Posts Tagged ‘Large Bowel’

Crohns Disease and Post Surgical Blockage

08.31.09

An intestinal obstruction is a partial or complete blockage of the small or large intestine. Surgery is sometimes necessary to relieve the obstruction. The small intestine is composed of three major sections: the duodenum just below the stomach; the jejunum, or middle portion; and the ileum, which empties into the large intestine.

The large intestine is composed of the colon, where stool is formed; and the rectum, which empties to the outside of the body through the anal canal. A blockage that occurs in the small intestine is called a small bowel obstruction, and one that occurs in the colon is a colonic obstruction.There are numerous conditions that may lead to an intestinal obstruction. The three most common causes of small bowel obstruction are adhesions, which are bands of scar tissue that form in the abdomen following injury or surgery; hernias, which develop when a portion of the intestine protrudes through a weak spot in the abdominal wall; and cancerous tumors.

Adhesions account for approximately 50% of all small bowel obstructions, hernias for 15%, and tumors for 15%. Other causes include volvulus, or formation of kinks or knots in the bowel; the presence of foreign bodies in the digestive tract; intussusception, which occurs when a portion of the intestine telescopes or pulls over another portion; infection; and congenital defects.

While most small bowel blockages can be treated with the administration of intravenous (IV) fluids and decompression of the bowel by the insertion of a nasogastric (NG) tube, surgical intervention is necessary in approximately 25% of patients with a partial obstruction, and 50%–65% of patients with a complete obstruction.An obstruction of the large intestine is less common than blockages of the small intestine.

Blockages of the large bowel are usually caused by colon cancer; volvulus; diverticulitis (inflammation of sac-like structures called diverticula that form in the intestines); ischemic colitis (inflammation of the colon resulting from insufficient blood flow); Crohns disease (a disease that causes chronic inflammation of the intestines); inflammation due to radiation therapy; and the presence of foreign bodies. As in the case of small bowel obstruction, most patients with a blockage of the large intestine can be treated with IV fluids and bowel decompression. To cut is not to cure. Every clinician involved in caring for patients with Crohns disease is facing this dilemma.

Although resection of stenotic or perforated intestinal segments is often unavoidable, surgical remission is only temporary in patients with Crohns disease. More than 70% of patients will have new lesions detected by endoscopy within a year, and 40% will be symptomatic within 4 years.1 Repeated bowel resections can result in short-bowel syndrome, and the quest for bowel-conserving strategies has introduced both endoscopic and surgical strictureplasty to clinical practice over the last 25 years.

Material and methods : We prospectively evaluated 128 patients with Crohns disease at the moment of diagnosis. We predicted the evolution of their disease using the mathematical model Z = -9.49 + 2.2643 (AD) – 0.0066 (DD) + 2.5282 (AM) + 1.3433 (OS). The cut-off value (reveiver operating characteristics curve) obtained in the training set of patients was P = 0.45. A value higher than this cut off discriminated patients who developed a stricturing pattern. The actual behaviour of the patients’ Crohns disease was observed after a median of 19 months from diagnosis. Of the 128 patients, 80 were classified into one of the two known patterns. Thirty-nine patients (48.8%) developed a stricturing pattern while 41 (51.2%) had a penetrating form of Crohns disease. Results : The sensitivity of the model for predicting a stricturing type was 100% and the specificity was 31.7%. A P value of < 0.45 proved to be highly reliable in predicting the evolution to a penetrating pattern (positive predictive value was 100% and negative predictive value was 58%). No statistical differences were found between stricturing-type or penetrating-type groups in terms of anal disease, abdominal mass, duration of disease or onset of symptoms.

Compared to patients with the penetrating form, initial ileal location was significantly more frequent than colonic location in patients with the stricturing type of Crohns disease.Conclusions : We have validated a simple mathematical model that is able to predict the behaviour of Crohns disease in patients based on clinical variables collected at their initial evaluation.

This model can be considered a useful tool for patient management. The anatomical location of the disease is related to the evolutive pattern.

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Colitis Ulcerosa

07.13.09

Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD). Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon.

The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine. Because of the name, IBD is often confused with irritable bowel syndrome (“IBS”), a troublesome, but much less serious condition. Ulcerative colitis has similarities to Crohns disease, another form of IBD.

Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.Ulcerative colitis is a rare disease, with an incidence of about one person per 10,000 in North America.

The disease tends to be more common in northern areas. Although ulcerative colitis has no known cause, there is a presumed genetic component to susceptibility. The disease may be triggered in a susceptible person by environmental factors. Although dietary modification may reduce the discomfort of a person with the disease, ulcerative colitis is not thought to be caused by dietary factors. Although ulcerative colitis is treated as though it were an autoimmune disease, there is no consensus that it is such.

Treatment is with anti-inflammatory drugs, immunosuppression (suppressing the immune system), and biological therapy targeting specific components of the immune response. Colectomy (partial or total removal of the large bowel through surgery) is occasionally necessary, and is considered to be a cure for the disease. Ulcerative colitis is a relatively uncommon, chronic, recurrent inflammatory disease of the colon or rectal mucosa. Often a lifelong illness, the condition has profound emotional and social impact on the affected individual. Ulcerative colitis is defined as continuous idiopathic inflammation of the colonic or rectal mucosa.

The rectum is involved in more than 95% of cases. Some authorities believe that the rectum is always involved in an untreated patient. Partial healing may occur in a patient treated with topical therapy, creating diagnostic confusion. Ulcerative colitis occurs more frequently in white people. The incidence of ulcerative colitis is reported to be 2-4 times higher in Jewish people. However, recent population studies in North America do not completely support this assertion. Ulcerative colitis seems to have a female preponderance. Ulcerative colitis affects 30% more females than males. The incidence of ulcerative colitis peaks in people aged 15-25 years and in people aged 55-65 years, although it can occur in people of any age.

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Colitis in Dogs

06.24.09

The term colitis in the dog and cat is very general.  It often refers to any one of a variety of afflictions of the intestinal tract with emphasis on the large intestine (large bowel).

Whenever veterinarians are confronted with a case of colitis in the dog or cat, a process of elimination is started in order to achieve a specific diagnosis for what type of colitis is present. In general, colitis is either acute (sudden onset) or chronic (long term and reoccurring).

The usual signs of colitis in  dogs and cats can cover a range of abnormalities from intermittent constipation to long term (chronic) diarrhea.  In general, because the bowel tissues are inflamed and irritated, the most common signs are frequent need to defecate and soft to watery stool.  Some dogs and cats with colitis pass liquid stool, often with blood, six to ten times a day.

Straining to defecate (called tenismus) while producing little or no stool, is another common sign.  These dogs and cats with colitis are very uncomfortable and often their appetite is suppressed due to a general state of ill health.  Along with the debilitating effects of passing frequent, loose stool (called diarrhea), many dogs and cats with colitis ( IBD, IBS, SBS ) will display a gradual weight loss.  Chronic colitis almost always creates a weight loss situation in dogs and cats due to the loss of vitamins, rapid transit of food through the entire gastrointestinal system, blood and fluid loss, and infectious agents entering the animal’s body through the damaged intestinal wall.


Common Causes of Colitis:
1. Parasitic – Whipworms reside in the upper colon (unlike hooks and rounds); protozoan parasites in some areas of the country are caused by Giardia, Trichomona, Amoeba and Balantida.
2. Foreign Body Colitis – We’ve all seen the dog that eats grass and straw.  This indigestible fiber really irritates the large bowel.  Any dog with pica (the compulsion to eat non food material) is a candidate for intermittent colitis.
3. Bacterial Colitis – Often is caused by Salmonella and Campylobacter.
4. Chronic Inflammatory Bowel Disease ( IBD )- This is an important group.  This disorder is due to an invasion of the wall of the large bowel by certain types of body cells.  Eosinophilic Colitis is a good example. Another common cellular infiltration into the wall of the large bowel is due to lymphocytes and plasmacytes. This is referred to by veterinarians as LPIBD… Lymphocytic-plasmacytic Inflammatory Bowel Disease and is thought to be due in great measure to allergic reactions within the bowel and even throughout the digestive tract.  The wall of the large intestine is invaded by the individual’s own inflammatory cells in response to some triggering antigen.  An allergen is any substance that incites an immune reaction.
5. Irritable Bowel Syndrome – Usually has a neurological or psychological origin.  It is seen often in the hyper-excitable dog that is stressed, overworked, or apprehensive.
6. Typhilitis – Inflammation of the cecum which is a dead-end pocket branching from the intestinal tract where the small and large intestine join.  (The medical term for this area is Ileoceco-colic junction.) This is located near where the human appendix would be, however  dogs and cats don’t have an appendix.
7. Cancer – The two most common types are lymphosarcoma and adenocarcinoma.

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Colitis and Crohns

06.07.09

Inflammatory bowel disease, or IBD, describes two similar yet distinct conditions called Crohns disease and ulcerative colitis. These diseases affect the digestive system and cause the intestinal tissue to become inflamed, form sores and bleed easily. Symptoms include abdominal pain, cramping, fatigue and diarrhea.Crohns disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Patches of inflammation occur, with healthy tissue between the diseased areas.

The inflammation can extend through every layer of affected bowel tissue. Crohns disease can not be cured by drugs or surgery, although either or both can help relieve symptoms.Ulcerative colitis affects only the inner layer of the colon, or large bowel. It always starts in the rectum and may extend as a continuous inflammation from there into the rest of the colon. Usually ulcerative colitis can be controlled with medication. The disease can be completely eliminated by surgically removing the colon, but afterward, waste material may have to be stored and expelled through an external appliance.

While ulcerative colitis causes inflammation only in the colon (colitis) and/or the rectum (proctitis), Crohns disease may cause inflammation in the colon, rectum, small intestine (jejunum and ileum), and, occasionally, even the stomach, mouth, and esophagus.The patterns of inflammation in Crohns disease are different from ulcerative colitis. Except in the most severe cases, the inflammation of ulcerative colitis tends to involve the superficial layers of the inner lining of the bowel. The inflammation also tends to be diffuse and uniform. (All of the lining in the affected segment of the intestine is inflamed.) Unlike ulcerative colitis, the inflammation of Crohns disease is concentrated in some areas more than others and involves layers of the bowel that are deeper than the superficial inner layers. Therefore, the affected segment(s) of bowel in Crohns disease often is studded with deeper ulcers with normal lining between these ulcers.

The most common disease that mimics the symptoms of Crohns disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.

Currently there is no cure for Crohns disease and remission may not be possible or prolonged if achieved; in cases where remission is possible, relapse can be prevented and symptoms controlled with medication, lifestyle changes and in some cases, surgery. Adequately controlled, Crohns disease may not significantly restrict daily living. Treatment for Crohns disease is only when symptoms are active and involve first treating the acute problem, then maintaining remission.

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