Crohn’s Disease
|
CROHN’S DISEASE/ REGIONAL ENTERITIS GRANULOMATOUS COLITIS / TERMINAL ILEITIS |
|
|
|
Can affect any part of GIT, but me sites – terminal ileum, ileocecal valve, and cecum |
|
|
|
HLA-DR1/DQw5 |
|
|
|
|
|
|
Morphology |
||
|
Skip lesions |
|
|
|
Thick bowel wall |
|
|
|
Strictures common |
|
|
|
Transmural inflammation |
|
|
|
Non caseating granulomas (35%) |
|
|
|
Moderate pseudopolyps |
|
|
|
Deep, knife-like ulcers |
|
|
|
Fibrosis, serositis – marked |
|
|
|
Perianal disease – painful skin tags, anal fissures, perianal abscesses, fistulas |
|
|
|
Rectum mostly spared |
|
|
|
|
|
|
Clinical features |
||
|
Intermittent mild diarrhea, fever, abdominal pain (MC) Right lower quadrant mass, weight loss, anemia Sometimes mimics appendicitis or bowel perforation |
|
|
|
Anal complaints (fissure, fistula, abscess) – frequent |
|
|
|
Less incidence of perforation |
|
|
|
Fat/vitamin malabsorption present |
|
|
|
Malignant potential + with colon involvement |
|
|
|
Recurrence after surgery common |
|
|
|
Toxic megacolon – not common |
|
|
|
Investigations |
||
|
70% ASCA +ve (anti Saccharomyces cerevisiae Ab) 10% pANCA positive |
|
|
|
Barium meal follow through or small bowel enema
|
|
|
|
|
|
|
Treatment |
||
-first-line agents to induce remission in moderate to severe disease and to maintain remission
|
||
Exam Question
- Most common cause of death in Crohn’s disease is due to Malignancy.
- A 26 year old man has had Crohn’s disease of the ileum for 10 months and has been treated with several drugs. He now suffers from muscle weakness, centripetal obesity, and a round, plethoric face. These side effects are most likely associated with the long-term use of Prednisone.
- Crohn’s disease is frequently associated with “skip lesions,” discontinuous areas of active disease in the colon and small intestine with intervening segments that appear normal..
- Pseudopolyps are more commonly found in ulcerative colitis than Crohn’s disease..
- Crohn’s disease may be caused by Clostridium Difficile.
- String sign of Kantor is seen in Crohn’s Disease.
- The endoscopic finding which suggests crohns in a patient with chronic diarrhea among the following is Anorectal lesions.
- Comb sign in CT abdomen is seen in Crohn’s Disease.
- Creeping fat is a feature of Crohn’s Disease.
- Skip granulomatous lesions ,Transmural involvement,Cobblestone appearance,Crypt Abscess ,Fissuring ulcer ,hrough and through involvement of thickness of bowel wall are seen in Crohn’s Disease.
- Extra intestinal manifestations of Crohn’s disease: Migratory polyarthritis,Sacroiliaitis , Hepatic pericholangitis , Clubbing , Ankylosing spondylitis,Erythema Nodosum,Uveitis ,Primary sclerosing cholangitis.
- Anti-Saccharomyces cerevisiae antibodies are seen in Crohn’s Disease.
- Skip lesions of colon with epitheloid granuloma are usually seen with Crohn’s Disease.
- Fistula is most common in – Crohn’s Disease.
- Yellowish exudates at multiple sites seen in colonoscopy indicates Crohn’s Disease.
- Megaloblastic anemia is seen in Crohn’s Disease.
- The established biological therapy for Crohn’s disease is Anti TNF alpha-antibody.
- Immumodulators used in Crohn’s disease :-i) Anti-TIVF-a : Infliximab, adalimumab, certolizumbab ii)Anti-Integrin therapy : Natalizumab.
- An eight year old boy had abdominal pain, fever with bloody diarrhea for 18 months. His height is 100 ems and weight is 14.5kg. Stool culture was negative for known enteropathogens. The sigmoidoscopy was normal. During the same period, child had an episode of renal colic and passed urinary gravel. The mantoux test was 5 x 5 mm. The most probable diagnosis is Crohn’s Disease.
- 14 year old girl with history of abdominal pain (periumbilical), postprandial, passing blood in stools, fever, weight loss since ten months. She also has episodes of passing blood in stools. Crohn’s Disease may be the likely diagnosis.
- A patient gives chronic history of diarrhoea and blood in stool presents with multiple fistulae in the perineum and multiple stricture in small intestine. The diagnosis is Crohn’s Disease.
- Inflammatory bowel disease found in children is Ulcerative Colitis and Crohn’ Disease.
- In a 27 yr old male most common cause of a colovesical fistula would be Crohn’ Disease.
- A patient of Crohn’s Disease, underwent resection anastomosis. Now presents on 7th post-op day with anastomotic site leak from a fistula. Everyday leakage volume adds up to 150-200m1. There is no intraabdominal collection and the patient is stable without any complaints. The next line of management would be:Do conservative treatment and leave him and hope for the spontaneous resolution.
- Crohn’s disease can be seen in Mouth to anus.
- A patient with Crohn’s disease was opened for and an inflammed appendix found. The treatment of choice is Appendicectomy.
- Reccurence is common after surgery in Crohn’s Disease.
- Transmural inflammation is seen in Crohn’s Disease.
- Crohn’s Disease is not a commoner cause of intestinal perforation.
- Enteo-enteric fistula is seen in Crohn’s Disease.
- First radiological sign of Crohn’s disease in terminal ileum is Aphthoid Ulceration.
- Terminal ileum is MOST commonly affected by Crohn’s Disease.
Don’t Forget to Solve all the previous Year Question asked on Crohn’s Disease
