Let's talk about inflammatory bowel disease.
Inflammatory bowel disease. This is a disease process that
causes inflammation of the bowel.
Inflammatory bowel disease. It is an autoimmune disease.
And the way I want you to learn this is if you know one by
default, you know the other because there are two that we're
going to learn. One is called ulcerative
colitis, the other one is called Crohn's.
Now, if you just look at the names ulcerative colitis and
Crohn's, 1 is clearly descriptive.
So if you know 1, you know the other by default.
What are some parameters that we're going to look at when it
comes to inflammatory bowel diseases between ulcerative
colitis and Crohn's? Well, the first thing we want to
look at is location. Where in the bowel is this
inflammatory process happening? Then we want to look at the type
of bowel movement, the type of bowel movement.
We want to know how to test for it.
How do you be able to confirm that this is in fact either
ulcerative colitis or Crohn's? Then the diet that's involved
and lastly, the treatment. So again, ulcerative colitis
versus Crohn's. Ultimately, if it's inflammatory
bowel disease, what are we worried about happening?
Well, we go back to the four eyes of structural compromise,
inflammation, infection, ischemia and infarct.
If any of these happen again, we're going to have structural
compromise of that portion of the bowel.
In this situation, it is in fact inflammation of the four eyes
that we're worried about because if it stays inflamed and we do
not take care of it, we're worried about perforation, which
will lead to peritonitis, which will lead to sepsis.
So again, that same concept that I talk about over and over
again, the four eyes in this one, it's the inflammation.
If that inflammation is happening in the bowel anywhere,
depending on if it's ulcerative colitis or Crohn's, wherever in
the bowel is happening, it will get weaker, it will get thin, it
will get structurally compromised and then boom, it
ruptures, it perforates. If it perforates, everything
leaks out causing that peritonitis.
If things leak out, that peritoneal signs of rigidity,
abdominal guarding, rebound tenderness, all these are going
to be there. But what we're worried about
happening is that this is going to turn into sepsis.
So again, parts of as graph concepts of the four eyes of
structural compromise. And lastly, the perforation,
peritonitis and sepsis. Again, all these all these
concepts that I've talked about are in your notes.
They're pretty much everywhere, anywhere you can think of in the
quick tips online, so on and so forth.
So let's start by differentiating the two.
Well, I mentioned that ulcerative colitis has a very
descriptive name, ulcerative and colitis, meaning I'm giving you
the location of where it's at. All sort of colitis I'm giving
you because the first thing I want to talk about is location.
So I'm giving you where it's located.
This is located in the colon, which means by default Crohn's
is anywhere from mouth to anus, from mouth to anus.
So again, ulcerative colitis, I'm telling you it's in the
colon. By default, Crohn's is anywhere
from the mouth to the anus. So any part of your GI tract,
I'm telling you this is an ulcerative process.
Well, think of ulcers. Do they bleed?
Yeah, they do. So if I have an ulcerative
colitis, that means I've got bloody diarrhea, which means
Crohn's by default is watery diarrhea, ulcerative.
I'm telling you they're ulcer, they're having ulcers in their
bowel, they're bleeding. So bloody diarrhea versus
Crohn's, which is just going to be watery diarrhea.
If a patient has ulcerative colitis, how are we going to
test for this? Well, going to the colon, a
colonoscopy with biopsy. We do this under general
anesthesia. So we do not let them drive
home. We must obtain informed consent.
So again, it's located in the colon.
Ulcerative colitis. All you need to do is a
colonoscopy with biopsy under general anesthesia.
Don't let them drive home. Get informed consent.
Whereas Crohn's is anywhere from the mouth to the anus.
Which means is a colonoscopy going to suffice?
No, because what if it's above the colon?
We do an endoscopy as well too. Endoscopy and colonoscopy with
biopsy, again, same thing under general general anesthesia.
Do not let the patient drive home.
Get informed consent. We talked about how fiber and
protein work on the bowel. Fiber makes the bowel move,
protein slows it down. Fiber makes the bowel move,
protein slows it down. In this situation, do we want
their bowel to keep going to having diarrhea?
No, we don't. We don't want that bowel going
fast and fast and fast and have and exacerbating that diarrhea
by giving them more fiber. So what we do is we decrease the
fiber or residue, same thing in their diet, but we increase the
protein to slow their bowel down, slow their bowel down.
The treatment here is going to be fairly simple.
If it is inflammatory, give them an anti-inflammatory things like
steroids. So if they are on steroids, and
this may be long term, if they're on long term
immunosuppressants, we've talked about this over and over again,
what are we worried about? We're worried about them going
to that live festival, make sure they're wearing a mask, make
sure they're getting their vaccine.
Because ultimately if they complain of that sore throat,
that UTI, that GI distress, it's not a normal infection because
they're immunosuppressed. So make sure that we educate,
educate, educate, perfect. Select all that apply a question
Ulcerative colitis and Crohn's disease.
Look at these two columns that I can make location, type of bowel
movement. The way I test for it, the diet,
the treatment. This is a perfect matrix grid
case study. A perfect matrix grid case
study. We're also going to give
sulfasalazine. Sulfasalazine is a sulfa drug.
So we are worried about photosensitivity with that
mnemonic SAT for a photo, SAT for a photo.
So again, inflammatory bowel disease, ulcerative colitis
versus Crohn's location, type of bowel movement, testing, diet
and treatment.