Inflammatory Bowel Disease Đánh giá ban đầu

The symptoms of inflammatory bowel syndrome depend on the segment of the intestinal tract involved. These include chronic diarrhea or constipation, abdominal pain and cramps, blood in the stool, pain with bowel movement, urgency in bowel movement, tenesmus, reduced appetite, weight loss, fever, fatigue, growth retardation, primary amenorrhea, night sweats and joint pain with swelling/redness.  

Inflammatory bowel syndrome is confirmed by clinical evaluation and a combination of biochemical, endoscopic, radiologic, histologic and/ or nuclear medicine-based investigations. The specific diagnosis of ulcerative colitis or Crohn’s disease is not determined in about 5% of patients because they have features of both conditions; this is termed as inflammatory bowel disease type unclassified (IBDU).  

Clinical Features  

Ulcerative Colitis  

The cardinal symptoms of ulcerative colitis are bloody diarrhea, and frequent, small volumes. The associated symptoms of ulcerative colitis are colicky abdominal pain, tenesmus, and urgency. This is characterized by a relapsing and remitting course.  

Crohn’s Disease  

The cardinal symptoms of Crohn’s disease are chronic diarrhea, abdominal pain, weight loss, abdominal mass, perianal lesions, stomatitis, fissures and fistulas. Malaise, fever, and anorexia are more common with Crohn’s disease than ulcerative colitis. Symptoms occur in a majority of cases as a chronic, intermittent course. 

A complete patient history should include recent travel history, intolerances to food, smoking history, sexual history, medication (including use of nonsteroidal anti-inflammatory drugs [NSAIDs] and antibiotics), vaccination history, past medical history (eg previous appendectomy, tuberculosis [TB], intestinal infection), and family history. The onset and duration of symptoms, stool frequency, consistency, and urgency should be included. The presence of extraintestinal manifestations (eg arthritis, osteoporosis, fractures, inflammatory ocular symptoms, thromboembolic symptoms, primary sclerosing cholangitis (PSC), secondary amyloidosis, erythema nodosum, pyoderma gangrenosum) and mood disorders should also be noted.