Inflammatory Bowel Disease: Intestinal Problems (cont.)
Lori Kam, MD
Leslie J. Schoenfield, MD, PhD
Leslie J. Schoenfield, MD, PhD
Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
In this Article
What should be done about polyps in IBD?
Not all polyps that are found in IBD patients are pre-cancerous or cancerous.Some polyps form as a result of the inflammatory and healing processes. Thesepolyps are called inflammatory polyps or pseudopolyps, and they do not turn intocancer. The only way to make sure that polyps do not have pre-cancerous orcancerous cells, however, is to remove (biopsy) and examine them under themicroscope.
What is toxic megacolon and what are its causes and symptoms?
Toxic megacolon causes
Toxic megacolon is a widened (dilated) segment of the colon in a patient withsevere inflammation of the colon (colitis). The megacolon develops when thelining of the colon is so inflamed that the colon loses its ability to contractproperly. When this happens, the propelling (peristaltic) contractions areunable to move the intestinal gas along through the colon. The colon, therefore,accumulates excessive amounts of gas. The gas then increases the pressure on thebowel wall, which causes the colon to dilate.
Toxi megacolon symptoms
Patients with toxic megacolonusually are very ill, with abdominal pain, bloating (distention), and fever. Thedilated colon can allow bacteria to leak through the bowel wall into the bloodstream (septicemia). With continuing dilation, the inflamed colonic wall becomesat high risk for bursting (perforating) and causing inflammation of theabdominal cavity (peritonitis). Both septicemia and peritonitis are seriousinfections, which, in some cases, can even lead to death.
Toxic megacolon typically occurs when inflammation of the colon is severe. This complication,however, does not occur exclusively in patients with ulcerative colitis or Crohn's disease. Thus, a toxicmegacolon can develop in other types of colitis, such as amebiasis or bacillarydysentery (shigella). Narcotics, codeine, or anti-diarrheal medications such asdiphenoxylate (Lomotil) or loperamide (Imodium) can decrease the contractions ofthe colon and allow excessive gas to accumulate. These medications, therefore,predispose to the development of toxic megacolon and should be avoided duringsevere episodes (flares) of colitis.
Medically Reviewed by a Doctor on 1/8/2014
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