Liver & GIT
A patient gives chronic history of Diarrhoea and blood in stool presents with multiple fistulae in the perineum and multiple stricture in small intestine. The diagnosis is:
|D||Ischemic bowel disease|
Clinical Features – Clinical features depend on the site and pathological process involved.
Ileocolitis – Initially it presents with, recurrent right lower quadrant colicky pain and diarrhea.
a. Low grade fever is usually seen.
b. Weight loss is common due to diarrhea and anorexia.
c. An inflammatory mass is palpable in right lower quadrant of abdomen composed of inflamed bowel, adherent and indurate mesentery and enlarged abdominal lymph node.
d. Later diarrhea decrease and chronic bowel obstruction and constipation occur due to fibro stenotic narrowing and stricture.
e. Fistula formation to adjacent bowel, skin ( enterocutaneous fistula), and vagina ( enterovaginal fistula ) Qoccur due to localized wall thinning with micro perforation.
a. Malabsorption and steatorrhea due to loss of digestive and absorptive surface.
b. Nutritional deficiency due to poor intake and enteric loss leading to hypoalbuminemia, hypocalcaemia, vitamin D deficiency (Causing vertebral fracture), megaloblastic anemia, pellagra. (Hyperoxaluria leading to renal stone)
Colitis and perianal disease-
a. Fever, hematochezia (Bright red blood per rectum), diarrhea are common with colitis.
b. Crampy abdominal pain caused by passage of fecal material through narrowed and inflamed segments of large bowel.
c. Stricture leading to bowel obstruction can occur.
d. Fistula into stomach or duodenum causes vomiting of fecal material.
e. Bacterial over growth due to enterocolic fistula..
f. Rectovaginal fistula, enterocutaneous fistula, Perianal fistula.
g. Perianal disease causes incontinence, large hemorrhoidaltags and strictures, anorectal fistula and perirectal abscesses.
Gastro duodenal disease
a. Nausea vomiting, epigastric pain.
b. H. Pylori negative gastritis.
c. Chronic gastric outlet obstruction in patients with advanced gastro duodenal CD.
a. Anemia, Leucocytosis. b. Increased ESR,CRP level.
c. Hypoalbuminemia d. ASCA antibodies (60-70%)
e. p-ANCA (5-10%) f. Anti goblet antibodies (30%)
g. Anti colon antibodies (13%) h. Pancreatic auto antibodies(30%)