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TUMOURS OF THE SMALL INTESTINE Small bowel tumours are rare and in total account for less than 10% of gastrointestinal neoplasia.

Tuberculosis of the intestine Tuberculosis, like CD, can a ff ect any part of the gastrointestinal tract. The sites a ff ected most often are the ileum, proximal colon and peritoneum. There are two principal disease presentations. Ulcerative tuberculosis Ulcera...

VASCULAR ANOMALIES OF THE INTESTINE Mesenteric ischaemia Mesenteric vascular disease may be classified as acute intestinal ischaemia – with or without occlusion – venous, chronic arte rial, central or peripheral. The superior mesenteric vessels are the visceral...

Ye r s i n i a Yersinia enterocolitica is a Gram-negative rod that can infect the terminal ileum, appendix, ascending colon and mesenteric lymph nodes, and can cause a granulomatous inflammatory process that may mimic CD. Yersinia typically causes a fever and g...

A C U T E C O L I T I S Approximately 5% of patients present with acute severe (fulminant) colitis. Intensive medical treatment leads to remission in 70% but the remainder require urgent surgery . Toxic dilatation should be suspected in patients who develop ...

Acute severe colitis Patients with a mild attack usually respond to a course of oral prednisolone. A moderate attack often responds to oral prednisolone, twice-daily steroid enemas and 5-ASA. Failure to achieve remission as an outpatient is an indication for ...

Aetiology The aetiology of CD remains incompletely understood but is thought to involve a complex interplay of genetic and environ mental factors. Although CD shares some features with chronic infections, particularly tuberculosis, no causative organism has e...

Bacteriology A stool specimen should be sent for microbiological analysis when UC is suspected in order to exclude infective colitides, notably Campylobacter , which may be very di ffi cult to distin - guish from acute severe UC. Clostridium di ffi cile colitis ma...

CANCER RISK IN COLITIS The risk of cancer in ulcerative colitis increases with duration of disease. At 10 years from diagnosis, it is approximately 1%, increasing to 10–15% at 20 years and 20% at 30 years. Patients with pancolitis (defined as the presence of ...

CLASSIFICATION OF SEVERITY The assessment of the severity of colitis is determined by the - frequency of bowel action and the presence of systemic signs of illness, as originally proposed by Truelove and Witts: - /uni25CF Mild disease is characterised by ...

CLINICAL MANIFESTATIONS The clinical manifestations of IBD primarily depend on the diagnosis (either CD or UC), the location (small or large intestine, or both) and the extent of the disease. In the large bowel, the clinical presentation depends in large par...

CROHN’S DISEASE (REGIONAL ENTERITIS) Chronic inflammatory disease of the ileum, possibly first recognised by Morgagni in 1761 and described separately by Le´ sniowski and Dalziel in the early twentieth century , is known as Crohn’s disease after a key publicati...

Clinical features The clinical presentation depends on the pattern of disease. Occasionally , CD presents acutely with ileal inflammation and symptoms and signs resembling those of acute appendicitis or, much less commonly , free perforation of the small int...

Colonic Crohn’s disease Colonic involvement is found in 30% of patients with CD, frequently in association with perianal disease, and may coexist with small bowel pathology . Colonic CD presents with symptoms of colitis and proctitis as described for UC, alt...

Duodenal Crohn’s disease The duodenum is an uncommon site for CD and involvement is more commonly the result of inflammation in another part of the bowel as a bystander e ff ect (secondary). This can often be managed by resection of the source of the fistula ...

EXTRAINTESTINAL MANIFESTATIONS Arthritis occurs in around 15% of patients and is typically an asymmetrical large joint polyarthropathy , a ff ecting knees, ankles, elbows and wrists. Sacroiliitis and ankylosing spondy litis are 20 times more common in patients...

Endoscopic dilatation in Crohn’s disease Although penetrating disease will often require surgical resec tion, stricturing may be amenable to endoscopic treatment. This may be accomplished by enteroscopy or colonoscopy , depending on the site of the stricture....

Endoscopy Colonoscopic examination may be normal or show patchy eal inflammation. Characteristically , there are areas of normal mucosa in between areas of inflammation that are irregular and ulcerated, with a mucopurulent exudate. The earliest findings are oft...