Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

IBD · Inflammatory Bowel Disease

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In one line

·The immune system mistakenly attacks the gut lining over and over, causing long-lasting swelling and damage.

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Normal physiology

·The gut is a muscular tube lined by a single-cell-thick barrier that absorbs nutrients, keeps bacteria and food particles contained, and blocks germs from entering the bloodstream. The immune system in the gut wall normally tolerates friendly bacteria and food proteins while attacking true pathogens.

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What goes wrong

·The immune system loses its ability to tolerate harmless gut bacteria and food, so T cells flood the gut wall and cause chronic swelling and tissue damage.

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Hallmark signs

·Diarrhea (loose, watery poops) that keeps coming back or won't go away
·Blood or mucus in the stool
·Cramping belly pain, often worse before or during a bowel movement
·Urgent need to poop, sometimes waking you up at night
·Weight loss without trying
·Fever and feeling very tired
·Sores or pain around the anus (bottom)
·Joint pain or swelling, especially in large joints like knees and ankles

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Red flags · escalate now

·Severe belly pain that doesn't ease, or a belly that becomes hard and very tender (could mean a perforation—a hole in the intestine—or severe blockage)
·Heavy rectal bleeding that soaks through toilet paper quickly or makes you dizzy (sign of major blood loss)
·High fever over 101.5°F (38.6°C) with shaking chills, especially with worsening belly pain (could mean a serious infection or abscess)
·Sudden inability to pass stool or gas, with severe cramping and vomiting (signs of a bowel obstruction)
·Signs of severe dehydration: very little urine, dark urine, extreme thirst, confusion, or a racing heart (from fluid loss through diarrhea)

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Workup

·Complete blood count (CBC)
·C-reactive protein (CRP) and red blood cell (erythrocyte) sedimentation rate (ESR)
·Fecal calprotectin
·Stool culture and testing for Clostridioides difficile, parasites, and other infections
·Colonoscopy with biopsy
·MR enterography or CT enterography
·Serology: anti-Saccharomyces cerevisiae antibodies (ASCA) and perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA)
·Albumin and pre-albumin levels

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Treatment

·5-aminosalicylic acid (5-ASA) drugs like mesalamine or sulfasalazine for mild-to-moderate ulcerative colitis
·Corticosteroids like prednisone (oral) or methylprednisolone (IV) during acute flares
·Immunomodulators like azathioprine, 6-mercaptopurine (6-MP), or methotrexate for steroid-dependent or moderate-to-severe disease
·Biologic drugs: anti-TNF agents (infliximab, adalimumab, golimumab, certolizumab), anti-integrin (vedolizumab, natalizumab), anti-IL-12/23 (ustekinumab), or JAK inhibitors (tofacitinib, upadacitinib)
·Antibiotics like metronidazole or ciprofloxacin for perianal Crohn disease, abscesses, or bacterial overgrowth
·Surgery: total colectomy (remove the entire colon) for ulcerative colitis; bowel resection or stricturoplasty (widen narrow spots) for Crohn disease
·Colon cancer surveillance: colonoscopy every 1 to 2 years starting after 8 to 10 years of disease

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NCLEX trap

·IBD means the immune system is attacking the gut wall like a confused army firing at its own fort. Anti-diarrheal drugs trap the inflamed stool inside and can make things worse—they slow the bowel but don't stop the immune attack. You must calm the immune attack first with steroids (to quiet the whole immune system fast) or biologics like infliximab or adalimumab (to block TNF-alpha, a messenger chemical that drives inflammation). Treat the cause, not just the symptom.
·Ulcerative colitis only swells the inner lining of the colon and rectum—like paint peeling off a wall. Crohn disease swells the whole gut wall (all layers, like the wall itself is rotting) and can happen anywhere from mouth to anus, plus it skips around leaving healthy patches. Surgery to remove the colon can cure ulcerative colitis because the disease never comes back once the colon is gone. But Crohn can return even after surgery because it can pop up anywhere in the digestive tract. Location and depth change the plan—mesalamine works better for ulcerative colitis, and surgery is a cure only for ulcerative colitis.
·NSAIDs and aspirin irritate the gut lining and can trigger or worsen IBD flares—they block prostaglandins (chemicals that protect the stomach and intestine lining), so the gut wall gets even more damaged. Use acetaminophen (Tylenol) for pain instead, or better yet, treat the real problem: steroids and immune-calming drugs to stop the inflammation that's causing the pain.
·A massively swollen colon in IBD is called toxic megacolon—a surgical emergency. The colon wall is so inflamed and weak it can rupture (burst open) and spill bacteria and stool into the belly, causing peritonitis (infection of the belly lining) and sepsis. Watch imaging carefully: if the colon is over 6 cm wide, the patient has fever, fast heart rate, or severe pain, call surgery immediately. Do NOT send them home.
·IBD is a whole-body autoimmune disease. The same confused immune system that attacks the gut also attacks joints (causing arthritis—swollen, painful joints), eyes (causing uveitis—redness, pain, and blurred vision), skin (causing redness (erythema) nodosum—painful red bumps on the shins or pyoderma gangrenosum—deep ulcers), and the liver (causing primary sclerosing cholangitis—scarring of the bile ducts). These are called extraintestinal manifestations and are part of the same disease process, not coincidences. Treating the IBD often helps these other problems too.
·Biologics shut down part of the immune system—specifically, they block TNF-alpha (a key messenger that fights infections and inflammation). If TB (tuberculosis bacteria hiding in the lungs or lymph nodes) or hepatitis B (a liver virus that can hide quietly for years) is hiding, the biologic will let the infection run wild and the patient can get very sick or die. Always screen with a TB blood test (QuantiFERON or T-SPOT) or skin test (PPD) and hepatitis B blood tests (HBsAg, anti-HBc) before starting biologics. If positive, treat the infection first.

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