Inflammatory Bowel Disease: Types, Causes and Effects

rabble-rousing Bowel ailment Types, Causes and EffectsChapter 1 THE INFLAMMATORY intestine DISEASEWHAT IS INFLAMMATORY BOWEL DISEASEInflammatory bowel indisposition (IBD) means chronic ignition of all or part of your compendiumive parcel. IBD fag end be classified into two, which is, ulcerative inflammatory bowel disease and Crohns disease. IBD is very untellable and debilitating, and hatful sometimes contract to life-threatening complications. The IBD is called an autoresistant disease be actor the embodys repellent system attacks the digestive system. The disease is so severe that it whitethorn cause abdominal muscle throe, smeary diarrhea, cramps and fever.This is sole(prenominal) different from Irritable Bowel Syndrome (IBS).DIFFERENCE BETWEEN INFLAMMATORY BOWEL DISEASE (IBD) AND INLAMMATORY BOWEL SYNDROME (IBS)The difference between the IBS and the IBD is that IBD is structural, unless IBS is not. If the gut is examined by x-ray, endoscopy, biopsy or su rgery, structural damage to the gut can be seen. In IBD, the damage is caused by the fire and whitethorn require heavy profession medication, or even surgery. Whereas in IBS, the examination of the gut of a soulfulness having IBS would help detect nothing. It can only be detected by gut symptoms. These whitethorn include abdominal cramps or pain, harder or looser bowel movements than average, excess gas, diarrhea and constipation or alternating between the two. twain of these collide with mickle of all ages but young people be to the highest degreely takeed. Females have to a greater extent chances of having IBS. IBD has no gender preference but is mostly found in Jews and people from Northern Europe. IBS is a ecumenic disorder, while IBD is prominent in the planets temperate zones.In IBD, the gut is damaged by chronic inflammation. The damage is fought by the demurral mechanism of the body resulting in fever and malaise. The intestines atomic number 18 disrupted, they may melt d take in and anemia is common too. on that point is inability to eat during attacks, inflammation is caused which results in wasting of energy, ultimately resulting in weight loss and malnutrition.IBS cannot be determine by findings of physical examination. However, the structural damage caused by IBD is besides adequate of producing striking physical findings the like a mass in the tummy, or the symptoms such as that of weight loss and anemia. Other differences include the subscribe for surgery in IBD, which is not require in IBS. IBS does not deliver complications in the gut, skin, joints and eyes, but IBD does.CROHNS DISEASE This is the example of IBD that may drive any part(s) of the gastrointestinal tract, ranging from m surfaceh to anus. Listed below atomic number 18 a few characteristic featuresInflammation usually legislates in patches.The pain is usually see in the lower right abdomen.The colon may turn midst and might appear to be rocky.Ulcers in and on the digestive tract ar very deep, sometimes extending into every layer of the bowel wall.During bowel movement, rectal bleeding is not common.ulcerative inflammatory bowel disease is the second type of IBD, which is taken up in the subsequent chapters.Chapter 2 ULCERATIVE colitisDefining Ulcerative colitisinflammatory bowel disease means the inflammation of the colon, or to a greater extent largely, inflammation of the large intestine ( that comprises of colon, caecum and rectum). Ulcerative colitis is a disease of the colon, which is the largest part of the large intestine, characterized by ulcers (open sores). These ulcers ar painful wounds, they may bleed and also produce mucus and pus. The mucosa (inner lining) of the intestine becomes red and swollen. The rectal bea is most severely affected. If the lining of the colon is damaged, it may cause telephone liney diarrhea.Where Crohns disease can affect almost any part of the digestive tract, Ulcerative colitis on ly affects the large intestine. Crohns disease can be treated by removing the affected parts and reconnecting the healthy ones. Whereas to treat ulcerative colitis, one may have to remove the large intestine in all (called colectomy). It can occur at highly irregular intervals, at times, with symptoms extremely severe, and sometimes, no symptoms at all.Ulcerative Colitis- An autoimmune conditionIn autoimmunity, an organism fails to recognize its amaze constituent parts as self, and thus operates to an immune retort against its own tissues and cells. Such diseases be termed as autoimmune diseases.In some another(prenominal) words, our bodys defense mechanism goes wrong and attacks its own healthy tissue. There atomic number 18 harmless bacteria present inside the colon, which are monstrous to be harmful by the defense mechanism, and are attacked, ahead(p) to inflammation.Classifying Ulcerative ColitisUlcerative ProctitisThis is Ulcerative colitis in its loonyest form. Th ere is inflammation only within the rectal area. The various signs and symptoms are as followsrectal painRectal bleedingThere is an urge to move the bowels but inability to do so.ProctosigmoiditisThis involves the lower end of the colon, that is, the sigmoid colon and the rectum. The signs and symptoms are as followsAbdominal painBloody diarrheaAbdominal cramps unalterable urge to go to the toiletLeft sided colitisThere in inflammation in the rectum, up on the left field side along the sigmoid colon and the descending colon. The signs and symptoms areAbdominal cramping on the left sideBloody diarrheaWeight lossPancolitis (Universal colitis)This involves and affects the wholly colon. The signs and symptoms areBloody diarrhea ( at that place may be severe bouts)Abdominal painAbdominal crampsWeight lossFatigueFulminant ColitisThis is the most rare form of colitis and it can be life threatening. It affects the whole colon. Patients erecting from fulminant colitis are at a unending attempt of toxic megacolon (the colon becomes swollen, or bloated, or distended) and colon rupture. The signs and symptoms are as follows bare diarrhea, that can lead to shock and dehydrationSevere painSYMPTOMS OF ULCERATIVE COLITISThe Gastrointestinal symptoms includeDiarrhea with kin and mucus. This implies the gradual onset of the disease which may persist for an extended period, perhaps weeks. If rectal examination is conducted, blood may be found. The patients also suffer from drastic weight loss. Due to the inflammation and extreme loss of blood from the gastrointestinal tract, anaemia may occur. There may be barmy abdominal pain, or painful bowel movements go with with painful abdominal cramping. mavin may even experience fatigue and loss of appetite.One may experience very mild or almost no symptoms, called remission, which may be followed by symptoms that are troublesome, called flare-ups or relapses. These may be triggered by stress. Flare-ups may be very troublesome , in which patients may have to empty their bowels about six times or more from apiece one day. Heartbeat may be fast or irregular, accompanied by shortness of breath and high fever.Severity of the disease small diseaseThis means less than four stools each day. Blood may be present or absent. Patient may experience mild cramping and abdominal pain. The patient may feel constipated, with a continuous intuitive feeling of needing to empty the bowel, with cramping or pain and little or almost no fecal output.Moderate diseaseThis means more than four stools each day. Patient also displays signs of anemia, fever around 100 to 102 degrees Fahrenheit.Severe indispositionThis means around six stools with blood each day, implying observable bowel movement, toxicity demonstrated in the form of fever, anaemia and tachycardia.Fulminant DiseaseThis means more than or equal to ten bowel movements each day, accompanied by continuous bleeding, abdominal tenderness, toxicity, colonic dilation and blood transfusion is oftentimes required. Patients may have toxic megacolon as the inflammation extends beyond the mucosal layer. At times, the serous membrane also gets mixed causing colonic perforation. If not treated, fulminant disease may lead to death.Extraintestinal SymptomsAs ulcerative colitis is an autoimmune disease, patients may develop symptoms as well as complications outside the colon. These includeUlcers in the mouth.Opthalmic stung and red eyes, or inflammation o iris called iritis.Musculoskeletal fruitless joints (arthritis). These may be large joints, or small joints of hands or feet. Or joints of the spine.Cutaneous Inflammation of the subcutaneous tissue.Painful and ulcerating lesion of the skin.A fault of the ends of the fingers (Clubbing).Inflammation of the bile ducts (Primary Sclerosing Cholangitis).Chapter 3 Causes of Ulcerative ColitisThe causes of Ulcerative Colitis are still not known. Yet, the possible causes are listed below geneticsThe disease ca n be inherited if one has a cobblers function relative hapless from the disease. Hence it can be found in the family. The regions of the genome that can be linked to this disease are the chromosome number 1, 3, 5, 6, 12, 14, 16, 19. Since no(prenominal) of these have been faulty continuously, it has led to a conclusion that the disease occurs delinquent(p) to a combination of various genes. One of the regions, for example, has been linked to ulcerative colitis is chromosome band 1p36.ENVIRONMENTAL FACTORSInflammation may be encouraged by diet. For example, if there is a large intake of vitamin b6 and unsaturated fat affect the development of ulcerative colitis. There are many other find dietary factors which may lead to the relapse or development of the disease, like meat protein and alcoholic beverages. Vitamin D deficiency is also a leading cause of the disease. Breastfeeding may also lead to the development of the disease.The role of sulfur in Ulcerative ColitisSulphur is found in many foods and substances like milk, eggs, cheese, mayonnaise. It is also used as a food preservative because it stabilizes protein structures. It also prevents microbial growth during fermentation of wine and beer.Bacteria that are present in the bowel convert the sulphur present in the food to enthalpy sulphide, which is called fermentation. This substance is harmful as it can cause abdominal pain and urgent and frequent bowel movements. Because of the already real inflammation of the bowel lining, patients suffering from ulcerative colitis find it uncorrectable to break down the gas as they produce more hydrogen sulphide than normal. This toxic substance, in high amounts, reduces the protective unction of the cells that are lining the bowel. It can also cause cell death and name ulceration in the superficial mucosa of the intestine. Hence the cells lining the colon are harmed.IMMUNE SYSTEMTheories suggest that a virus or a bacterium also may trigger ulcerative colitis as the digestive tract may become reddened when the immune system tries to get rid of the invading microorganism (pathogen). This inflammation is caused due to the release of white blood cells to destroy the present pathogen. This may lead to an autoimmune reaction/condition in which the body produces an immune reply even during the absence of the pathogen. This happens because the body tries to eliminate pathogens which are either gut friendly, or non-existent.RISK FACTORSThe factors that raise the risk of ontogeny Ulcerative colitis are as followsAge Though it may affect people at any and every age, it is more commonly found in people aged 15 to 30.Genetics If someone has a windup relative with the Crohns disease or ulcerative colitis, they are at a high risk of development of the disease.Isotretinoin The treatment of cystic acne is often done with the help of this medicine. It can cure other kinds of acne too, but it increases the risk of this disease. The medicine is also ca lled Accutane. Amnesteem, Sotret and Claravis (These are the various other brand names). appendectomy The removal of the appendix may lead to the reduction of the risk of developing ulcerative colitis but an increased risk of Crohns disease.Chapter 4 DIAGNOSISUlcerative colitis is diagnosed only when the possible signs and symptoms of infection, Crohns disease, excitable bowel syndrome (IBS) and colon cancer have been ruled out. The following tests are carried outBLOOD TESTSThey help to check anaemia, and also help to diagnose the name of the bowel disease the patient has.STOOL SAMPLEIf there are white blood cells present in the stool, it implies that the patient is suffering from an inflammatory disease, possibly ulcerative colitis. It also helps rule out other diseases, like those caused by bacteria, viruses and parasites. Clostridium difficile usually causes diarrhea but also common amongst people suffering from ulcerative colitis. Bowel infection can also be checked this way.C OLONOSCOPYThe entire colon can be viewed using a flexible, thin and lighted tube which has a camera attached to it. Small tissue samples are also taken (called biopsy) so that a laboratory analysis can be conducted and ulcerative colitis may be diagnosed.SIGMOIDOSCOPYThis test is done if the colon is inflamed severely. A thin, lighted and flexible tube is used to examine the last portion of the colon, the sigmoid. But the drawback of this procedure is that the problems occurring higher up the colon may be missed and a full picture of the affected colon is not achieved.BARIUM ENEMAThe entire large intestine can be examined using an X-Ray. A contrast solution of barium accompanied with some air is placed into the bowel with the help of an enema. Once the barium coats the entire lining of the colon, rectum and a part of the large intestine, it creates a silhouette. This is a dangerous test and hence rarely used because the pressure that is employ to inflate the colon and coat it may lead to its rupture.X-RAYAn roentgenogram of the abdominal area can be done to rule out the possibility of toxic megacolon and perforation as these conditions may appear because of the severe symptoms.CT SCANThis scan is carried out to check the extent of inflammation of the colon. The abdomen and pelvis are scanned if complications due to ulcerative colitis are ascertained or an inflamed small intestine that may be because of Crohns disease.VIDEO CAPSULE ENDOSCOPY (VCE)In this test, a patient swallows a condensing containing a camera which takes pictures of the intestine as it travels through it and sends them to a recording machine wirelessly. The pictures can then be reviewed.Chapter 5 TREATMENTThe treatment of ulcerative colitis is done on the basis of the severity of the disease. It mainly consists of changes in the diet and medication. If symptoms are found to be severe and long lasting, more medicines may be required or even surgery. But medicines cannot completely the dise ase. They can only minimize the risk of cancer, induce remissions and agree them and correct the quality of life.AMINOSALICYLATESThese are anti- inflammatory drugs that are used to induce and maintain remission. 5-aminosalicylic acid (5- ASA) produces the anti-inflammatory action. Examples of aminosalicylates are-MESALAZINE Also called Pentasa, Octasa and AsacolSULFASALAZINE This belongs to a class of antibiotics and it decomposed in the intestine to release 5-ASA.Since this substance is not entirely absorbed by the intestine, it gives a topical relief.CORTICOSTEROIDSThese are often used with 5-ASA drugs to induce remission of ulcerative colitis. These work by the blocking the parts where leukocyte adhesion cascade occurs to induce inflammation. These have many side effects like the puffiness on the face, called moon face, and manic behavior. It may also cause bipolar disorder, inducing periods of elevated mood and depression.Examples include Cortisone, Hydrocortisone, Prednisone. IMMUNOSUPPRESSIVE DRUGSThese inhibit the immune system. They stop cell division of white blood cells that occur as an immune response. Examples are Mercaptopurine, Methotrexate, Azathioprine.DIET MODIFICATIONFresh fruit, carbonated suck up and caffeine should be avoided by patients suffering from diarrhea and abdominal cramping. rough patients show lactose intolerance (they are not able to digest lactose) hence they cant consume lactose. To supplement the bone loss, atomic number 20 is given to them.The gastrointestinal and auto-immune symptoms can be helped by using the particularised Carbohydrate Diet that allows only the use of monosaccharides and not the other carbohydrates.At times due to metabolic defects, Hydrogen Peroxide may reconstruct up underneath the membrane that usually protects the walls of the intestine from the bacteria that are present. To protect ourselves from these oxidants, a need to take antioxidants arises. These include vitamins A, E, C, Selenium and ma nganese. herbal MEDICINEWhile Kampo is a medicine that is used in Japan, genus Boswellia is and Ayurvedic medicine that can be used as an alternative to other drugs.Medicinal cannabis can also be used as it helps reducing abdominal discomfort and abdominal irritability caused by ulcerative colitis.HELMINTHIC THERAPYSometimes, parasites may help in the reduction of the immune response of the intestine. Whipworm may be used for this purpose. Reduction of immune response may help in the complete elimination of ulcerative colitis.SURGERYColectomy is required to remove all or a part of the colon when it gets give and begins to spread the infection to other parts.It can be classified as followsTOTAL COLECTOMY The entire colon is removedPARTIAL COLECTOMY The entire colon is not removed, but only a part of it is.HEMICOLECTOMY Removal of the left or right part of the colonPROCTOCOLECTOMY Removal of the colon as well as the rectum.Once colectomy is performed, the remaining portions of the ga strointestinal tract are reattached in order to allow the waste to be eliminated from the body.