RE: Discussion - Week 8
Inflammatory Bowel Disease and Irritable Bowel Disease
In this week’s discussion we are discussing digestive disorders and in this text I will be discussing the pathophysiology of inflammatory Bowel disease and Irritable bowel disease with explanation of their likeness and differences. Common treatment likely for both disorders including the likelihood of the same treatment being used for both disorders. The impact of Age factor on the disorders will also be discussed. Inflammatory bowel disease is a noninfectious condition of the bowel that is characterized by repeated passage of mucopurulent, bloody diarrhea which is noted by negative stool culture results for infectious organism and no treatment response to only antibiotics. Inflammatory bowel disease is known for the feature of remissions and exacerbations. Inflammatory bowel disease occurs in two types namely Crohn Disease and Ulcerative Colitis. Irritable bowel syndrome is a form of gastrointestinal disorder characterized by presence of abdominal pain, irregular bowel habits with no pathological process, specific motility or structural abnormalities found as the cause (McPhee, & Hammer, 2010).
Pathophysiology of Inflammatory Bowel Disease
Inflammatory bowel disease occurs in two types namely Crohn Disease and Ulcerative Colitis. Both Crohn Disease and Ulcerative Colitis are complex chronic inflammatory diseases that occur spontaneously related to unknown factors (Huether, & McCance, 2012). In ulcerative colitis, the initial inflammation starts at the crypt of lieberkuhn base in the large intestine with disease starting in the rectum as proctitis, and spreading upwards to the entire colon (pancolitis). Continuous fashion, dark red velvety, hyperemic mucosa may appear. Small erosions start to form and develops into ulcer with possible abscess formation, necrosis and rough (ragged) mucosal ulcers development. The lumen of the involved colon may be narrowed by edema and muscularis mucosae thickening. Some symptoms like cramping pain, bleeding and repeated urge to defecate. UC is characterized by having frequent stooling with small amount of blood and purulent mucus. The Large volumes of watery stools is caused by lack of absorptive mucosal surface. While Crohn disease starts from the mouth to the anus and skips lesions as it spreads affecting more of the right side. It is triggered by a cell mediated (TH1) response, increased level of interferon gamma and the tumor necrosis factor alfa (TNF- α). Some environmental factors like bacteria and viruses can also cause inflammation which originates from the sub-mucus lining of the intestine and extend inwards involving the mucosa and the serous membranes of the intestine (McPhee, & Hammer, 2010). The ascending and transverse colon are mostly affected. The ulceration in Crohn disease give rise to fissures that leads inflammation of the lymphoid tissue with granulomatous lesion formation that appears like a cable stone from projections of inflamed tissue surrounded by ulcerations. There may be fistula formation in the parietal area in between loops of the intestine or extend into the bladder, rectum or vagina and strictures may develop leading to obstruction. Smoking also predisposes the individual to a higher risk and poor prognosis. The two forms of the inflammatory bowel diseases have some similarities in the cause and manifestations yet have characteristic symptoms that distinguishes it from another. Both has mucosal alterations and inflammation of the GI tract, can be caused by psychologic factors, immune-mediated interstitial damage, and host immune responses (McPhee. & Hammer, 2010).
Pathophysiology of Irritable Bowel Syndrome
Irritable bowel syndrome is a form of gastrointestinal disorder characterized by presence of abdominal pain, irregular bowel habits with no pathological process, specific motility or structural abnormalities found as the cause (McPhee, & Hammer, 2010). There is a change in the bowel regulation alternating with constipation and diarrhea and abdominal pain related to intestinal spasms, bloating or abdominal distension may be present with interluminal gas caused by gas swallowing, bacteria formation and diminished absorption of gas (McPhee, & Hammer, 2010). This distension may be related to visceral hypersensitivity which may originate from peripheral or central nervous system or irregularities in the brain-gut axis or alteration of the autonomic nervous system (Huether, & McCance, 2012). Abnormal gastro motility and secretions may be related to irritable bowel disease. The transit times in the individuals with diarrheal type is more rapid while it is delayed in individuals with bloating and constipation type. This mechanism could also be related to visceral hypersensitivity, dysregulation of the brain-gut axis and dysfunction of the serotonin role in the enteric nervous system. Intestinal infection with ongoing low grade inflammation can be attributed with IBS (Huether, & McCance, 2012). Excess growth of the small intestinal flora may increase the symptoms while the presence of methane gas slows the intestinal transit time leading to constipation and bloating. Food intolerance or allergies as in food borne pathogens or antigen may stimulate the immune system of the mucus lining and alter the intestinal flora or trigger hypersensitivity reactions that leads to IBS symptoms. Psychosocial factors like stress stimulate brain-gut communication and neuroendocrine, autonomic nervous system and modulatory responses to pain leading to irritable Bowel Syndrome symptoms Huether, & McCance, 2012). IBS presents with lower abdominal pain and discomfort related to spasms, diarrhea predominant or constipation predominant or alternating with diarrhea and constipation. Bloating gas distention and nausea present can be relieved with having bowel movement. Irritable bowel syndrome does not interfere with sleep. Endoscopic test CT scan, ultrasound of the abdomen and blood studies to rule out celiac disease, or glucose intolerance as well as food allergies. (Huether, & McCance, 2012).
Similarities and differences of Irritable Bowel Syndrome and Inflammatory Bowel Diseases.
There is presence of cramping abdominal pain, diarrhea, and Endoscopic test is common for both IBS and IBD. The cause for both diseases is idiopathic and chronic in nature. Psychologic stress play a part in exacerbating both diseases.
The differences is that inflammatory Bowel disease progresses to the extent of causing bleeding, ulcer formation, fissures and fistula and it always present diarrhea stool especially during exacerbations. While Irritable Bowel syndrome could be constipation predominant or diarrhea pre-dominant or alternate with both.
Treatments for Irritable Bowel Syndrome and Inflammatory Bowel Disease
Diagnosis and treatments for both disease are based on medical history and signs and symptoms of the disease presentation. Treatment is individualized based on the symptoms and diagnostic test including the extent of mucosal involvement. Psychotherapies are required as the diseases are not curable. For inflammatory bowel disease treatment is based on the result of endoscopic and colonoscopy findings. Antispasmodics, Total parenteral nutrition or surgical resection may be used in the treatment of inflammatory bowel disease as well as use of immunosuppressant, immunomodulatory and TNF-α blocking agents may be used for inflammatory bowel disease. While irritable bowel syndrome is treated symptomatically, with laxatives for constipation, antidiarrheal, anti-depressants, probiotics, and acupuncture (Huether, &, McCance, 2012). The treatment that can be used for bot disease include, probiotics, antispasmodics, antidepressants for anxiety and fluid and nutritional replacement for diarrhea situations with TPN, Mesalamine products and treatment for any infection present.
Impact of Age in the pathophysiology of Irritable Bowel Syndrome and Inflammatory Bowel Disease
Both inflammatory Bowel Disease and Irritable Bowel Syndrome affects individuals in their youth and middle age. Inflammatory affects the age group of 10-40years (Huether, & McCance, 2012) and that confuses the diagnosis unless other symptoms are compared.
IBS and IBD cause is idiopathic and may likely lead to depression and anxiety. Inflammatory bowel disease presents with diarrhea, possible bleeding, ulceration, fissures and fistula on the intestines. The Irritable bowel syndrome may be diarrhea predominant or constipation predominant or alternate with both. And treatment is symptomatic and there are no curable treatment so far delineated for both diseases. Treatment is symptomatic rather than curative and both diseases are chronic and have no definitive causative factors.
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
McPhee, S. J., & Hammer, G. D. (2012). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.
|Due By (Pacific Time)
||10/22/2015 12:00 pm