Ileocolonic storage and

salvage
The distal ileum acts as a reservoir,
emptying intermittenly by bolus
movement.
The resident bacteria in the colon are
necessary for the digestion of unabsorbed
carbohydrates.
In health, the ascending and transverse
regions (average transit, 15 h)
The descending colon (average transit, 3 h)

Source : harrisons, vol 1, ed 17, p 246

Colonic motility
Motility -> Low
Method :
1. Haustra contraction -> non propulsif
2. Mass movement -> propulsif
Reflex :
3. Reflex gastrokolon
4. Reflex gastroileum

Source : Sherwood, ed 2, p 582-584

Segmentation Contraction
Defecation
Defecation is throw away feces from the
rectum.
Distention of the rectum reflex defecation
relaxation the internal anal sphincter
(involuntary) rectum and sigmoid colon
contraction more stronger external anal
sphincter relaxation the feces out.
External anal sphincter can contract or relax
(voluntary)
If contraction feces not out
If relaxation feces out
Lower GI bleeding
Clinical characteristic of Lower GI
Bleeding
- Hematokezia
- Melena
- Occult

Source : IPD FKUI jilid 1, ed 4, p. 293

Most commonly, lower GI bleeding produces
passage of bright red stools.
Chronic slow GI bleeding may present with iron-
deficiency anemia.
The most prevalent lower GI sources of
hemorrhage include:
- Hemorrhoids
- Anal fissures
- Diverticula
- Ischemic colitis
- Nepoplasm
- IBD
- Infectious colitis
- Drug induced colitis
IBD

EPYDEMIOLOGY
International
The incidence of inflammatory bowel
disease (IBD) ranges from 2.2-14.3 cases
per 100,000 person-years for ulcerative
colitis and from 3.1-14.6 cases per
100,000 person-years for Crohn's disease.
Overall, the combined incidence for
inflammatory bowel disease is 10 cases
per 100,000 annually.
Incidence is slightly greater in females
than in males.
MORTALITY/MORBIDITY
The quality of life generally is lower in those with
Crohn's disease than in those with ulcerative
colitis, in part because of recurrences after
surgery performed for Crohn's disease.
The most common causes of death in inflammatory
bowel disease (IBD) are peritonitis with sepsis,
malignancy, thromboembolic disease, and complications
of surgery.
Toxic megacolon, one of the most dreaded complications
of ulcerative colitis, can lead to perforation, sepsis, and
death.
Malnutrition and chronic anemia are observed in long-
standing Crohn's disease.
Children with Crohn's disease or ulcerative colitis
can exhibit growth retardation.
INFLAMMATORY BOWEL DISEASE

Two major forms of IBD : Chrons disease

and ulcerative colitis
But, if we difficult to differentiate both :
indeterminate colitis
Cause of IBD is not completely understood,
but in involves the interaction of the GI imun
system, genetic, and environment factors
General clinic characteristics of IBD :
diarrhea, fever, weight loss, anemia,
malnutrition, FTT
Specific clinic characteristics of IBD
ULCERATIVE COLITIS vs. CHRONS DISEASE
ULCERATIVE COLITIS CHRONS DISEASE
Presentation
Perianal disease
Bloody diarrhea Mass in abdomen
Abdominal pain (65%)
Gross Pathology
Rectum always involved Rectum may not be involved
Thin wall Thick wall
Stricture << Stricture >>
Diffuse ulceration Cobblestone appearance
Histopathology
No granulomas
Granulomas
Inflammation <<
Inflammation >>
Deeper ulcers
Shallow ulcers
Pseudopolyps
Fibrosis
Abcess in crypts
SYMPTOMPS
Abdominal cramps and pain
Bloody diarrhea
Severe urgency to have a bowel
movement
Loss of appetite
Fever
Weight loss
Anemia (due to blood loss)
COLITIS
INFECTIVE COLITIS
Shigellosis Lower abdominal pain, dysentery, fever
Mass in RLQ, diarrhea with blood,
Tuberculosis Colitis
subfebris
Dysentery and the other symptoms
Amebic Colitis
(based on the clinical condition)
Pseudomembran Colitis Diarrhea, cramp and pain abdominal,
fever, leucositosis, abdominal tenderness
NON-INFECTIVE COLITIS
Ulcerative Colitis
IBD Diarrhea, fever, anemia, malnutrition
Chrons disease
Nausea, vomit, diarrhea, tenesmus,
Radiation Colitis
hematocezia, colic
Ischemic Colitis
Simple Colitis
DIFFERENTIAL DIAGNOSIS
Appendicitis, Acute
Diverticular Disease
Endometriosis
Pelvic Inflammatory Disease
MEDICATION
Antidiarrheal agents
Loperamide (Imodium)
Diphenoxylate and
Atropine (Lomotil)
Cholestyramine (Questran)
Antispasmodic agents
Dicyclomine (Bentyl)
Aminosalicylates
Sulfasalazine (Azulfidine)
Olsalazine (Dipentum)
Mesalamine (Asacol,
Pentasa, Rowasa, Canasa)
Corticosteroids
Prednisone (Sterapred)
Methylprednisolone
(Adlone, Medrol, Solu-
Medrol)
Hydrocortisone (Anusol-
HC, Anuprep HC)
Immunosuppressants
Azathioprine (Imuran)
Antibiotics
Metronidazole (Flagyl)
Tumor necrosis
inhibitors
Certolizumab pegol
(Cimzia)
Infliximab (Remicade)
COMPLICATIONS
Profuse bleeding from the ulcers
Perforation (rupture) of the bowel
Stricturesand obstruction
Fistulae(abnormal passage) and
perianal disease
Toxic megacolon(acute
nonobstructive dilation of the
colon)
Malignancy
Ischemic colitis usually occur in middle
age and old people.

Clinical manifestation :
- In transmural lession
abdominal pain suddenly, bloody
diarhea, syok, colaps
- In mural and mucosa lession
abdominal pain, GI bleeding, feel not
comfort in abdomen
Source : Buku ajar patologi vol 2, ed 7, p.
635
Diagnose :
- Laboratorium : leucositosis
- Kolonoskopi :
normal mucosa (12-15 cm) then
appear mucosa edema, bloody
- Barium enema examination
inflamation lession in colon
thumbprinting mucosa edema
Source : IPD FKUI jilid 1, ed 4, p. 401
Polip :
- Pedunculated
- Sesile

Polip :
- Non-neoplastic
- Neoplastic

Source : Buku ajar patologi vol 2, ed 7,

p. 650
 Polip non-neoplastic
Polip non-neoplastic 90% epitelial
polip
Usually occur in old people (60 years
old or more )
Most in colon rectosigmoid regio
Histology :
Kriptus >> with goblet cell, good
differentiation

Source : Buku ajar patologi vol 2, ed 7,

 Polip juvenils
Usually occur in child < 5 years old but can
occur in adult too.
Big lession, circle, licin

Clinical manifestation :
Rectal bleeding

Source : Buku ajar patologi vol 2, ed 7, p.

650
 Adenoma
3 type :
- Adenoma tubular
- Adenoma villosa
- Adenoma tubulo-villosa
Clinical manifestation :
- Small adenoma => asymptomatic
- Adenoma villosa => rectal bleeding,
hipoproteinemia
Source : Buku ajar patologi vol 2, ed 7,
p. 652
Hemorrhoids
Anal fissures
(Fissura in ano)
Hard feces distention a crack in anus wall
Etiology :
- Iritation because of diarhea
- Laksans
- Partus
Clinical manifestation :
- Constipation
- Hard feces
- Very pain when defecation
- Hematokezia
Diagnose :
- Pain spontaneus, during defecation
- Bleeding
- Constipation
- Sfingter spasme
- Fissura, papila hipertropic, skin umbai
trias

- Drink more watter

- Eat more fiber
- Topical anestetic
Abses anorectal