Posts Tagged ‘Large Intestine’

Ulcerated Colitis

06.05.10

Ulcerative colitis is a chronic disease in which the large intestine becomes inflamed and ulcerated (pitted or eroded), leading to flare-ups (bouts or attacks) of bloody diarrhea, abdominal cramps, and fever. The long-term risk of colon cancer is increased. Ulcerative colitis may start at any age but usually begins between the ages of 15 and 30.

A small group of people have their first attack between the ages of 50 and 70.Ulcerative colitis usually does not affect the full thickness of the wall of the large intestine and hardly ever affects the small intestine. The disease usually begins in the rectum or the rectum and the sigmoid colon (the lower end of the large intestine) but may eventually spread along part or all of the large intestine.

Ulcerative proctitis, which is confined to the rectum, is a very common and relatively benign form of ulcerative colitis. In some people, most of the large intestine is affected early on.

The cause of ulcerative colitis is not known for certain, but heredity and an overactive immune response in the intestine seem to be contributing factors. Cigarette smoking, which is detrimental in Crohns disease, seems to decrease the risk of ulcerative colitis.

However, smoking in order to reduce the risk of ulcerative colitis is ill-advised in light of the many health problems that smoking can cause. 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.

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Ischemic Colitis

03.13.10

Ischemic Colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia.

Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed via endoscopy.

Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill.Patients with mild to moderate ischemic colitis are usually treated with IV fluids, analgesia, and bowel rest (that is, no food or water by mouth) until the symptoms resolve.

Those with severe ischemia who develop complications such as sepsis, intestinal gangrene, or bowel perforation may require more aggressive interventions such as surgery and intensive care. Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a stricture or chronic colitis.

Ischemic colitis is injury of the large intestine that results from an interruption of its blood supply.
•    Abdominal pain and bloody stools are common.
•    Colonoscopy is usually done.
•    Most people get better with fluids given intravenously and nothing to eat, but a few require surgery.

Ischemic colitis results from a temporary blockage of blood flow through arteries that supply the large intestine. Often doctors cannot find a cause for the reduced blood flow, but it is more common among people with heart and blood vessel disease, people who have had surgery on their aorta, or people who have problems with increased blood clotting.

Ischemic colitis affects primarily people who are 60 or older.Blockage of blood flow damages the inside lining and inner layers of the wall of the large intestine, causing ulcers (sores) in the lining of the large intestine, which can bleed. Usually, the person experiences abdominal pain. The pain is felt more often on the left side, but it can occur anywhere in the abdomen.

The person frequently passes loose stools that are often accompanied by dark red clots. Sometimes bright red blood is passed without stool. Low-grade fevers (usually below 100° F [37.7° C]) are common.A doctor may suspect ischemic colitis on the basis of the symptoms of pain and bleeding, especially in a person older than 60. People with ischemic colitis are hospitalized.

Initially, the person is given neither fluids nor food by mouth so that the intestine can rest. Instead, fluids, electrolytes, and nutrients are given intravenously. Antibiotics are often given to prevent infection that might follow the inflammation.

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Early Stage Symptoms of Crohns

02.06.10

The most common early symptoms of Crohns disease are chronic diarrhea (which sometimes is bloody), crampy abdominal pain, fever, loss of appetite, and weight loss. Symptoms may continue for days or weeks and may resolve without treatment.

Complete and permanent recovery after a single attack is extremely rare. Crohns disease almost always flares up at irregular intervals throughout a person’s life. Flare-ups can be mild or severe, brief or prolonged. Severe flare-ups can lead to intense pain, dehydration, and blood loss. Why the symptoms come and go and what triggers new flare-ups or determines their severity is not known. Recurrent inflammation tends to appear in the same area of the intestine, but it may spread to adjacent areas after a diseased segment has been removed surgically.

Common complications of inflammation include scarring that can produce intestinal blockage (obstruction) and deep ulcers penetrating through the bowel wall that can create pus-filled pockets of infection (abscesses) or abnormal connecting channels between the intestine and other organs (fistulas). Fistulas may connect two different parts of the intestine. Fistulas also may connect the intestine and bladder or the intestine and the skin surface, especially around the anus.

Although fistulas from the small intestine are common, wide-open holes (perforations) are rare. When the large intestine is affected extensively by Crohns disease, rectal bleeding commonly occurs. After many years, the risk of colon cancer (cancer of the large intestine) is greatly increased. About one third of people who develop Crohns disease have problems around the anus, especially fistulas and cracks (fissures) in the lining of the mucus membrane of the anus.

Crohns disease may lead to complications in other parts of the body. These complications include gallstones, inadequate absorption of nutrients, urinary tract infections, kidney stones, and deposits of the protein amyloid in several organs (amyloidosis). When Crohns disease causes a flare-up of gastrointestinal symptoms, the person may also experience inflammation of the joints (arthritis), inflammation of the whites of the eyes (episcleritis), mouth sores (aphthous stomatitis), inflamed skin nodules on the arms and legs (erythema nodosum), and blue-red skin sores containing pus (pyoderma gangrenosum). Even when Crohns disease is not causing a flare-up of gastrointestinal symptoms, the person still may experience pyoderma gangrenosum, while inflammation of the spine (ankylosing spondylitis), inflammation of the pelvic joints (sacroiliitis), inflammation inside the eye (uveitis), or inflammation of the bile ducts (primary sclerosing cholangitis) are liable to occur entirely without relation to the clinical activity of the bowel disease.

In children, gastrointestinal symptoms such as abdominal pain and diarrhea often are not the main symptoms and may not appear at all. Instead, the main symptoms may be slow growth, joint inflammation, fever, or weakness and fatigue resulting from anemia.

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Crohns Disease Surgery

01.17.10

Crohns disease can cause a variety of symptoms of gastrointestinal distress.

The three classic (though not specific) symptoms of inflammatory bowel disease are:
•    Persistent or recurrent diarrhea (possibly with blood, mucus, or pus)
•    Abdominal pain
•    Fever

There also may be signs and symptoms unrelated to the gastrointestinal tract. A doctor will obtain a complete medical history and perform a thorough physical examination, along with laboratory and diagnostic tests, to diagnose Crohns disease. The examination and other tests are necessary to rule out a number of transient conditions, such as viral, bacterial, or parasitic infection, that cause symptoms similar to Crohns disease.

Diarrhea
In cases of Crohns disease, patients often experience frequent loose or watery bowel movements. The stool is occasionally accompanied by thick, dark blood (not bright red smears of blood, which usually result from a bleeding hemorrhoid). There is less mucus or pus in the stool than in cases of ulcerative colitis.

Pain
Patients may experience crampy, achy, or even sharp pain in the affected area. Most often, patients with Crohns disease feel pain on the lower right side of the abdomen (lower right quadrant) and just below the bellybutton. This is because the majority of cases of Crohns disease involve disease in the terminal ileum, where the small intestine meets the large intestine. The terminal ileum crosses from left to right just above the beltline, and joins the large intestine in the lower right quadrant. The type of pain associated with Crohns disease depends on what part of the GI tract is affected. Disease in the terminal ileum generally causes sharp pain, while disease in the colon causes more crampy pain, similar to that that of ulcerative colitis. Pain is sometimes relieved (temporarily) after a bowel movement.

Fever
Crohn’s is an inflammatory disease, and one of the key characteristics of the inflammatory process is fever. (The others are pain, swelling, and redness.) Some individuals with Crohns disease suffer a high fever, especially during the acute phase of a flare-up. Others run a persistent, low-grade fever. Fever may be accompanied by irritability and fatigue. Sometimes, the fever recurs each day, especially late in the day, then repeatedly breaks during sleep, causing night sweats.

Signs and Symptoms Unrelated To The GI Tract
A number of signs and symptoms that do not involve the gastrointestinal tract can occur with Crohns disease. These may occur at the same time as the intestinal symptoms, or may be experienced weeks or even months before any intestinal symptoms are noticed. If your doctor suspects inflammatory bowel disease, he or she will ask you detailed questions about whether or not these extra-intestinal symptoms have appeared:
•    Reddening and inflammation of the eye (iritis)
•    Joint pain (usually in the large joints of the knees, ankles, elbows, wrists, and shoulders), which sometimes migrates from one joint to another (migrating arthralgia)
•    Skin lesions, including tender red nodules on the shins or calves (erythema nodosum)
•    Sores inside the mouth (aphthous ulcers)

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Crohns Disease in Children

10.31.09

In the last quarter century, it has become clear that Crohns disease and ulcerative colitis affect large numbers of children and young teens. Nutritional deficiency is a major issue in treatment of children with Crohns disease. Children are growing machines.

Inflammatory bowel disease may not cause great weight loss for youngsters at first, so failure to grow normally or backsliding on height and weight charts should be taken as signs that something is wrong and worth investigating. Children facing Crohns disease also have significant self-image issues to deal with.

The disease changes their routines, and its effects may separate them from the normal activities of childhood and adolescence. Therefore, these youngsters need sensitive support from family, friends, and physicians to help them maintain their social, as well as their physical, growth. Crohns disease is a serious, chronic disease affecting the digestive system. Chronic means that the disease is long-term and persistent, usually lifelong. Crohns disease causes inflammation, most often in the small intestine (which has three parts: duodenum, jejunum, and ileum).

The walls and lining of the affected areas become red and inflamed, leading to ulcers and bleeding. Crohns disease sometimes is named by referring to inflammation in the part of the intestine affected, such as jejunoileitis, ileitis, ileocolitis, or colitis (when it involves the large intestine, also called the colon).

Crohns disease can appear at any age, but it is most often diagnosed in adults in their 20s and 30s. However, approximately 30% of people with Crohns disease develop symptoms before 20 years of age. In the United States, about 100,000 teens and preteens have Crohns disease.Along with ulcerative colitis, a similar illness, Crohns disease is also called inflammatory bowel disease, or IBD.

Ulcerative colitis attacks only the large intestine in a continuous manner and does not affect the entire thickness of the bowel wall. Crohns disease, on the other hand, can occur anywhere in the digestive tract, from mouth to the anus, attacks different sites in the intestine with areas of normal intestine in between (“skip lesions”), and affects the full thickness of the intestinal wall.

Both conditions wax and wane: there are times when symptoms reappear or get worse (exacerbations or “flares”) and other periods when symptoms get better or go away altogether (“remission”).While Crohns disease causes many problems for people of all ages, it can present special challenges for children and teens. In addition to bothersome and often painful symptoms, the disease can stunt growth, delay puberty, and weaken the bones. Crohns disease symptoms may sometimes prevent a child from participating in enjoyable activities.

The emotional and psychological issues of living with chronic disease can be especially difficult for young people. As many as 70% of children with the disease have inflammation of the lower part of the ileum. More than half of these children also have inflammation in variable segments of the colon.

•    About 10%-20% of children have inflammation in the colon only.
•    Another 10%-15% have inflammation scattered around the small bowel, mainly in the middle section (jejunum and upper ileum).
•    A very small number have inflammation only in the stomach and the uppermost section of the small intestine where the stomach empties into the bowel (duodenum).

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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 Treatment

07.07.09

Because the symptoms and progress of ulcerative colitis vary from person to person, treatments must be tailored to individuals. In most cases, however, drug therapy is the first line of treatment for ulcerative colitis.Drug therapy helps treat the symptoms of ulcerative colitis and prevent them from coming back. The four main categories of medication for ulcerative colitis all work by reducing inflammation. The drug categories are aminosalicylates, corticosteroids, immunomodulators and biologic therapies.

Aminosalicylates are called “5-ASA” drugs because they contain 5-aminosalicylic acid, which helps control inflammation. These drugs usually are the first treatment for people with mild or moderate colitis. Most are taken orally, though if inflammation is located low in the large intestine, they can be delivered in enemas or suppositories.

Azulfidine (sulfasalazine): a combination of 5-ASA and the sulfa drug sulfapyridine, sulfasalazine was the first aminosalicylate used widely to treat colitis. In this combination, the sulfapyridine prevents 5-ASA from being absorbed until it reaches the large intestine. But the sulfa drug can cause unpleasant side effects. Newer 5-ASA drugs, while they still have side effects, are easier for some people to tolerate. Also called steroids, these medications can relieve symptoms quickly, but they usually are not effective in preventing symptoms from returning. They also can have serious side effects. As a result, corticosteroids usually are used for short periods of time only. People with ulcerative colitis gradually taper off corticosteroids since an abrupt stop can bring on symptoms. The drugs can be taken orally, delivered in enemas, suppositories and foams, or given intravenously.

Immunomodulators reduce inflammation by suppressing the immune system. Immunomodulators are usually prescribed for people who:
•    Do not respond to other medications
•    Have become dependent on corticosteroids
•    Have active, severe cases of the disease

Because these drugs are “strong,” people must be monitored carefully for complications, including pancreatitis, hepatitis, reduced white blood cell count and infection. The drugs are taken orally, and it may take up to six months before they are fully effective.

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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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