Inflammatory bowel disease

35 Inflammatory bowel disease



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Fig. 35.1A This patient has thick-walled descending colon caused by active inflammatory bowel disease.



Background


Many conditions can cause the appearance of thick-walled bowel, with thumb printing.


The clinical presentation and patient demographics are important. This chapter aims to give an overview of all the conditions that produce this appearance on a plain film.


Inflammatory bowel disease refers to ulcerative colitis (UC) and Crohn’s disease, which are of unknown aetiology. UC always affects the rectum and extends proximally, in a continuous manner. Crohn’s disease can affect any part of the GI tract between mouth and anus with intervening normal segments, but terminal ileum is a common site.


Peak incidence for both conditions is in the second and third decades of life.


Toxic megacolon is a feared complication, which carries a high mortality rate. See below.



Clinical features



Symptoms



• Haematochezia

• Increased stool frequency, diarrhoea

• Abdominal pain

• Symptoms of extraintestinal manifestations (joint pains, iritis, rashes, perianal disease in Crohn’s disease).


Signs


Signs include abdominal tenderness, pyrexia and tachycardia. The findings are non-specific.


These conditions can present to an on-call physician or surgeon as well as to A&E. The differentials can present on any ward – see below.



Differential diagnosis


Any of the following can cause the same appearances on plain radiographs. The clinical history is the key.


• Infective colitis (pseudomembranous colitis – Clostridium difficile infection in patients on broad-spectrum antibiotics. Patient will have an appropriate history and Clostridium difficile toxin will be present on the stool culture.)

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Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Inflammatory bowel disease

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