etiology pathology diagnosis treatment surgery

1. Crohn’s Disease
Adhil Hasbulla
119i4a
Surgical Diseases

2. Introduction
• Is an idiopathic, chronic regional enteritis that most commonly affects
the terminal ileum but has the potential to affect any part of the
gastrointestinal tract from mouth to anus.
• Untreated CD is characterized by chronic transmural inflammation,
involvement of discontinuous segments of the intestine (skip areas),
and, in a proportion of cases, by non-necrotizing granulomas
composed of epithelioid histiocytes.
• Patients present with a range of symptoms, including crampy
abdominal pain and diarrhea, which may be complicated by intestinal
fistulas, particularly after surgical intervention, by intramural
abscesses, and by bowel obstruction.
• Also called regional ileitis.

3. Cobblestone change of
the mucosa of the
terminal ileum.
Caseation is characteristically absent.

5. Etiology
• INFECTIOUS AGENTS.
Mycobacterium paratuberculosis
Measles virus
• IMMUNOLOGICAL FACTORS.
Autoimmunity focal ischemia
• GENETIC FACTORS
Relatively high incidence in Ashkenazi jaws.
• SMOKING
• DIET
Increase intake of hydrates, animal protein, polyunsaturated fatty acids
etc.

6. Clinical Features
• Crampy, lower right quadrant or periumbilical pain that is often
relieved by defecation – Some patients report more diffuse and
constant pain.
• Stage of fistula formation
• Prolonged nonbloody diarrhea with accompanying weight loss and
possible malabsorption syndromes – If the colon is involved, the
diarrhea may contain blood, mucus, and pus.
• Low-grade fever and feeling of general fatigue and malaise
• In pediatric patients, unexplained growth failure in addition to the
above symptoms
Extraintestinal features are common and include the following:
• Ocular manifestations (uveitis, recurrent iritis, and episcleritis)
• Dermal manifestations (erythema nodosum, pyoderma gangrenosum,
and Sweet syndrome)
• Inflammatory seronegative arthropathies (sacroiliitis, ankylosing
spondylitis, psoriatic arthritis, and reactive arthritis) [37]

8. EPISCLERITIS
SWEET
SYNDROME

9. Diagnosis
• Laboratory findings
a. Anemia —caused by iron, vitamin B12, or folate deficiency.
b. Hypoalbuminemia
c. Tests of bowel function (D-xylose absorption, bile acid breath test)
are abnormal with extensive disease.
• Radiographic findings
a. Upper GI with enteroclysis
(1) Narrowed terminal ileum (Kantor’s string sign)
(2) Fistulas
(3) Nodules, sinuses, clefts, linear ulcers

10. b. Barium enema
(1) Thickened bowel wall, longitudinal ulcers, transverse fissures,
cobblestone formation, and rectal sparing
(2) Terminal ileum may contain strictures (string sign)
c. Abdominal computed tomography
(1) Intra abdominal abscesses
(2) Thickened bowel wall
(3) Fistulas— enterovesical or enteroentero
• Endoscopy
a. Esophagogastroduodenoscopy
b. Colonoscopy
(1) Normal rectum (rectal sparing) in 40% to 50% of patients

11. Characteristic lesions
(a) Aphthous ulcers or Canker Sore
(b) Mucosal ulcerations
(c) Anal fissures
(d) Cobblestoning
Chronic inflammation may ultimately lead to fibrosis, strictures, and
fistulas in either small or large intestine.
(e) Segmental (skip) lesions

12. Treatment
• Aminosalicylates- oral agent (mesalamine) used for mild-to-moderate
disease.
• Antibiotics
a. Decrease intraluminal bacterial load
b. Metronidazole—reported to improve Crohn’s colitis and perianal
disease.
c. Fluoroquinolones—may be effective in some cases.
• Corticosteroids—acute exacerbations
• Immunosuppressants

14. Differential Diagnosis
• Crohn disease versus ulcerative colitis
• Infectious disease
• Drugs-induced colitis
• Conditions with small bowel fissuring ulcers
• Diverticular disease
• Ischemic changes
CT, MRI, Endoscopy and Ballon-assisted Enteroscopy.

15. Crohn's disease of the small bowel detected
with capsule endoscopy: (A) normal small
bowel mucosa, (B) aphthous ulceration, (C)
linear ulcers, and (D) ulcerated stenosis