Inflammatory Bowel Disease
Inflammatory Bowel Disease
Inflammatory Bowel Disease, (IBD), is a general term that refers to a chronic inflammatory condition of the alimentary tract. IDB is a disorder that can adopt two forms, either Ulcerative colitis or Crohn’s disease. Approximately one in six hundred people in the UK have Ulcerative Colitis, (www.ibdclub.org.uk), an inflammatory disease of the large intestine that mainly affects the colon and rectum. The inner lining, or mucosa, becomes irritated and inflamed resulting in ulcers and infections, which are typically accompanied with rectal bleeding. Crohn's disease occurs predominantly at the terminal ileum and the rectum but may become more widespread through out the digestive system. Crohn's disease affects one in a thousand people in the UK, (www.ibdclub.org.uk), and causes irritation to the mucosa and serosa resulting in inflammation of the full thickness of the intestinal wall. The inflammation may cause partial obstruction of the lumen, creating problematic blockages known as skip lesions, (Ross and Wilson. 1999). Crohn's disease may also cause the large and small intestinal walls to ulcerate and bleed. Both males and females are equally susceptible to Inflammatory Bowel Disease, with the majority of cases being diagnosed between the ages of fifteen and thirty-five. It is estimated that thirty percent of all IBD cases occur in young people between the ages of ten and nineteen years old. Jewish people of European descent are five times more likely to develop IBD than others that are part of the general population. IBD seems to be more common among city dwellers and occurs most frequently in developed countries, indicating that both genetic factors and environmental conditions, such as diet, may be involved in its development.
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Causes and symptoms of IBD
The exact cause of IBD is unknown however it is thought that genetics play a significant role as twenty-five percent of people with IBD also have family members with the disease. A recent scientific study reported that genetic abnormalities of the two disorders, Crohn's and Ulcerative Colitis, share locations and chromosomes 1, 3, 4, 7, 12 and 16. Some researchers believe that the disease can be triggered, in people who have a genetic susceptibility, by a virus or bacteria. During an immune system response the body releases T- cells, which create cytokines such as, tumor necrosis factor that damage a target area. People with IBD are thought to have an abnormal immune response that causes the healthy GI tract to be persistently attacked. White blood cells are activated by increased levels of ICAM-1, a protein found abundantly on the intestinal walls of IBD patients. Andrew J. Wakefield, an English gastroenterologist from the Royal Free Hospital in London suggested in the Journal of Medical Virology, (April 1993), that IBD was caused by the measles virus. More specifically, he stated that IBD was directly linked to the Measles, Mumps and Rubella, (MMR), vaccine routinely administered to young children. Other experts believe that environmental factors, such as diet, have a significant role in the development of IBD. Some theorise that diets high in animal fats and processed sugars increase the risk of developing bowel disorders, and that a diet high in vitamin C, fruits, fluids, and vegetables would reduce the risks.
As Crohn's disease and Ulcerative Colitis are chronic diseases there are symptom free periods, or remission, and times when symptoms flare up, also referred to as relapses. The most common symptom of IBD is diarrhoea, which may include either frank or occult blood. Some people with IBD develop constipation, in Crohn's disease this would occur as a result of an obstruction in the small intestine. Other symptoms of IBD, which may be mild or severe and disabling, include abdominal pains, fever, nausea, fatigue, loss of appetite and weight, and rectal bleeding. Complications may also occur outside of the GI tract, the most common of which is arthritic-like joint stiffness. Inflammation may develop in other areas of the body causing eye problems, mouth sores, hepatitis, and complications within the kidneys and airways. People with IBD are at an increased risk of having troublesome gallstones, psoriasis, gallbladder disease, serious blood clots, menstrual abnormalities and reduced fertility. Ulcers that occur as a result of Crohn's disease frequently result in the development of fistulas, most commonly located around the anus and rectum. Fistulas are deep channels that burrow between organs and into the surrounding tissues of the intestines, bladder and vagina forming pockets of infection or abscesses. Constant inflammation and bleeding may produce Anaemia or Strictures, (pieces of scar tissue), that would block the intestinal passages causing severe pain and vomiting. People affected with Crohn's disease are also at an increased risk of developing colon cancers. Almost half of the women that have Crohn's disease report pain during intercourse and approximately forty percent have ovarian cysts. Symptoms of Ulcerative colitis are similar to those of Crohn's disease but patients would be less likely to develop fistulas and more likely to suffer with Toxic Megacolon, a potentially fatal condition. Toxic Megacolon is a serious complication that can occur when inflammation spreads to the deeper layers of the colon. The colon may enlarge, become paralysed or in more severe cases rupture, a surgical emergency that carries a thirty percent mortality rate.
Diagnosis and treatment
In order to diagnose IBD a doctor would require a medical history of the patient, blood samples, a stool sample, and may perform a physical examination. A blood sample would be tested for elevated white blood cell levels and lowered levels of zinc, albumin and magnesium. To accurately diagnose Ulcerative Colitis or Crohn's disease other tests such as a flexible Sigmoidoscopy or Colonoscopy, Barium enema, biopsy or a small bowel X-ray may also be required. Once the type of disease has been identified a doctor will establish the severity of the IBD, a crucial factor when determining the correct treatment plan. Ulcerative Colitis is considered serious if a patient has more than six bowel movements a day, blood in their stool, fever, a rapid pulse rate, anaemia, and pain or distension of the abdomen. In cases of severe Crohn's disease a patient may display very frequent bowel movements, anaemia, weight loss, joint pain, referred pain, inflammation and feel generally unwell.
Treatment for IBD may involve surgery, drug therapy, a change of diet, and emotional support. Surgical removal of the colon may be necessary in cases of severe Ulcerative Colitis, and is currently the only cure for the disease. Surgery may be needed to prevent a large amount of bleeding, remove an obstruction or to repair perforations in the intestinal wall caused by ulceration. A combination of anti-inflammatory, antibiotic, and immunosuppressive drugs with additional vitamin and mineral supplements are also commonly used to treat the symptoms of Inflammatory Bowel Disease. The emotional consequences of IBD can be very devastating to the affected individual. Eating may become associated with pain, and chronic attacks of diarrhoea can cause social isolation and low self esteem. Normal sexual function can become impaired for emotional or physical reasons such as drug side effects or fistulas. A good support system involving health care professionals, family and friends may assist significantly in the treatment of IBD.
Although IBD is a chronic disease that has periods of remission and relapse, it is important to remember that most people have a normal life span and a good quality of life. Those people that have continuing symptoms should aim to build a good working relationship with their health care team and ensure that they remain informed about their condition and any new treatments available. It may be beneficial for an IBD patient to educate their family and friends about the disease, so that they don't feel isolated or depressed. Maintaining a healthy lifestyle, balanced diet, and regular exercise all help to decrease symptoms. Following the doctor's advice and using medication as instructed may also improve the lives of people with Ulcerative Colitis or Crohn's disease.
Wilson, Kathleen J.W., and Waugh, Anne. 1996. Ross and Wilson Anatomy and Physiology in Health and Illness. 8th edition. Churchill Livingstone. Page 325.
Tortora G.J., and Grabowski S.R.2000. Principles of Anatomy and Physiology. 9th edition. John Wiley and Sons Inc. Page 866.
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Quality of writing
Diagnosis Explain why all the tests are required, you did this for the blood sample, but you also need to explain why the others are required - medical history to see if there is any likely genetic links from family members etc. Overall The candidate has shown some knowledge, but is treating this topic more in terms of the effect rather than the cause. There are quite a lot of text which looks like it says something, but if one reads it again, a lot don't say a lot. Try to be more concise to allow space for extra details.
Level of analysis
Causes and symptoms The body does not release T cells, the T cells are activated, and they releases chemicals such as cytokines. There are a lot said about the effects of the disease, but very little mention of the mechanism of how ICAM-1 causes IBD. Does it bind to a receptor? Is is an inhibitor? - Say it is a cell surface glycoprotein and then explain how it interacts with other molecules in the cell and on other cells and ligands.
Response to question
Introduction There are two main forms of IBD, though there are many other types. In the introduction, you mentioned how common the disease is, but did not mention the effects of it - how does the disease cause discomfort to the patient? Just give a short line here and expand in subsequent paragraphs. Good references to scientific papers rather than news articles, but make sure you reference for every claim. Number your references so you can refer to them by numbers instead of inserting the whole website in parenthesis, which looks unprofessional.