Download Ulcerative Colitis

PAIN ABDOMEN (INTESTINAL TB, CRHON’S DISEASE AND ULCERATIVE COLITIS)
INTESTINAL TUBERCULOSIS
History:
Pulmonary TB in patient or family, Taking cow’s milk (raw)
Unwell feeling – months, Diffuse pain abdomen. Weight loss
Alternating diarrhea / constipation
May present with repeated subacute Intestinal obstruction.
Stricture formation in the small intestine (ileum) is the pathological hallmark.
No fistula formation in small intestinal region. If fistula present, consider Crhon’s disease as first diagnosis.
Fistula may be found in Anorectal tuberculosis
Extraintestinal manifestation (arthritis, skin lesion etc) usually not there.
Diagnosis and Treatment
Illoscopy for tissue diagnosis.
Caseating granulomas – AFB may be present on Zeil – Nelson stain
Treatment minimum 6 months
Site of involvement
Pattern of
involvement
Diarrhea
Severe abdominal
pain
Perianal disease
Fistula
Endoscopic findings
Radiologic finding
Histologic features
Smoking
Serology
Predisposing Factors
Differentiating Features
Ulcerative Colitis
Crohn’s Disease
Only involves colon
Any area of the
gastrointestinal tract
Rectum always involved
Rectal sparing
Continuous
Skip lesions
Bloody
Rare
Usually nonbloody
Frequent
No
No
Erythematous and friable
Superficial ulceration
Tubular appearance
resulting from loss of
haustral folds
Mucosa only
Crypt abscesses
In 30% of patients
Yes
Aphthoid and deep ulcers
Cobblestoning
String sign of terminal ileum
RLQ mass, fistulas,
abscesses
Transmural
Crypt abscesses, granulomas
(~30%)
Worsens course
ASCA more common
Not clear but genetic
predisposition ++
Protective
pANCA more common
Not clear. Genetic
predisposition +
Intestinal Tuberculosis
Primarily ileum
Rectum may be involved
Regional segments
Diarrhea / Constipation
Pain usually dull and
moderate
Occasional
Rare in Anorectal area
Deep Ulcerating / Fibrotic
Stricture mostly ileum
and commonly sparing of
the rest of GIT
Transmural with regional
L.Nodes.
No effect
PCR for AFB
History of Pulmunary TB
and family Hx of TB ++
ASCA=anti-saccharomyces cerevisiae antibodies; pANCA= perinuclear antineutrophil cytoplasmic; RLQ=right lower quadrant.
Table – 36
Treatment Options
Disease Severity Ulcerative Colitis
Mild
Oral and topical
5-ASA compounds
Moderate
Severe
Oral and topical
5-ASA compounds
Oral steroids
Azathioprine, 6-MP
IV steroids
Cyclosporine
Azathioprine, 6-MP
Surgery
5-ASA=5-aminosalicylic acid; 6-PM=6-mercaptopurine
Crohn’s Disease
5-ASA compounds
Antibiotics
Elemental diet
5-ASA compounds
Antibiotics
Budesonide or
Oral steroids
Azathioprine, 6-MP
Methotrexate
Infliximab
IV steroids
Infliximab
Azathioprine, 6-MP
Surgery
Intestinal TB
Needs a minimum
of six months of
course with anti TB
medications