Immune Thrombocytopenia causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Synonyms and keywords: IBD ;

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract that represents 2 distinctive disorders, Crohn’s disease and ulcerative colitis. Both disorders are characterized by unpredictable exacerbations and remissions. Genetic and environmental factors are believed to play a key role in the pathogenesis of IBD. A dysregulated immune response to environmental factors in a genetically susceptible host results in activation of cytokines, triggering a cascade of reactions ultimately bowel inflammation. Common symptoms of inflammatory bowel disease include persistent diarrhea, abdominal pain, rectal bleeding/bloody stools, weight loss and fatigue. IBD can be diagnosed using a combination of endoscopy for Crohn’s disease or colonoscopy for ulcerative colitis and imaging studies, such as contrast radiography, magnetic resonance imaging, or computed tomography. The goal of medical therapy is to induce remission initially with medications, followed by the administration of maintenance medications to prevent a relapse of the disease. Sulfasalazine along with steroids are the main stay of treatment for IBD. Immunosuppressive agents such as infliximab or 6-mercaptopurine and azathioprine are recommended alternatives to steroids.

While the causes of inflammatory bowel disease is unknown, several possibly interrelated studies have been suggested following causes:

• Mutations in the CARD15 gene (also known as the NOD2 gene) are associated with Crohn’s disease.
• Mutations of the transporter proteins such as OCTN1 and OCTN2 and scaffolding proteins such as the MAGUK family are believed to cause ulcerative colitis.

• Alterations in normal bacterial flora of the intestinal tract is responsible for Crohn’s disease.
• Smoking: Unlike Crohn’s disease, ulcerative colitis has a lesser prevalence in smokers than non-smokers.
• Use of NSAIDs
• Stress
• Red meat consumption

• Hemolytic uremic syndrome
• Connective tissue disease
• Vasculitis
• Radiation therapy to the prostate or pelvic area
• Chemical or physical trauma to anorectal area
• Amyloidosis
• Behçet syndrome
• Chronic lymphocytic leukemia
• Lymphoma
• Lipid proctocolitis
• Tuberculosis
• Syphilis
• Infection with Entamoeba histolytica or Giardia lamblia, most often seen in patients with acquired immune deficiency syndrome.
• Infection with C difficile

Inflammatory bowel disease can be classified into Crohn’s disease and ulcerative colitis.

Inflammatory bowel disease must be differentiated from other diseases that present with abdominal pain, fever and diarrhea which include appendicitis, diverticulitis, Whipple’s disease, mesenteric ischemia, Tropical sprue, hepatitis and spontaneous bacterial peritonitis.

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram