Search Results

FURTHER READING Baumgart DC, LeBerre C. Newer biologic and small-molecule therapies for inflammatory bowel disease. N Engl J Med 2021; 385 : 1302–15. Brown SR, Fearnhead NS, Faiz OD et al . The Association of Coloproctology of Great Britain and Ireland consensu...

I N V E S T I G A T I O N S Endoscopy and biopsy Rigid/flexible sigmoidoscopy can detect proctitis in the clinic; - the mucosa is hyperaemic, bleeds on touch and there may be a - Figure 75.4 Resection specimen from a patient with longstanding ulcerative colitis...

INDETERMINATE COLITIS Approximately one in 10 patients with colitis presents with histological features that make their disease di ffi cult to charac - terise. While the clinical history may suggest the diagnosis in some cases (for example, a history of recurre...

INFLAMMATORY BOWEL DISEASE

Ileal pouch–vaginal fistula Ileal pouch–vaginal fistula is most commonly due to an anastomotic complication; however, a delayed presentation may reflect an underlying diagnosis of CD rather than UC. Management depends on cause: biological therapy for CD, diverti...

Indications for surgery Surgery has a significant role in managing complications of IBD and in improving quality of life for patients with IBD. Current best practice ensures that surgeons and stoma therapists are an integral part of the multidisciplinary tea...

INTRODUCTION The term inflammatory bowel disease (IBD) is reserved for conditions characterised by the presence of idiopathic intes tinal inflammation. Conditions such as infective or ischaemic enteritis are covered in Chapters 6, 74 and 77 . Crohn’s disease (CD...

Investigations Laboratory A full blood count should be performed as anaemia is common, resulting from iron deficiency owing to blood loss, malabsorp tion or chronic disease. Vitamin B12 and folate deficiency may occur as a consequence of terminal ileal disease ...

Learning objectives To understand: The aetiology and pathology underlying in /f_l ammatory • bowel disease The distinguishing features of ulcerative colitis and • Crohn’s disease

Medical treatment Improved understanding of the complex cell signalling path ways that underlie aberrant immune responses in both UC and CD has radically changed treatment algorithms. The focus is now on both clinical and endoscopic remission end points with ...

Nutritional support It is essential that nutritional status is evaluated in all patients with IBD. Nutritional support is frequently required. Patients - with moderate nutritional impairment will require nutritional supplementation and severely malnourished pa...

Operative treatment Emergency In the emergency situation (or for a patient who is malnour - ished or on high-dose steroids), the safest procedure is subtotal colectomy and end-ileostomy . The rectosigmoid remnant may be left long and can either be brought out ...

Pathology The terminal ileum is the most commonly a ff ected segment of bowel in patients with CD, often occurring in combination with other areas of disease. More proximal small bowel is less frequently involved. Colitis alone occurs in up to one-third of ca...

Perianal Crohn’s disease Perianal CD is distressing and often debilitating for patients. The most common presentation is with a perianal abscess: perianal swelling, redness and pain, followed by discharge of pus or faecal drainage to perianal skin or vagina, r...

Radiology A plain abdominal film may indicate the severity of disease in the acute setting and is particularly valuable in demonstrating May o score named after the Mayo Clinic, R ochester MN, USA. been replaced by CT , although a contrast study will show a fe...

SURGERY Many general surgeons have relatively little experience in managing patients with IBD. High-volume centres have lower morbidity and mortality rates after colectomy for emergency surgery for IBD and after primary ileocaecal resection for CD. Specialist ...

TREATMENT E ff ective treatment of UC requires a multidisciplinary approach to management. Members of the IBD multidisciplinary team - typically include specialists in IBD gastroenterology , colorectal surgery , IBD nursing, stoma therapy , gastrointestinal a...

ANATOMY The vermiform appendix is present only in humans, certain anthropoid apes and the wombat. It is a blind muscular tube with mucosal, submucosal, muscular and serosal layers. Morphologically , it is the undeveloped distal end of the large caecum found i...