1 / 53

INFLAMMATORY BOWEL DISEASE IN CHILDREN

INFLAMMATORY BOWEL DISEASE IN CHILDREN. Abdulwahab Telmesani FRCPC, FAAP Associate Prof. of Pediatrics Umm Al-Qura University. INFLAMMATORY BOWEL DISEASE IN CHILDREN. CROHN’S DISEASE ULCERATIVE COLITIS INDETERMENANT (non specific) COLITIS. INFLAMMATORY BOWEL DISEASE IN CHILDREN.

elie
Télécharger la présentation

INFLAMMATORY BOWEL DISEASE IN CHILDREN

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. INFLAMMATORY BOWELDISEASE IN CHILDREN Abdulwahab Telmesani FRCPC, FAAP Associate Prof. of Pediatrics Umm Al-Qura University

  2. INFLAMMATORY BOWELDISEASE IN CHILDREN CROHN’S DISEASE ULCERATIVE COLITIS INDETERMENANT (non specific) COLITIS

  3. INFLAMMATORY BOWELDISEASE IN CHILDREN 1/3 of the incidence of IBD occurs in < 20 years of Age

  4. INFLAMMATORY BOWELDISEASE IN CHILDREN Highest in Scandinavian Western European North American Jews > Non Jews Urban > Rural Lowest in Asian African South American

  5. STRONG GENETIC PREDISPOSITION 10-25% in first degree relatives 7% in siblings Linkage with chromosome 16, 12, 14, 19, 6 & 1

  6. IBD IN SAUDI ARABIA Not Uncommon Adult > Children UC > CD Milder than the west

  7. PATHOPHYSILOLOGY Proinflammatory Cytokines & Eicosanoids Active inflammation Increase permeability & vasodilatation Symptoms & Signs Cont.#

  8. PATHOPHYSIOLOGY SYMPTOMS / SIGNS: Diarrhea Abdominal pain Protein Loss Bleeding Electrolyte Loss Stricture Formation

  9. EXPRESSION & DISTRIBUTION CROHN’S DISEASE 90% of patients have small bowel affected Classically terminal ileum 10-15% Only colon affected 60% Ileocolitis 20% have perirectal disease Cont.#

  10. EXPRESSION & DISTRIBUTION Trans mural inflammation Fistulas arise when inflammation extends through the serosa (Bladder, Vagina, Perineum) Granuloma is the Hallmark of Chron’s disease, found in 30% of all cases.

  11. EXPRESSION & DISTRIBUTION ULCERATIVE COLITIS 5% Proctitis 10-15% proctosigmoiditis 30-40% up to splenic flexure 50% pancolitis Almost always starts at the rectum Pathology limited to the mucosa Crypt abscesses, distorted architecture & goblet cell depletion, are typical

  12. PRESENTATION ULCERATIVE COLITIS Commonly Bloody mucoid diarrhea frequent loose stool lower abdominal pain more with defecation • Fulminant disease (10-15% of PT’s) • > 6 Bloody stools per day • Abdominal tenderness • Fever, tachycardia • Anemia HypoalbuminemiaCont.#

  13. PRESENTATION{CONTD} Constipation in proctitis Colonic carcinoma 1% by 10 years 1-2%per year thereafter Anorexia &Weight loss < Crohn’s Disease

  14. PRESENTATION • CROHN’S DISEASE • Abdominal pain ( awakens patient from sleep) • Site of disease dictates the nature & site of pain • Ileum RT quadrant pain • Gastroduodinal dyspeptic pain • Diarrhea & Rectal Bleeding may resemble U.C. • Cont.#

  15. PRESENTATION • Perianal disease(Fissures, fistulas & skin tags) • Intestinal obstruction is common • Abscesses (Interloop, intramesentric, • retroperitoneal, iliopsoas or subdiaphragmatic) • Carcinoma (Crohn’s Colitis)

  16. EXTRAINTESTINAL MANIFESTATIONS SYSTEMICLOCALISED Fever Eyes {C.D. > U.C. } Joints Malaise Skin Anorexia + wt loss Liver {C.D. 40% > U.C. 10%} Bone Delayed Growth & Kidneys Sexual Development Vascular {C.D. > U.C.} Hematological Heart

  17. EXTRAINTESTINAL MANIFESTATIONS EYE Uveitis, Episcleritis, Keratitis, RetinalVasculitis LIVER Sclerosing cholangitis U.C.>C.D. SKIN Erythema nodosum C.D.>U.C. Pyoderma gangrenosum U.C.> C.D.

  18. EXTRAINTESTINAL MANIFESTATIONS - JOINTS Arthralgia or Arthritis, Knees > Ankles > Hips> Wrists> Elbow Most common localised manifestations {ankylosing spondylitis, sacroilitis}U.C.>C.D. - BONE Demineralization {Steroid+Rest+Vit D def,Decreased Protein} - KIDNEYS Ca oxalate,Ca phosphate,Uric acid. Inflammation

  19. EXTRAINTESTINAL MANIFESTATIONS -VASCULAR Thrombocytosis Thrombophlebitis Activation of clotting cascade - HEMATOLOGICAL Anemia {B12 +Folic Acid def.} Effect of chemotherapy - HEART Perimyocarditis (good prognosis)

  20. DIAGNOSIS • Hx & P/E: • Stool Analysis + C/S • WBC N or slightly elevated • ESR Elevated 70 % • Thrombocytosis 60% • Albumin

  21. DIAGNOSIS Endoscopy Vs Radiology

  22. ENDOSCOPY Sigmoidoscopy Colonoscopy Ileum Upper endoscopy

  23. ULCERATIVE COLITIS Mucosa: Erythematus Granular Friable Loss of normal vascular

  24. CROHN’S Aphus Lesions Psudopolyps Patchy Distribution Bx normal mucosa

  25. RADIOLOGY -Upper G.I. Series Irrigular nodular and thickend bowel loops stenosis, ulcers & fistulas -Abdominal U/S & C.T. for complication of Crohn’s Disease

  26. TREATMENT AIM: Relief of symptoms Improve quality of life Improve growth

  27. TREATMENT Pharmacotherapy Nutrition Surgery

  28. TREATMENT Pharmacotherapy: 5- Aminosalicylate (P.O. Knema) Sulfasalzine

  29. TREATMENT Corticosteroids: Prednisone Budesonide

  30. TREATMENT Antibiotics: Metronidazol Ciprofloxacin

  31. TREATMENT Immunomodulators: 6- mercaptopurine Asathioprine Cyclosporine

  32. TREATMENT • Anti-tumer necrosis factor -Alpha • Infliximab • CDP571 • Thalidomide • Others

  33. TREATMENT • Clonidine (better than Sulfasulazine) • Na chromoglycate (No favorable effect)

  34. ANTIDIARRHEAL DRUGS Loperamide : Frequency of Diarrhea Contraindicated in sever colitis

More Related