1. IBD (UC or CD)- probably UC given that bleeding is so evident and pain is so minor
2. Infectious Diarrhea (bacteria or parasitic)
3. CRC rarely (2nd degree relative + not all that relavant)
4. STD (unlikely given how long bleeding has persisted)
So probably UC given the distribution in the rectum, continuously up to the descending colon
B: No vasculature (non-specific- ischemia, infection, etc) or ULCERS (its still UC)
Bloody diarrhea without much pain
He was a non-smoker= **UC is more common in non-smokers actually** (the diagnosis of UC in a smoker is probably wrong). Nicotine doesnt help tx. of UC (neither does smoking)
Not really ulcerated, just lots of inflammation
Cant distinguish between UC and CD based on active colitis
CD will be transmural!
Immunostains are available to find CMV
One of the long-term complications of ulcerative colitis (and Crohn disease) is dysplastic transformation. What are the risk factors?
• Duration of the disease. Risk increases sharply 8 to 10 years after disease onset.
• Extent of the disease. Patients with pancolitis are at greater risk than those with only left-sided disease.
• Nature of the inflammatory response. Greater frequency and severity of active inflammation (characterized by the presence of neutrophils) confers increased risk.
Mesalamine may reduce risk of CRC
Colicky pain= wave like pain that has mild pain and then bouts of severe pain (non specific)
X-ray shows air-fluid levels (Caused by distension)
Could be CD, or something is obstructing the abdomen
Ulcereation in the small bowel in pt. 2
Need to consider Intestinal TB if born elsewhere
Meds: NSAIDs can cause ulcers and strictures (pt. will most likely be asymptomatic)
Surgery cannot cure CD! It will come back and note that CD can involve any part of the GI tract from the mouth to the anus and unlike UC, can occur any place at any time
Smoking in crohns disease= bad prognosis, less likely to respond to therapy