Inflammatory bowel diseases: ulcerative colitis and Crohn’s disease, and other types of colitis
1. Big picture
Inflammatory bowel disease (IBD) mainly means ulcerative colitis (UC) and Crohn’s disease (CD). For a surgery state exam, the key question is not only “What is IBD?” but:
When does a medical disease become a surgical disease?
The surgical logic is:
Chronic diarrhoea ± blood/mucus + abdominal pain → suspect IBD → confirm with endoscopy/biopsy + exclude infection → treat medically first → operate for complications, cancer risk, emergency deterioration, or failed medical therapy.
The most important distinction:
| Feature | Ulcerative colitis | Crohn’s disease |
|---|---|---|
| Distribution | Colon and rectum only | Anywhere mouth to anus, commonly terminal ileum ± colon |
| Pattern | Continuous, starts in rectum | Skip lesions |
| Depth | Mucosa/submucosa | Transmural |
| Classic symptom | Bloody diarrhoea | Crampy abdominal pain, diarrhoea, weight loss |
| Fistulas/strictures | Uncommon | Common |
| Surgery | Can be curative if colon/rectum removed | Not curative; bowel-sparing surgery for complications |
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