HPB Project: Analysis of Crohn's and Ulcerative Colitis Diseases

This report analyzes two inflammatory bowel diseases (IBD): Crohn's disease and ulcerative colitis, using the case of Mr. Bob Jackson. Part 1 focuses on Crohn's disease, detailing its symptoms (diarrhea, abdominal pain, blood in stool), causes, and diagnostic tests, including barium X-ray and CT s...Read More

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Table of Contents
Part 1.....................................................................................................................................................3
Part 2.....................................................................................................................................................5
Reference list.........................................................................................................................................9
Part 1
Mr. Bob Jackson is 55 years old man who was suffering from
Diarrhoea, Malaise and Nausea. He has been admitted in Emergency
Department of Hospital because of serious compliant regarding
abdominal pain and increase in size of Left Lower Quadrant. His medical
and surgical history is considered in order to diagnose the possible

disease. Aetiology refers as the study of origination or causation of a
particular disease which often stated in terms of mythical or historical
explanation. This study is used in investigation of disease and it has been
analysed that Mr. Bob Jackson suffers from a chronic disorder. After
examining respiratory rate, SpO2, blood pressure it can be said that Mr
Jackson Crohn disease.
Crohn's disease:
Crohn's disorder is an inflammatory bowel disease which cause
inflammation in digestive tract that can leads to severe diarrhoea,
abdominal pain, weight loss, malnutrition and fatigue. It can affect any
part of gastrointestinal tract from mouth to anus. This disease is
generally found at the ileum (small intestine) and beginning of colon
(large intestine). Main symptoms of this disease includes Fever,
Diarrhoea, blood in stool, mouth sores, pain or drainage around or near
the anus because of inflammation, fatigue, abdominal pain & cramping,
weight loss and reduced appetite (Hueber and et. al., (2012).
After reviewing the medical and surgical history of Mr. Bob
Jackson, it has been observed that he is facing problems of osteoarthritis
in right knee, obesity and hypertension. He was also go through the
surgical procedures like knee arthroscopy and appendicectomy. It is also
observed that patient is allergic to some medications including NKA. The
study of aetiology and pathophysiology is used to diagnose the disease
and to ascertain its main causes. Some causes that are determined in Mr.
Bob Jckson's case are defined below:
Blood in Stool: This is the stage in which blood is seen in toilet,
outside of stool or with with wiping after the bowel movement. The
causes of this rectal bleeding are fortunately not the life threatening. The
most common cause includes in it are anal fissures and hemorrhoids.
From the review of systems and medical history of patient it is observe
that 3/12 Hx of occasional loose stools along with frank blood in bowl
(Ananthakrishnan and et. al., (2012).

Diarrhoea: It is a condition when bowel movements become
watery or loose. It occurs when intestine lining is actively secretes fluid
or is unable to absorb it. Mr. Jackson is suffering from diarrhoea which is
one of the cause of Crohn disease.
Abdominal pain: It is the pain that occurs between chest and
pelvic region. It can be achy, intermiittent, crampy, dull or sharp.
Disease or inflammation that affect the organs in abdomen which can
cause abdominal pain. From medical history of Mr. Jackson, it is seen
that he is suffering from abdominal pain.
Diagnostic tests for Crohn's disease:
Barium X-ray studies:
By way of doing Barium X-ray studies, the nature, distribution, and
severity of disease can be identified. The chalky material, i.e., barium is
used as it is visible by X-ray (Suskind and et. al., (2014). When it is
ingested orally, it fills intestine and after that X-ray is taken of small
intestine and stomach. When it is administered by ractum, terminal ileum
and colon pictures can be obtained which can show narrowing,
ulcerations and fistule of bowel.
Computerized axial tomography scanning:
It is a computerized X-ray technique which allows imaging of pelvis
and entire abdomen. It is assistive in detecting abscesses. The imaging
techniques like CT and MRI enterography use oral contrast agents that
consist watery solutions. It provides adequate luminal distension
which helps in analysis of small bowel pathology in crohn's disease
patients.
Part 2
Ulcerative Colitis :-

Ulcerative Colitis is an inflammatory bowel disease which consists
of number of diseases that directly affects the gastrointestinal tract
(Dignass and et. al., (2012). A person get suffered from this disease when
large intestine or rectum become inflamed which produce tiny sores
knows as ulcers on the colon. It generally begins from final section of
large intestine and spread in upward direction which affect entire colon.
This inflammation kills the cells at lining surface of bowel in ulcers form
which causes bleeding and also discharge pus.
Symptoms of Ulcerative colitis range from mild to sever which
depends upon the part of large intestine which get affected and severity
of its inflammation. Hence symptoms may vary from time to time and
from person to person. Following are the causes of this diseases:
 Abdominal pain/discomfort.
 Fever
 Weight loss
 Blood or pus in stool
 Fatigue
 Reduced appetite
 Frequent, recurring diarrhoea
After reviewing the medical reports of Mr Bob Jackson and
symptoms of Ulcerative colitis, it has been identified that patient is
suffering from this disease (Feagan and et. al., (2013). As Bob Jackson is
suffering from Left Lower Quadrant(LLQ) abdominal pain and diarrhoea
from 1 week which is the main symptom of Ulcerative colitis. Following
are the symptom which are identified in medical history of Bob Jackson
that are explained below:
Abdominal pain:- This pain is felt at trunk which is below the ribs
and above the pelvis and is come from organ adjacent to belly. Although
pain can be arise through tissues of abdominal wall which surround the

abdominal cavity. It is mainly caused by inflammation, loss of blood
supply to organ or distension of an organ.
Diarrhoea:- It is a situation of frequent passage of loose, watery,
soft stool which can be with or without abdominal bloating, cramps and
pressure generally known as gas or flatulence. Main causes of diarrhoea
contains viral and bacterial infection, intestine disorder and reaction to
medicine.
Ulcerative colitis can be diagnosed by way of various kinds of test
procedures. Some of them are mentioned hereunder:
Blood test: By way of doing blood test of the patient, anaemia can
be detected: and this is the condition in which the patient does not have
an appropriate red blood cells to carry enough oxygen to their tissues.
This may help in detecting infection in the large intestine (Sandborn and
et. al., (2014).
Stool Sample: By taking stool sample, ulcerative colitis can be
found as this will reflect the white blood cells in the stool.
Colonoscopy: This helps the doctor to know about the whole
picture of the colon by way of thin, dynamic, lightened tube along with
the attached camera. At the time of the procedure, doctor can take small
samples of the tissue for laboratory analysis which would ultimately help
to diagnose such disease.
Sigmoidoscopy: Under this, doctor uses slender, lightned tube to
know about the rectum and sigmoid. This would help out to know about
the whole picture of the colon (Dignass and et. al., (2012).
Mr. Bob Jackson’s doctor would prefer to do any or some of above
mentioned tests so that they would get to know about ulcerative colitis
and adequate treatment could be provided in order to stop dispersing it.
Differences between Ulcerative colitis and Crohn disease:
Crohn disease Ulcerative colitis

 In crohn disease, inflammation
may be develop anywhere in GI
tract that can be from mouth
to the anus.
 It occurs mainly at the end of
small intestine and appears in
the form of patches.
 Inflammation may extend
throughout the entire
thickness of bowel wall.
 Inflammation in Ulcerative
colitis is only limited to large
intestine. It starts from last
section of large intestine and
then further spread in upward
direction.
 It generally occurs in colon
and rectum which sometime
involve the entire colon. It
appears in continuous pattern.
 In Ulcerative colitis,
inflammation is basically
occurs at the innermost lining
of the intestine.

Reference list
Hueber, W. and et. al., (2012). Secukinumab, a human anti-IL-17A
monoclonal antibody, for moderate to severe Crohn's disease:
unexpected results of a randomised, double-blind placebo-
controlled trial. Gut. 61(12). 1693-1700.
Ananthakrishnan, A. N. and et. al., (2012). Aspirin, nonsteroidal anti-
inflammatory drug use, and risk for Crohn disease and ulcerative
colitis: a cohort study. Annals of internal medicine. 156(5). 350-
359.
Suskind, D. L. and et. al., (2014). Nutritional therapy in pediatric Crohn
disease: the specific carbohydrate diet. Journal of pediatric
gastroenterology and nutrition. 58(1). 87-91.
Dignass, A. and et. al., (2012). Second European evidence-based
consensus on the diagnosis and management of ulcerative colitis
part 2: current management. Journal of Crohn's and Colitis. 6(10).
991-1030.
Feagan, B. G. and et. al., (2013). Vedolizumab as induction and
maintenance therapy for ulcerative colitis. New England Journal
of Medicine. 369(8). 699-710.
Sandborn, W. J. and et. al., (2014). Subcutaneous golimumab induces
clinical response and remission in patients with moderate-to-
severe ulcerative colitis. Gastroenterology. 146(1). 85-95.