{"presentation":{"slides":[{"elements":[{"x":4.357298474945534,"y":2.159827213822894,"width":91.50326797385621,"height":53.99568034557235,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

\n\t
Both are chronic granulomatous disorders <\/p>\n\t<\/li>\n\t
\n\t
Have similar clinical, endoscopic, radiologic, and histologic pictures<\/p>\n\t<\/li>\n\t
\n\t
However, the natural history of both these disorders is strikingly different<\/p>\n\t<\/li>\n\t

\n\t

Misdiagnosis may be associated with multiple problems, including unnecessary immune suppression, drug toxicity, and delay in appropriate treatment<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"a5243ef2-0cbb-4f8d-a907-624f339c9274","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":32.6797385620915,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

ITB vs Crohn\u2019s: Radiology<\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"7a345ffa-c1cb-4257-8940-9c165d0d7d2c","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":16.33986928104575,"y":10.799136069114471,"width":71.89542483660131,"height":77.7537796976242,"action":{"library":"H5P.Table 1.1","params":{"text":"

\n\t\n\t\t\n\t\t\t\n\t<\/tbody>\n<\/table>\n\n

<\/th>\n\t\t\t	<\/th>\n\t\t<\/tr>\n\t<\/thead>\n\t

\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t

Parameter<\/strong><\/span><\/td>\n\t\t\t

ITB <\/strong><\/span><\/td>\n\t\t\t

CD<\/strong><\/span><\/td>\n\t\t<\/tr>\n\t\t

Specific site of involvement<\/td>\n\t\t\t

Ileocaecal valve<\/td>\n\t\t\t

Left colon<\/td>\n\t\t<\/tr>\n\t\t

Length<\/td>\n\t\t\t

Short segment<\/td>\n\t\t\t

Long segment<\/td>\n\t\t<\/tr>\n\t\t

Multiple site<\/td>\n\t\t\t

Uncommon (<4)<\/td>\n\t\t\t

Common<\/td>\n\t\t<\/tr>\n\t\t

Skip lesions<\/td>\n\t\t\t

Uncommon<\/td>\n\t\t\t

Common<\/td>\n\t\t<\/tr>\n\t\t

Enhancement<\/td>\n\t\t\t

Homogeneous<\/td>\n\t\t\t

Stratified<\/td>\n\t\t<\/tr>\n\t\t

Fistulae<\/td>\n\t\t\t

Rare<\/td>\n\t\t\t

Common<\/td>\n\t\t<\/tr>\n\t\t

Mesenteric abscess<\/td>\n\t\t\t

Very rare<\/td>\n\t\t\t

May be seen<\/td>\n\t\t<\/tr>\n\t\t

Strictures<\/td>\n\t\t\t

Concentric<\/td>\n\t\t\t

Eccentric and sacculations<\/td>\n\t\t<\/tr>\n\t\t

Fibrofatty proliferation<\/td>\n\t\t\t

Rare<\/td>\n\t\t\t

Common<\/td>\n\t\t<\/tr>\n\t\t

Mesenteric nodes<\/td>\n\t\t\t

Larger, necrotic<\/td>\n\t\t\t

Small, homogeneous<\/td>\n\t\t<\/tr>\n\t\t

Omental involvement<\/td>\n\t\t\t

Common<\/td>\n\t\t\t

Rare<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n

<\/div>\n"},"subContentId":"5d5e08bf-891b-4e50-baba-60bd2e5c0965","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":66.44455337690633,"y":92.96544276457882,"width":33.551198257080614,"height":6.695464362850972,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Sharma R. Indian J Radiol Imaging<\/span>. 2016;26(2):161\u2013172. <\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"93e784c1-199c-4778-ac0d-b264d56b6d33","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":32.6797385620915,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

ITB vs Crohn\u2019s: Histopathology<\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"2e46a933-9a96-425d-b8b7-5aa29fc94931","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":86.05664488017429,"y":79.91360691144709,"width":11.982570806100219,"height":15.11879049676026,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Rathi P, Gambhire Assoc Physicians India 64: 38\u201347.<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"6ecd22d0-ae95-447f-9f32-ad58facf8690","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":12.958963282937365,"width":79.520697167756,"height":84.23326133909288,"action":{"library":"H5P.Table 1.1","params":{"text":"

\n\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t
Tuberculosis granuloma<\/strong><\/span><\/td>\n\t\t\t Granuloma in Crohn\u2019s disease<\/strong><\/span><\/td>\n\t\t<\/tr>\n\t\t
Caseating<\/td>\n\t\t\t Non-caseating<\/td>\n\t\t<\/tr>\n\t\t
Organisms seen on AFB staining (5 to 15 % cases)<\/td>\n\t\t\t Not seen<\/td>\n\t\t<\/tr>\n\t\t
5 or more granulomas in biopsies from one segment<\/td>\n\t\t\t Infrequent (< 5) granulomas in biopsies from one segment<\/td>\n\t\t<\/tr>\n\t\t
Granuloma larger than 400 \u03bcm in diameter<\/td>\n\t\t\t Granuloma usually less than 200 \u03bcm in diameter<\/td>\n\t\t<\/tr>\n\t\t
Granulomas located in the submucosa or in granulation tissue, often as palisaded epithelioid histiocytes, and disproportionate sub mucosal inflammation.<\/td>\n\t\t\t Granulomas located in the mucosa. Poorly organized and discrete or isolated. Micro granulomas, or aggregates of histiocytes and crypt centred inflammation such as pericryptal granulomas and focally enhanced colitis is a feature.<\/td>\n\t\t<\/tr>\n\t\t
Confluent granulomas<\/td>\n\t\t\t No confluent granulomas<\/td>\n\t\t<\/tr>\n\t\t
lymphoid cuff around granulomas<\/td>\n\t\t\t No confluent granulomas<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n<\/div>\n"},"subContentId":"0a73d45b-3882-4e57-bcb7-941b6cc2ce42","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":32.6797385620915,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
ITB vs Crohn\u2019s : Trial of ATT <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"e458bd55-a99c-4342-8373-901ebe3ae2f0","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.443790849673203,"y":12.992699784017278,"width":91.50326797385621,"height":82.07343412526998,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
A definitive diagnosis of ITB or CD may not be possible in all cases despite adequate evaluation<\/p>\n\t<\/li>\n\t
\n\t
If wrongly diagnosed as CD, the outcome may be catastrophic<\/p>\n\t<\/li>\n\t
\n\t
Such patients may benefit from a therapeutic trial of ATT <\/strong><\/p>\n\t<\/li>\n\t
In a recent study which evaluated therapeutic ATT for differentiation of ITB from CD revealed the following findings:<\/li>\n<\/ol>\n\n
\n\t
In patients with ITB, clinical response was seen in 94% at 3 months and in 99% at the end of 6 months.<\/li>\n\t
All IT patients had mucosal healing at the end of ATT, while only 5% of CD patients showed mucosal healing. <\/li>\n\t
Interestingly in patients with CD, symptom response was seen in 38% and 37% in patients at 3 and 6 months, respectively. This may be due to the waning and waxing nature of CD<\/li>\n<\/ul>\n"},"subContentId":"34f4d729-6112-4922-bda7-af63fba4ad30","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":46.83954248366013,"y":89.38250539956803,"width":51.19825708061002,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Pratap Mouli V et al. Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn\u2019s disease. Aliment Pharmacol<\/span><\/span> Ther. 2017;45<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"7a2ae24f-4107-43ae-a5c0-851a5d8535d5","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":32.6797385620915,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
ITB vs Crohn\u2019s : Trial of ATT <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"af5eaed3-133e-4167-a874-47120c251294","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":19.43844492440605,"width":66.44880174291939,"height":74.94600431965443,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b68fa146f50.png","mime":"image\/png","copyright":{"license":"U"},"width":1302,"height":745}},"subContentId":"df5c25c4-b52e-4667-865e-37e5f59cd9b4","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":72.98474945533769,"y":38.8768898488121,"width":23.74727668845316,"height":32.39740820734341,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
Symptomatic response to ATT in CD and ITB<\/li>\n\t
Changes observed on colonoscopy after ATT in CD and ITB <\/li>\n<\/ol>\n"},"subContentId":"7d47cd7e-3ab0-458e-bf0f-04f152a30b55","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":16.33986928104575,"y":15.11879049676026,"width":4.357298474945534,"height":8.639308855291576,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b68ff4641d1.png","mime":"image\/png","copyright":{"license":"U"},"width":128,"height":128}},"subContentId":"b6f84d89-c1ad-4f84-8978-bd8b454082bc","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":53.37690631808279,"y":15.11879049676026,"width":4.357298474945534,"height":8.639308855291576,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b69003be65d.png","mime":"image\/png","copyright":{"license":"U"},"width":128,"height":128}},"subContentId":"0cc2fc30-b72e-4d0e-86b0-b5db151ea54c","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.443790849673203,"y":6.490734341252699,"width":45.751633986928105,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Therapeutic Trial of ATT: Monitoring <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"15a4fca9-188e-4dff-a64b-1ad1d3c2c9da","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":41.39150326797385,"y":84.31771058315334,"width":56.64488017429194,"height":13.174946004319654,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Pratap Mouli V et al. Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn\u2019s disease. Aliment Pharmacol<\/span><\/span> Ther. 2017;45<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"9ec39d1e-4ad9-4812-8a3c-b7e1dd0d9899","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.3544662309368185,"y":15.146911447084232,"width":90.41394335511983,"height":28.077753779697623,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
Therefore, persistent symptoms after 8-12 weeks of ATT may indicate a diagnosis of CD <\/p>\n\t<\/li>\n\t
\n\t
However, the presence of a clinical response to ATT does not exclude the possibility of CD and mucosal healing should be sought.<\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"f5bd53c6-151a-46b2-92bc-d70f3f290443","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.443790849673203,"y":6.490734341252699,"width":45.751633986928105,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
ITB vs Crohn\u2019s : Clinical algorithm <\/span><\/span><\/strong><\/span><\/p>\n"},"subContentId":"350732a4-8e9f-475f-bfbf-dcd7eda47e81","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":49.0181917211329,"y":84.40194384449245,"width":49.01960784313726,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Pratap Mouli V et al. Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn\u2019s disease. Aliment Pharmacol<\/span><\/span> Ther. 2017;45<\/span><\/span><\/span><\/span><\/span><\/p>\n"},"subContentId":"8bc2d65a-660f-42d0-8841-ddbf38ec2e57","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":15.11879049676026,"width":47.167755991285404,"height":75.5939524838013,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64b690ce0cf50.png","mime":"image\/png","copyright":{"license":"U"},"width":1022,"height":828}},"subContentId":"ec8392d2-941d-40fe-9752-316352b3fe6b","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}}],"keywordListEnabled":true,"globalBackgroundSelector":{},"keywordListAlwaysShow":false,"keywordListAutoHide":false,"keywordListOpacity":90},"override":{"activeSurface":false,"hideSummarySlide":false,"summarySlideSolutionButton":true,"summarySlideRetryButton":true,"enablePrintButton":false,"social":{"showFacebookShare":false,"facebookShare":{"url":"@currentpageurl","quote":"I scored @score out of @maxScore on a task at @currentpageurl."},"showTwitterShare":false,"twitterShare":{"statement":"I scored @score out of @maxScore on a task at @currentpageurl.","url":"@currentpageurl","hashtags":"h5p, course"},"showGoogleShare":false,"googleShareUrl":"@currentpageurl"}},"l10n":{"slide":"Slide","score":"Score","yourScore":"Your Score","maxScore":"Max Score","total":"Total","totalScore":"Total Score","showSolutions":"Show solutions","retry":"Retry","exportAnswers":"Export text","hideKeywords":"Hide sidebar navigation menu","showKeywords":"Show sidebar navigation menu","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","prevSlide":"Previous slide","nextSlide":"Next slide","currentSlide":"Current slide","lastSlide":"Last slide","solutionModeTitle":"Exit solution mode","solutionModeText":"Solution Mode","summaryMultipleTaskText":"Multiple tasks","scoreMessage":"You achieved:","shareFacebook":"Share on Facebook","shareTwitter":"Share on Twitter","shareGoogle":"Share on Google+","summary":"Summary","solutionsButtonTitle":"Show comments","printTitle":"Print","printIngress":"How would you like to print this presentation?","printAllSlides":"Print all slides","printCurrentSlide":"Print current slide","noTitle":"No title","accessibilitySlideNavigationExplanation":"Use left and right arrow to change slide in that direction whenever canvas is selected.","accessibilityCanvasLabel":"Presentation canvas. Use left and right arrow to move between slides.","accessibilityProgressBarLabel":"Choose slide to display","containsNotCompleted":"@slideName contains not completed interaction","containsCompleted":"@slideName contains completed interaction","slideCount":"Slide @index of @total","containsOnlyCorrect":"@slideName only has correct answers","containsIncorrectAnswers":"@slideName has incorrect answers","shareResult":"Share Result","accessibilityTotalScore":"You got @score of @maxScore points in total","accessibilityEnteredFullscreen":"Entered fullscreen","accessibilityExitedFullscreen":"Exited fullscreen","confirmDialogHeader":"Submit your answers","confirmDialogText":"This will submit your results, do you want to continue?","confirmDialogConfirmText":"Submit and see results","slideshowNavigationLabel":"Slideshow navigation"}}

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Management of Intestinal TB vs Chrons' Disease

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Management of Intestinal TB vs Chrons' Disease

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