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Causes of Constipation Lifestyle Drugs Pelvic Floor Dysfunction Endo/Metabolic Neurologic Treatment of Constipation Fiber Fluids Exercise Medication Pelvic Floor Therapy Inflammatory Bowel Diseases Ulcerative Colitis Crohn's Disease Crohn's Disease Most common form is Crohn's Ileocolitis Beginning of the large intestine and end of the small intestine Never cured, only treated Spans the thickness of the intestinal wall (transmural) Granuloma's and apthoid lesions Causes of Crohn's Disease Genetic Susceptibility Immune Dysregulation Environmental Triggers Hygiene Hypothesis Most parasites are not located here These parasites may play a role in protecting us from IBD We are also overly hygienic Ulcerative Colitis Involves just the colon, mainly the mucosal lining Inflammation strips away the lining Anatomic Stages of Ulcerative Colitis Proctitis (starts at the end) Proctosigmoiditis (moves upward) Left Sided (eventually counter clockwise) Pan-Colitis Complications of Ulcerative Colitis Toxic megacolon: colon balloons and stops working Bleeding Perforation leading to sepsis Colorectal Cancer (from chronic inflammation) Treatment of Ulcerative Colitis Medication to suppress inflammation Removal of the colon by surgery (cure) Clinical presentation of Crohn's Disease Chronic pain and diarrhea Intestinal obstruction Acute inflammation (appendicitis-like) Complications of Crohn's Disease Fistula: bowel attaches to other internal organs Leakage of digested food or stool into other organs Diverticulosis Acquired herniation of mucosa/submucosa through the muscularis of the colon Side pockets form in the large intestine Result of too much pressure Bleeding in Diverticulosis Painless, but may be massive Due to damaged vasa recta Diagnosis of Diverticulosis Emergency Angiography Nuclear scanning (tagged RBC's) Early Colonoscopy Diverticulitis Infection resulting form diverticulosis Most common complication Fecalith Inspissated stool in tic abrasion causing low grade inflammation leads to micro or macroperforation Symptoms of Diverticulitis Left lower quadrant pain Fever Increased WBC's Clinical presentation of Colon Cancer Growths called polyps develop in the colon Asymptomatic Screening and Treatment is very effective Risk Factors for Colon Cancer Diet and Geography Age Family history Chronic Colitis Adenoma Previous Colorectal neoplasia Adenoma-Carcinoma Sequence of Colon Cancer Normal Mucosa => Adenoma => Severe Dysplasia => Cancer Colon Cancer Screening Fecal Occult Blood Test (inexpensive, non-specific) Flexible Sigmoidoscopy (only left side) Colonoscopy (traditional gold standard) Barium Enema Virtual Colonography Lactose Intolerance Reflects normal development: loss of lactase enzyme at the age of weaning Northern European high incidence of retaining lactase Celiac Disease Autoimmune Disorder to the protein gluten Gluten is found in wheat and similar grains Affects the upper part of the small intestine Clinical Presentation of Celiac Disease Widely variable presentation Most symptoms are mild, anemia, bloating, cramping Degree of symptoms depends on length of affected bowel The CD trio Environmental Trigger Genetic Risk Leaky Gut Some virus present sin childhood, antibodies mistake gluten for this virus later Diagnosis of Celiac Disease Folds not present in the bowel Endoscopy and biopsy Treatment of Celiac Disease Avoid all foods containing wheat, rye, barley Initially avoid oat gluten Initially, limit lactose and milk