Inflammatory Bowel Disease (IBD)

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Transcript:-
Inflammatory bowel disease I B D is a condition that causes inflammation of the gastrointestinal tract affected Parts are inflamed and developed ulcers causing pain in the abdomen. Prevalence of I B D is high among Caucasians. Ulcerative colitis and Crohn's disease are the major forms of I B D. Other forms of I B D are collagenous colitis, lymphocytic colitis, ischemic colitis, diversion colitis, besets syndrome, infective colitis, indeterminate colitis.

The swallowed food travels through the esophagus and enters the stomach [00:01:00] where it is partially digested before entering the small intestine where it is further digested and nutrients are absorbed. The remaining nutrients are absorbed in the where stool is formed and stored before being excreted the walls of the.

A made up of mucosa, submucosa, muscu, external and cosa. Mucosa is the innermost layer and is further subdivided into epithelium, lamina, propri, muscu, MUC. Submucosa contains large bundles of collagen and is the strongest layer of the. Muscularis external consists of distinct inner circular and outer longitudinal layers whose antagonistic activities create waves of [00:02:00] peristalsis responsible for the movement of ingested material. CI is the external layer of connective tissue of variable thickness present over the mucus. When this connective tissue blends with surrounding tissue, it is termed as a adventitia.

Gastrointestinal tract contains both cirrhosis and a adventitia. The mucosal immune system of the large intestine is continuously exposed to a wide array of antigens from ingested food and the billions of bacteria that live there. When pathogenic bacteria penetrate the intestinal epithelium, it stimulates an immune response. The bacteria that is recognized as antigen is engulfed by the antigen presenting dendritic cells, DC one, dendritic cell one, [00:03:00] and DC two dendritic cell two, which degrade them and display the fragments of antigen on their surface. DC one and DC two react with pret helper cells to form an immunological synapse individually.

The dendritic cell one pret helper cell complex secrete interleukin 12, which stimulate T helper one cells, which in turn release the cytokine TNF alpha and interferon ga. These cytokines stimulate macrophage to destroy the antigen and invite the leukocytes to the site of infection to produce inflammation.

The DC two and Pret helper cell complex release interleukin four, which stimulate the release of T [00:04:00] helper two cells, which in turn release interleukin. Five, 10, and 13 that activate the B cells. Activation of B cells results in antibody mediated immunity. Immunoglobulin E IgE is a type of antibody produced to clear the foreign bodies, bacteria, and toxic substances.

It binds to the antigen and then to the receptors of the mast cells. Triggering the release of histamine, heparin, cytokines, and leukotriene. This process brings about the destruction of pathogen simultaneously leading to inflammation at the site of infection. Inflammation occurs when specific molecules of the pathogen called the.

Pathogen associated molecular patterns [00:05:00] bind to the toll like receptors on mast cells. The mast cells undergo exocytosis, which release granules filled with mediators. These mediators may recruit all the WBCs such as macrophages, neutrophils, dendritic cells, B N T cells, natural killer cells. And eosinophils, or they may trigger the release of inflammatory mediators such as TNF alpha or histamine from the mast cells, reactive oxygen species from the macrophage and neutrophils, interleukin one from monocytes and macrophage. Inflammasome from macrophage and neutrophils activated by the bacteria and prostaglandin.

Inflammation causes redness, swelling, and [00:06:00] pain at the site of action. Inhibition of the response is brought about by feedback regulation. An increased amount of interleukin inhibits the dendritic cells in turn, inhibiting the production of interleukin four interferon gamma turns off the response of T helper one.

Thereby stopping further reaction other negative feedbacks. Interleukin four kills the precursors of dendritic cell two by apoptosis, thus inhibiting the T Helper two. Path and further production of interleukin four. Interferon Gamma may eventually turn off the T helper one response that produced it.

Ulcerative colitis, you see one of the major forms of I B D is a [00:07:00] condition with remitting and relapsing inflammation of the rectum and colon. It may affect only part of the colon or the entire colon and rectum. It generally affects the mucosa, but in severe cases, submucosa can also be affected.

Ulcerative colitis usually affects men and women between 15 to 30 years of age and rarely affects people between 50 to 70 years. Etiology of chronic gut inflammation and ulceration in ulcerative colitis is due to dysfunctional immune response to the normal gut. Flo. This leads to sustained overproduction of T helper cell one derived cytokines such as TNF alpha, interferon gamma, and alpha beta lympho toin.

These cytokines activate the resident macrophage in turn activating cell [00:08:00] ion molecules, which recruit neutrophils and monocytes that release copious amounts of tnf. Interleukin eight reactive oxygen and nitrogen species and metal of proteinases. This process leads to an imbalance of cytokine production within the intestinal interstitial, causing constant inflammation of crypts, of licon and abscesses, which make the colon empty frequently causing diarrhea.

The constant inflammation damages the cells of the mucosa causing ulcers, which bleed and produce, pus and mucus. The ulcerated areas are soon covered by granulation tissue, the undermining of mucosa and the excesses of granulation tissue form polypoidal mucosal cre, known as inflammatory polyps or pseudo [00:09:00] polyps.

Symptoms of ulcerative colitis may be mild to severe depending on the part of the colon affected. Major symptoms include abdominal cramps and pain, bloody diarrhea, severe urgency for bowel movement, fever, loss of appetite, weight loss, and anemia. Ulcerative colitis may result in complications such as perforations of the colon, colon cancer, hemorrhage, narrowing of the colon, inflammation of the joints, ankylosing spondylitis, sores, or lesions in the eye, mouth ulcers, liver problem, retarded growth and development in children and pyoderma gangrenosum.

Crohn's disease is another form of I B D that can affect a part or the entire gastrointestinal tract. [00:10:00] The pathophysiology of Crohn's disease is similar to that of ulcerative colitis here. The entire thickness of the tract wall is inflamed and ulcerated. Symptoms of Crohn's disease are diarrhea, abdominal pain, and rectal bleeding, which if persistent lead to anem.

Loss of appetite, weight loss, low grade fever, and slowed growth. In some children, Crohn's disease may result in complications such as obstructions or blockage of the bowel, sores, or blisters fistulas in areas such as bladder, vagina, and skin, nutritional deficiencies due to mal absor. Inflammation of the joints.

Erythema, naum, pyoderma, gangrenosum sores or lesions in the eye. Retarded growth and development in children. Massive dilatation [00:11:00] and perforation of the colon are potentially life-threatening complications. The exact cause of I B D is not known. Immune reactions for the ongoing infection by bacteria and virus can lead to inflammation.

Severe inflammation causes ulcers at the intestinal war. Dysfunctional or hyperactive immune system is another cause for the condit. It is also found that heredity may be one of the factors influencing the development of I B D. Barium Enema is used to diagnose and evaluate the extent of inflammatory bowel diseases in the procedure barium.

A radio opaque contrast medium is infused into the intestines through the rectum. A small inflated balloon at the tip of the NMR tube helps to keep the barium inside. The intestine is observed over an X-ray fluoroscope screen, and x-rays are taken at [00:12:00] intervals which show typical bowel contour appearances for ulcerative colitis and Crohn's disease.

Sigmoidoscopy and colonoscopy are endoscopic procedures. Both procedures involve insertion of a flexible fiber optic tube with a camera called an endoscope through the rectum To view the lining of the colon, the physician may also remove tissue samples for biopsy. Flexible sigmoidoscopy is done for detecting abnormalities in the lower third of the colon and is ideal for detecting ulcerative colitis.

Colonoscopy is done to examine the entire colon. And is used for diagnosing Crohn's disease. Barium enema is used to diagnose and evaluate the extent of inflammatory bowel disease in the procedure barium. A radio opaque contrast medium is infused into the intestines through the rectum. [00:13:00] A small inflated balloon at the tip of the NMR tube helps to keep the barium.

The intestine is observed over an X-ray fluoroscope screen, and x-rays are taken at intervals which show typical bowel contour appearances for ulcerative colitis and Crohn's disease. Sigmoidoscopy and colonoscopy are endoscopic procedures. Both procedures involve insertion of a flexible fiber optic tube with a camera called an endoscope through the rectum To view the lining of the colon, the physician may also remove tissue samples for biopsy.

Flexible sigmoidoscopy is done for detecting abnormalities in the lower third of the colon and is ideal for detecting ulcerative colitis. Colonoscopy is done to examine the entire colon and is used for diagnosing Crohn's disease. Treatment for I B [00:14:00] D involves anti-inflammatory drugs such as Sulfasalazine and other five aminos salicylic acid.

Five ASA containing. Such as sine mesalamine, bide aminosalicylates are important. Free radical scavengers, which can reduce leuko tryin production, and inhibit the cellular release of interleukin one lowering inflammatory response. They maintain remission by preventing recruitment of leukocytes into the bowel war.

Chemotactic response to leukotriene before reducing the synthesis of platelet activating factors and also inhibiting leukocyte edition molecule. Upregulation steroids are also administered for I B D. They may have [00:15:00] long-term adverse effects and are usually used in an acute. They are potent inhibitors of T-cell activation, immune system suppressors such as azathioprine six, mercaptopurine six n p, cyclosporine, and methotrexate may also be prescribed.

They are immunoglobulins that act by neutralizing the T N F. Since ulcerative colitis affects only the large intestine, removal of the entire large intestine can cure the disease. An ileostomy is done after removing the intestine. The surgery may also be done laparoscopically. Crohn's disease cannot be cured by surgery, but it is sometimes necessary for patients who do not respond to medication.

Surgery is often [00:16:00] performed to cure perforations, blockages, or intestinal bleeding. The disease often recurs after surgery. A balanced diet with adequate calories is important. Eat small meals throughout the day. Avoid food, high insult and fat. Try to identify foods that trigger the symptoms and avoid them. Proper treatment. Medical care helps to live a productive and normal life.