Inflammatory Bowel Disease

Karunia Valeriani J
 Definisi
• Immune mediated chronic intestinal condition

Types
• Ulcerative Colitis
• Crohn’s Disease
 Pathogenesis
• Jadi di dalam tubuh ada homeostasis antara
commensal microbiota, epithelial cells dan
immune cell
• Tp karena ada specific environmental (smoking,
antibiotic, entheropathogens) dan genetic factors
(susceptible host)  chronic dysregulated
inflammation
• Oleh IL1, IL6, TNF  fibrogenesis, collagen
production, activation of tissue
metalloproteinase, coagulation  chronic
inflammation
 Ulceratove Colitis (macroscopic)
• involves dari rectum ke colon
• 50% di rectum dan rectosigmoid
• Pada endoscopic terlihat “backwash ileitis”
• Banyak skip areas
• Mucosa erythematous dan fine granular surace 
seperti sandpaper
• Kalau udh parah bsa hemorrhagic, edematous,
ulcerated, dan ada psudopolyps (krna regenerasi
epithel)
• Pada pasien fulminant bisa develop megacolon dan
perforasi
 Ulcerative Colitis (microscopic)
• Distorted crypt architecture of colon (bifid
dan berkurang) , terkadang ada gap antara
cryps
• Basal plasma cells dan multiple basal
lymphoid aggregated
• Vascular congestion, edemam inflammatory
cell
• Villous atrophy, crypt regeneration, pathy
cryptitis
 Crohn’s Disease (macroscopic)
• Bisa affect dr mulut ke anus
• Rectum is almost spared disini
• Banyak skip area
• Perirectal fistula, fissures, abscesses, anal
stenosi
• Cobblestone appearance
Crohn’s Disease (microscopic features)
• Granuloma in all layers of bowell wall
• Banyak lymphoid aggregates
 Sign and symptoms of Ulcerative
Colitis
• Rectal bleding, tenesmus, passage of mucus,
crampy abdominal pain
• Melena
• Diarrheanya nocturnal/ postprandial
• Anorexia, nausea, vomitting, fever, weight loss
• PF: tender anal canal, blood saat RT , tender
pada palpasi colon
 Lab
• Anemia, CRP dan ESR meningkat, platelet
meningkat
• Fecal lactoferrin + (indikator inflamasi usus)
• Fecal calprotectin + (inflamasi histologi)
• Leukocytosis
 Radiography
• CT scan  not usefull , tp biasanya liat ada
penebalan
• Barium enema  fine mucosal granularity ,
deep ulcer (collar button) , loss of haustral
fold
• Endoscopy  erythema, absent of vascular
pattern, ulceration
 Crohn’s Disease (sign and symptoms)
• Ileocolitis
• Jejunoileitis
• Colitis dan perianal disease
• Gastroduodenal disease
 Lab, radiographic
• ESR dan CRP meningkat
• Endocopic  rectal sparring, fistula, skip
lession , string sign
• pANCA dan ASCA positif
 Ulcerative colitis Chron’s disease

Clinical

Gross blood in stool Yes Occasionally

Mucus Yes Occasionally
Systemic symptoms Occasionally Frequently
Pain Occasionally Frequently

Abdominal mass Rarely Yes

Significant perineal disease No Frequently

Fistula No Yes

Small intestinal obstruction No Frequently

Colonic obstruction Rarely Frequently

Respon to antibiotics No Yes
Recurrence after surgery No Yes

Endoscopic

Rectal sparring Rarely Frequently

Continuous disease Yes Occasionally
Cobblestone No Yes
Granuloma on biopsy No Occasionally
 Ulcerative Colitis Chron’s Disease
Radiographic
Small bowel with significant No Yes
abnormality
Abnormal terminal ileum No Yes
Segmental colitis No Yes
Asymmetrical colitis No Yes
Stricture Occasionally Frequently
TREATMENT
Protein Malnutrition
 Definition
• Marasmus  starvation related malnutrition
• Cachexia  chronic disease related
malnutrition
• Kwarshiorkor  acute disease / injury related
malnutrition
 Marasmus and cachexia Kwarshiorkor

Clinical setting Prolonged lacking of energy Acute lacking of energy and

and protein intake with or protein intake with substantial
without systemic systemic inflammation
inflammation

Time course to develop Months or years Weeks

Clinical features BMI rendah, reduced triceps Normal BMI , Easy hair pluck
kinfold, reduced micdarm ability, edema
muscle circmferenc

Lab findings Albumin normal, ataupun Hypoalbumin, TIBC menurun,

decreased (untuk cachexia) lymphocytes menurun, anergy

Clinical course Reasonably preserved Infections, poor wound

responsiveness to short term healing, decubius ulcers, skin
stress breakdown
Mortality risk Low High

Diagnostic criteria Triceps skinfold <3mm, Hypoalbumin, at least ada

midarm muscle circumference salah satu dari (poor wound
<15 cm healing, easy hair pluckability,
edema)