Review of Inflammatory Bowel Disease Crohns Disease Imaging Crohns Disease Ulcerative Colitis Imaging Ulcerative Colitis
Hughes, Pamela, Managing News Editor has reference to this Academic Journal, PHwiki organized this Journal Review of Inflammatory Bowel Disease Crohn Disease Ulcerative Colitis Pseudomembranous Colitis Crohns Disease Transmural inflammation involving any part of the GI tract, from mouth to anus. Terminal Ileitius 80% Ileocolic 50% Colitis 20% Differentiate from UCCrohns patients tend to have rectal sparing Perianal Disease 30% Oral in addition to Esophagus small percentage. Incidence: Most common 15-40, second peak between 50-80 (bimodal distribution) Signs/Symptoms: Typical history of prolonged diarrhea with abdominal pain, wt loss in addition to fever +/- gross bleeding. Characteristics: skip lesions, apthous ulcers, cobblestone appearance (submucosal thickening interspersed with mucosal ulceration) Treatment: Corticosteroids, aminosalicylates, immune modulators, infliximab (anti-TNF), metronizadole. Surgery should be avoided if possible since Crohns disease is not curable unlike UC. Complications: Abscess, fistula, obstruction, cancer, perianal disease Imaging Crohns Disease Small bowel contrast study vs CT SBFT useful as long as characterizing length of involvement in addition to areas of stricture Characteristic Findings Mucosal nodularity Narrowed lumen Ulceration String sign Abscesses or fistula String Sign Term often applied to the appearance of any marked narrowing of the lumen, but originated as descriptor of reversible narrowing in Crohn disease. Narrowing caused by incomplete filling as result of irritability/spasms associated with ulceration. String Sign Masselli G. The gastrointestinal string sign. Radiology. 2007 Feb;242(2):632-3.
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Ulcerative Colitis Inflammation confined to mucosal layer of colon that extends from rectum proximally in continuous fashion Autoimmune process Incidence: Ages 15-40 or 50-80 (bimodal distribution) Signs/Symptoms: Rectal bleeding, loose bloody stools, passage of mucus from rectum, abdominal pain Complications: per as long as ation, stricture, megacolon, cancer Treatment: Medical: Mild/moderate disease5-ASA, corticosteroids Severe diseaseIV steroids or immunosuppressants as long as refractory disease Surgical: Proctocolectomy (curative) Indications: Failure of medical therapy, increasing risk of cancer with long st in addition to ing disease, bleeding, per as long as ation Prognosis: Approximately 1-2% risk of cancer at 10 years, 1%/year thereafter Imaging Ulcerative Colitis Barium Enema vs. CT Barium Enema is no longer the test of choice Findings Continuous lesions from rectum proximally with circumferential involvement Lead Pipe Sign Repeated episodes of mucosal ulceration in addition to marked muscularis hypertrophy results in shortening, narrowing in addition to smoothing out of the normal haustral markings. Lead pipe appearance of colon due to chronic scarring in addition to retraction/loss of haustra Weinstein A et al. A super lead pipe colon: radio-pathological correlation of long-st in addition to ing ulcerative colitis. SA Journal of Radiology;2008 Oct:70-72 Pseudomembranous Colitis An acute colitis characterized by as long as mation of an adherent inflammatory exudate (pseudomembrane) overlying the site of mucosal injury Most commonly due to overgrowth of C.difficile, a gram-positive, anaerobic spore as long as ming bacilus Typically occurs after broad-spectrum antibiotics (especially clindamycin, ampicillin, or cephalosporins) eradicate normal intestinal flora Signs/Symptoms Self-limited diarrhea to invasive colitis with megacolon or per as long as ation as possible complications Diagnosis Detection of C.diff toxin in stool, proctoscopy or colonoscopy Treatment Stop offending antibiotic in addition to give flagyl or vancomycin Prognosis High rate of recurrence (20%) despite high response rate to treatment
CT findings Colonic wall thickening Target sign Thickened bowel wall demonstrates three layers that comprise a contrast-enhanced inner in addition to outer layer of high attenuation between which is a layer of decreased attenuation. Indicates hyperemia in the mucosa in addition to the muscularis propria, serosa, or both with submucosal edema or inflammation Accordion sign Alternating edematous haustral folds separated by transverse mucosal ridges filled with oral contrast material, simulating the appearance of an accordion. Colonic dilatation Pneumatosis coli or portal venous gas Ahualli J. The target sign: bowel wall. Radiology. 2005 Feb; 234(2):549-550 Macari M et al. The accordion sign at CT: a nonspecific finding in patients with colonic edema. Radiology. 1999 June;211(3):743-746 QUIZ Case 1 23 yo male with h/o loose stools in addition to abd pain Diagnosis
Case 2 What is the finding What is the diagnosis 3. Which inflammatory bowel disease is this most commonly associated with Case 3 60 year old female presents with abdominal pain, diarrhea, in addition to weight loss. What is the diagnosis Name three complications of this disease. Case 4 65 yo male treated with intravenous vancomycin as long as osteomyelitis of the foot presents with diarrhea in addition to elevated WBC Diagnosis
Case 5 What are the findings What is the diagnosis Case 6 49 yo female on adjuvant chemotherapy as long as breast cancer with abd distension in addition to diarrhea What is the most likely diagnosis What are two CT imaging findings that can be seen with this ANSWERS
Case 1 23 yo male with h/o loose stools in addition to abd pain Diagnosis Ulcerative Colitis Case 2 What is the finding Increased periportal echogenicity 2. What is the diagnosis Sclerosing Cholangitis 3. Which inflammatory bowel disease is this most commonly associated with Ulcerative Colitis Sclerosing Cholangitis Classic sonographic finding is thickening (increased echogenicity) of intra in addition to extra-hepatic bile ducts 75% of pts with PSC have inflammatory bowel dz (usually UC)
Sclerosing Cholangitis Disease is characterized by inflammation, destruction in addition to fibrosis of bile ducts Increased incidence of bacterial cholangitis in addition to cholangiocarcinoma Definitive treatment is orthotopic liver transplant Secondary causes of SC include drugs, prior surgery, multiple opportunistic infections Case 3 60 year old female presents with abdominal pain, diarrhea, in addition to weight loss. 2. Name three complications of this disease. Abscess, fistula, obstruction What is the diagnosis Crohns Disease Case 4 65 yo male treated with intravenous vancomycin as long as osteomyelitis of the foot presents with diarrhea in addition to elevated WBC Diagnosis Pseudomembranous Colitis
Case 5 2. What is the diagnosis Crohns Disease What are the findings Narrowing of bowel lumen with cobblestoning Case 6 49 yo female on adjuvant chemotherapy as long as breast cancer with abd distension in addition to diarrhea What is the most likely diagnosis Pseudomembranous Colitis What are two CT imaging findings that can be seen with this Target sign Accordion sign THE END
Hughes, Pamela Managing News Editor
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