Pouchitis (Part I): Diagnosis and Management for Sx Residents. Part 4 of IBD Series. скачать в хорошем качестве

Pouchitis (Part I): Diagnosis and Management for Sx Residents. Part 4 of IBD Series.

#pouchitis #ulcerativecolitis #ibdawareness #chronicillness #digestivehealth #autoimmunedisease #inflammatoryboweldisease #colitisawareness #surgicalresidents #IBDseries #diagnosisandmanagement #medicaleducation #gastroenterology #surgerytraining Pouchitis Diagnosis and Management for Surgery Residents Pouchitis is an inflammatory condition that affects patients who have undergone ileal pouch-anal anastomosis (IPAA) surgery, commonly performed in the treatment of ulcerative colitis. As surgery residents, understanding the diagnosis and management of pouchitis is crucial for providing comprehensive care to your patients. Here's a brief overview: Diagnosis: Clinical Presentation: Patients may present with symptoms resembling ulcerative colitis, such as increased frequency of bowel movements, urgency, abdominal cramps, and bloody diarrhea. Persistent or recurrent symptoms after IPAA surgery should raise suspicion. Endoscopy: Colonoscopy with pouchoscopy is the gold standard for diagnosis. It allows direct visualization of the pouch mucosa and assessment of inflammation. Pouchitis is typically defined by endoscopic and histologic criteria, such as increased vascularity, friability, and erosions. Biopsy: Histological evaluation of pouch mucosal biopsies can confirm the diagnosis and rule out other conditions. Clinical Scoring Systems: Disease activity can be assessed using scoring systems like the Pouchitis Disease Activity Index (PDAI), which considers clinical, endoscopic, and histologic parameters. Management: Antibiotics: Antibiotics are the first-line treatment for pouchitis. Ciprofloxacin and metronidazole are commonly used. They are effective in approximately 70-80% of cases. Combination therapy may be necessary for refractory cases. Biologics: In patients who don't respond to antibiotics, anti-TNF biologics such as infliximab can be considered. They have shown promising results in the management of refractory pouchitis. Probiotics: There is some evidence to support the use of probiotics to prevent pouchitis, but their role in treatment is less well-defined. Dietary Modification: Dietary changes like a low-residue diet or avoiding specific trigger foods may help manage symptoms. Regular Follow-up: It's essential to follow up with patients to assess treatment response and disease activity. This includes clinical assessment, endoscopy, and histology as needed. Surgical Revision: In severe, unresponsive cases or when complications like fistulas, strictures, or abscesses develop, pouch revision or even pouch excision may be necessary. Patient Education: Educate patients on the chronic nature of pouchitis, the importance of adherence to treatment, and when to seek medical attention for worsening symptoms. Psychosocial Support: Living with pouchitis can be challenging, and patients may benefit from psychological support to cope with the condition's impact on their quality of life. Understanding the diagnosis and management of pouchitis is essential for surgery residents as it helps ensure timely and effective care for patients who have undergone IPAA surgery. Early recognition, appropriate treatment, and ongoing follow-up are key to improving patients' outcomes and quality of life. Disclaimer: Please be aware that surgical procedures depicted in this video and on this channel may contain graphic and explicit content, including images of real surgical operations. Viewer discretion is advised, and the video should only be accessed by those who are prepared for such visual content. The information shared in this video tutorial is meant for general education and information of surgery trainees only, and is not a substitute for expert opinion. The cases shown here are for discussion and demonstration only and may not match the real-life scenario. Some parts of surgery may have been modified for the interest of demonstration. Before making any decision, viewers should take advice from experts and refer to the official Govt websites, standard medical journals, and books. No one should start or stop any treatment based on the knowledge available on the internet, YouTube, Google, etc. Always consult the experts and take proper advice for any doubts or clarifications. Also, viewers are requested to keep updated on local developments in their area and follow local authorities’ guidelines. Stay Informed, Stay Healthy. Happy Learning! Thanks & Regards. Sincerely Yours, Dr Strange MCh (HPB & GI Sx) & Team.