramping may make it difficult to eat. The body may not be able to consume a sufficient amount of nutrients.
Individual's who have Crohn's disease may experience blockage in the intestine. Food contents may become lodged in areas of the intestine that are inflamed. Some cases may require surgery to remove the diseased portion of the gastrointestinal tract.
- Toxic megacolon
Toxic megacolon is a rare, but potentially life-threatening complication of severe IBD. Toxic megacolon is characterized by a dilated colon (megacolon), abdominal distension (bloating), and occasionally fever, abdominal pain or shock. In severe cases, the condition may cause the colon to become paralyzed. Toxic megacolon prevents the individual from having bowel movements. If the condition is not treated, the colon may rupture, resulting in peritonitis, a life-threatening condition that requires emergency surgery.
Ulcers (open sores) may develop anywhere there is chronic inflammation in the gastrointestinal tract, including the mouth or anus.
Many individuals who have had long-standing Crohn's disease may develop osteoporosis (weak, brittle bones). Researchers speculate that this may be related to low levels of vitamin K, which is involved in binding calcium to bone.
Usually inflammatory bowel disease is treated with medication, exercise, and sometimes, surgery. Treatments for IBD are directed against the inflammation in the bowel. Medicines can both control flare-ups and prevent recurrences during symptom-free periods. It is important to control IBD inflammation in order to prevent complications.
Drugs work by calming down the immune system's attack on the bowel. The most common types of treatments are anti-inflammatory medicines in a drug family known as five-amino salicylic acids; steroids; antibiotics; and immune-system modulators such as mercaptopurine and azathioprine. If symptoms are limited to the bowel near the rectum, some of these medications can be given rectally, through enemas. This method helps people avoid some of the side effects that occur when the medications are taken in pill form by mouth. Sometimes, dietary changes can help, and there is evidence that fish-oil capsules are beneficial in treating ulcerative colitis. It is possible in severe cases to "cure" the symptoms of ulcerative colitis by removing the entire colon surgically. By contrast, because Crohn's disease can affect areas in the digestive tract above the colon and rectum, colon surgery cannot cure this disease. When surgery is required in Crohn's disease, the purpose usually is to correct complications.
Proper exercise helps to reduce stiffness, maintain joint motion, and strengthen the muscles around the joints. Maintaining the range of motion of affected joints is important in order to prevent or reduce deformity caused by lack of use. If you have ankylosing spondylitis, range of motion exercises of the spine are of benefit. Deep breathing exercises are emphasized, because motion of the ribs may eventually be restricted as the disease moves up the spine. If you smoke, you should stop in order to help prevent breathing complications.
Surgical removal of the diseased bowel is usually a permanent cure for ulcerative colitis. This surgery also puts an end to any arthritis that may be present, unless the arthritis involves the spine. Ankylosing spondylitis may last even after removal of the diseased colon. Crohn's disease does not respond as well to surgery. Surgical removal of the diseased bowel may be necessary, but it does not cure Crohn's disease. Thus, symptoms of arthritis may recur when and if bowel symptoms reappear.
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