1
00:00:00,440 --> 00:00:04,960
Let's talk about inflammatory 
bowel disease. 

2
00:00:04,960 --> 00:00:11,080
Inflammatory bowel disease. 
This is a disease process that 

3
00:00:11,080 --> 00:00:13,160
causes inflammation of the 
bowel. 

4
00:00:14,480 --> 00:00:20,120
Inflammatory bowel disease. 
It is an autoimmune disease. 

5
00:00:20,920 --> 00:00:28,160
And the way I want you to learn 
this is if you know one by 

6
00:00:28,160 --> 00:00:31,280
default, you know the other 
because there are two that we're

7
00:00:31,280 --> 00:00:35,400
going to learn. 
One is called ulcerative 

8
00:00:35,400 --> 00:00:38,960
colitis, the other one is called
Crohn's. 

9
00:00:40,000 --> 00:00:46,640
Now, if you just look at the 
names ulcerative colitis and 

10
00:00:46,640 --> 00:00:51,120
Crohn's, 1 is clearly 
descriptive. 

11
00:00:53,440 --> 00:00:58,600
So if you know 1, you know the 
other by default. 

12
00:00:59,080 --> 00:01:03,400
What are some parameters that 
we're going to look at when it 

13
00:01:03,400 --> 00:01:07,600
comes to inflammatory bowel 
diseases between ulcerative 

14
00:01:07,600 --> 00:01:10,560
colitis and Crohn's? 
Well, the first thing we want to

15
00:01:10,560 --> 00:01:15,520
look at is location. 
Where in the bowel is this 

16
00:01:15,520 --> 00:01:21,520
inflammatory process happening? 
Then we want to look at the type

17
00:01:21,560 --> 00:01:25,560
of bowel movement, the type of 
bowel movement. 

18
00:01:28,800 --> 00:01:30,640
We want to know how to test for 
it. 

19
00:01:31,840 --> 00:01:37,040
How do you be able to confirm 
that this is in fact either 

20
00:01:37,040 --> 00:01:44,600
ulcerative colitis or Crohn's? 
Then the diet that's involved 

21
00:01:47,480 --> 00:01:55,480
and lastly, the treatment. 
So again, ulcerative colitis 

22
00:01:56,960 --> 00:02:01,960
versus Crohn's. 
Ultimately, if it's inflammatory

23
00:02:01,960 --> 00:02:05,560
bowel disease, what are we 
worried about happening? 

24
00:02:05,960 --> 00:02:09,360
Well, we go back to the four 
eyes of structural compromise, 

25
00:02:10,680 --> 00:02:15,520
inflammation, infection, 
ischemia and infarct. 

26
00:02:17,480 --> 00:02:20,640
If any of these happen again, 
we're going to have structural 

27
00:02:20,640 --> 00:02:22,560
compromise of that portion of 
the bowel. 

28
00:02:22,560 --> 00:02:26,880
In this situation, it is in fact
inflammation of the four eyes 

29
00:02:27,160 --> 00:02:32,720
that we're worried about because
if it stays inflamed and we do 

30
00:02:32,720 --> 00:02:39,520
not take care of it, we're 
worried about perforation, which

31
00:02:39,520 --> 00:02:43,240
will lead to peritonitis, which 
will lead to sepsis. 

32
00:02:43,240 --> 00:02:46,600
So again, that same concept that
I talk about over and over 

33
00:02:46,600 --> 00:02:48,880
again, the four eyes in this 
one, it's the inflammation. 

34
00:02:49,440 --> 00:02:52,280
If that inflammation is 
happening in the bowel anywhere,

35
00:02:52,280 --> 00:02:55,840
depending on if it's ulcerative 
colitis or Crohn's, wherever in 

36
00:02:55,840 --> 00:03:00,720
the bowel is happening, it will 
get weaker, it will get thin, it

37
00:03:00,720 --> 00:03:04,680
will get structurally 
compromised and then boom, it 

38
00:03:04,680 --> 00:03:08,920
ruptures, it perforates. 
If it perforates, everything 

39
00:03:08,920 --> 00:03:11,400
leaks out causing that 
peritonitis. 

40
00:03:12,000 --> 00:03:16,240
If things leak out, that 
peritoneal signs of rigidity, 

41
00:03:16,560 --> 00:03:20,760
abdominal guarding, rebound 
tenderness, all these are going 

42
00:03:20,760 --> 00:03:23,320
to be there. 
But what we're worried about 

43
00:03:23,320 --> 00:03:26,840
happening is that this is going 
to turn into sepsis. 

44
00:03:28,680 --> 00:03:33,200
So again, parts of as graph 
concepts of the four eyes of 

45
00:03:33,200 --> 00:03:37,520
structural compromise. 
And lastly, the perforation, 

46
00:03:37,560 --> 00:03:41,320
peritonitis and sepsis. 
Again, all these all these 

47
00:03:41,320 --> 00:03:44,720
concepts that I've talked about 
are in your notes. 

48
00:03:45,600 --> 00:03:50,280
They're pretty much everywhere, 
anywhere you can think of in the

49
00:03:50,280 --> 00:03:53,280
quick tips online, so on and so 
forth. 

50
00:03:55,120 --> 00:03:57,520
So let's start by 
differentiating the two. 

51
00:03:59,120 --> 00:04:04,640
Well, I mentioned that 
ulcerative colitis has a very 

52
00:04:04,640 --> 00:04:11,480
descriptive name, ulcerative and
colitis, meaning I'm giving you 

53
00:04:11,480 --> 00:04:17,399
the location of where it's at. 
All sort of colitis I'm giving 

54
00:04:17,399 --> 00:04:19,519
you because the first thing I 
want to talk about is location. 

55
00:04:19,800 --> 00:04:22,440
So I'm giving you where it's 
located. 

56
00:04:22,440 --> 00:04:27,800
This is located in the colon, 
which means by default Crohn's 

57
00:04:27,800 --> 00:04:34,520
is anywhere from mouth to anus, 
from mouth to anus. 

58
00:04:36,000 --> 00:04:39,120
So again, ulcerative colitis, 
I'm telling you it's in the 

59
00:04:39,120 --> 00:04:42,600
colon. 
By default, Crohn's is anywhere 

60
00:04:42,600 --> 00:04:47,000
from the mouth to the anus. 
So any part of your GI tract, 

61
00:04:50,320 --> 00:04:53,560
I'm telling you this is an 
ulcerative process. 

62
00:04:53,800 --> 00:04:55,640
Well, think of ulcers. 
Do they bleed? 

63
00:04:56,360 --> 00:05:00,360
Yeah, they do. 
So if I have an ulcerative 

64
00:05:00,360 --> 00:05:08,880
colitis, that means I've got 
bloody diarrhea, which means 

65
00:05:08,880 --> 00:05:16,360
Crohn's by default is watery 
diarrhea, ulcerative. 

66
00:05:16,840 --> 00:05:20,200
I'm telling you they're ulcer, 
they're having ulcers in their 

67
00:05:20,200 --> 00:05:24,560
bowel, they're bleeding. 
So bloody diarrhea versus 

68
00:05:24,560 --> 00:05:27,400
Crohn's, which is just going to 
be watery diarrhea. 

69
00:05:30,720 --> 00:05:37,200
If a patient has ulcerative 
colitis, how are we going to 

70
00:05:37,200 --> 00:05:42,520
test for this? 
Well, going to the colon, a 

71
00:05:42,520 --> 00:05:48,400
colonoscopy with biopsy. 
We do this under general 

72
00:05:48,400 --> 00:05:51,200
anesthesia. 
So we do not let them drive 

73
00:05:51,200 --> 00:05:55,720
home. 
We must obtain informed consent.

74
00:05:57,560 --> 00:05:59,480
So again, it's located in the 
colon. 

75
00:05:59,480 --> 00:06:02,960
Ulcerative colitis. 
All you need to do is a 

76
00:06:03,240 --> 00:06:07,160
colonoscopy with biopsy under 
general anesthesia. 

77
00:06:07,760 --> 00:06:09,840
Don't let them drive home. 
Get informed consent. 

78
00:06:09,840 --> 00:06:13,040
Whereas Crohn's is anywhere from
the mouth to the anus. 

79
00:06:13,160 --> 00:06:16,040
Which means is a colonoscopy 
going to suffice? 

80
00:06:17,520 --> 00:06:20,080
No, because what if it's above 
the colon? 

81
00:06:21,800 --> 00:06:28,720
We do an endoscopy as well too. 
Endoscopy and colonoscopy with 

82
00:06:28,720 --> 00:06:32,760
biopsy, again, same thing under 
general general anesthesia. 

83
00:06:33,240 --> 00:06:35,000
Do not let the patient drive 
home. 

84
00:06:35,000 --> 00:06:43,520
Get informed consent. 
We talked about how fiber and 

85
00:06:43,520 --> 00:06:49,880
protein work on the bowel. 
Fiber makes the bowel move, 

86
00:06:50,800 --> 00:06:55,720
protein slows it down. 
Fiber makes the bowel move, 

87
00:06:56,200 --> 00:07:00,480
protein slows it down. 
In this situation, do we want 

88
00:07:00,480 --> 00:07:03,040
their bowel to keep going to 
having diarrhea? 

89
00:07:04,720 --> 00:07:08,720
No, we don't. 
We don't want that bowel going 

90
00:07:08,720 --> 00:07:12,800
fast and fast and fast and have 
and exacerbating that diarrhea 

91
00:07:12,800 --> 00:07:16,840
by giving them more fiber. 
So what we do is we decrease the

92
00:07:16,840 --> 00:07:24,600
fiber or residue, same thing in 
their diet, but we increase the 

93
00:07:24,600 --> 00:07:30,960
protein to slow their bowel 
down, slow their bowel down. 

94
00:07:34,200 --> 00:07:38,000
The treatment here is going to 
be fairly simple. 

95
00:07:39,120 --> 00:07:46,040
If it is inflammatory, give them
an anti-inflammatory things like

96
00:07:46,040 --> 00:07:51,160
steroids. 
So if they are on steroids, and 

97
00:07:51,160 --> 00:07:55,160
this may be long term, if 
they're on long term 

98
00:07:55,160 --> 00:07:58,000
immunosuppressants, we've talked
about this over and over again, 

99
00:07:58,280 --> 00:08:01,000
what are we worried about? 
We're worried about them going 

100
00:08:01,000 --> 00:08:04,800
to that live festival, make sure
they're wearing a mask, make 

101
00:08:04,800 --> 00:08:06,400
sure they're getting their 
vaccine. 

102
00:08:08,600 --> 00:08:12,640
Because ultimately if they 
complain of that sore throat, 

103
00:08:13,520 --> 00:08:19,880
that UTI, that GI distress, it's
not a normal infection because 

104
00:08:19,880 --> 00:08:25,200
they're immunosuppressed. 
So make sure that we educate, 

105
00:08:25,200 --> 00:08:28,640
educate, educate, perfect. 
Select all that apply a question

106
00:08:29,040 --> 00:08:30,880
Ulcerative colitis and Crohn's 
disease. 

107
00:08:31,280 --> 00:08:37,480
Look at these two columns that I
can make location, type of bowel

108
00:08:37,480 --> 00:08:40,039
movement. 
The way I test for it, the diet,

109
00:08:40,280 --> 00:08:44,880
the treatment. 
This is a perfect matrix grid 

110
00:08:45,280 --> 00:08:48,560
case study. 
A perfect matrix grid case 

111
00:08:48,560 --> 00:08:51,400
study. 
We're also going to give 

112
00:08:51,440 --> 00:08:56,440
sulfasalazine. 
Sulfasalazine is a sulfa drug. 

113
00:08:57,080 --> 00:09:00,480
So we are worried about 
photosensitivity with that 

114
00:09:00,480 --> 00:09:05,360
mnemonic SAT for a photo, SAT 
for a photo. 

115
00:09:06,160 --> 00:09:10,240
So again, inflammatory bowel 
disease, ulcerative colitis 

116
00:09:10,240 --> 00:09:15,080
versus Crohn's location, type of
bowel movement, testing, diet 

117
00:09:15,880 --> 00:09:16,640
and treatment.