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1. Crohn Disease
Is a transmural process that can result in mucosal inflammation and ulceration, stricturing, fistula
development and abscess formation.
Dr. Demba Keita

2. General Considerations
1/3 of cases involved the terminal ileum(ileitis)
½ of all cases involved the small bowl and the colon(ileocolitis)
20% of cases involved the colon only.
1/3 of patients have associated perianal Disease
Less than 5% have symptomatic involment of the upper intestinal tract.
Dr. Demba Keita

3. Clinical Findings
(Symptoms and Signs)
• Fevers
• The patients general sense of well-being
• Weigh Loss, and lost of energy
• Abdominal Pain
• Number of bowel liquid movements per day
• Abdominal Tenderness
Dr. Demba Keita

4. Clinical Findings
(Clinical Constellations)
• Chronic Inflammatory Disease
• Intestinal Obstruction
• Penetrating Disease and Fistulae
• Perianal Disease
• Extraintestinal Manifestations
Dr. Demba Keita

5. Chronic Inflammatory Disease
• Most common form of Crohn
• Malaise , weigh loss
• In Ileocolitis Diarrhea usually nonbloody and intermitent
• In Colitis there may be bloody diarrhea and fecal urgency which may mimic the
symptoms of ulcerative colitis
Dr. Demba Keita

6. Intestinal Obstruction
• its due to mainly fibrotic stenosis
• postprandial bloating
• cramping pain
• loud borborygmi.
Dr. Demba Keita

7. Penetrating Disease and Fistulae
• Intra-abdominal retroperitoneal phlegmon or abscess manifested by
fever,chills, tender abdominal mass and leukocytosis
• Fistulas-small intestine-the colon.
• Fistulas-small intestine-bladder
Dr. Demba Keita

8. Perianal Disease
• anal fisuras
• perianal abscess
• fistulas
Dr. Demba Keita

9. Extraintestinal Manifestations
• Arthralgia
• Artritis
• Iritis or uveítis
• Pyoderma gangrenosum or Eritema Nodosum
• Oral Aphthous lesions are common.
Dr. Demba Keita

10. Laboratory Findings
• Complete blood count
• Serum Albumin
• Sedimentation Rate
• C- Reactive Protein
• Fecal Lactoferrin or Calprotectin levels
• Stool specimens examinations for pathogens

11. Specific Diagnostic
• Colonoscopy
• Endoscopy
• Mucosal Biopsies
• CT or MRI Enterography or Barrium upper Gastrointestinal Series
Dr. Demba Keita

12. Complications
• Abscess
• Obstruction
• Abdominal and Rectovaginal Fistulas
• Perianal Disease
• Carcinoma
• Hemorrhage
• Malabsorpcion
Dr Demba Keita

13. Differncial Diagnosis
• Irritable Bowel Syndrome
• Celiac Disease
• Appendicitis
• Intestinal Lymphoma
• Patients with undiagnose AIDs
• Intestinal Tuberculosis
• Ischemic Colitis
• Diverticulitis with Abscess
• NSAID-induced colitis
Dr. Demba Keita

14. Treatment of Active Disease
• Choice of Therapy depend on:
1. Disease Location
2. Severity
3. Patients Age
4. Comorbilities
5. Patients Preference
Dr. Demba Keita

15. A: Nutrition
• Diet
• Enteral Therapy
• Total Parenteral Nutrition Dr. Demba Keita

16. B. Symptomatic Medication
• Secretory induced Diarrhea responds to Cholestyramine 2-4g, Colestipol 5g, or
colesevelam 625mg one to two times daily before meal to bile malabsorbed bile salts.
• Antidiarrheal agents: Loperamide(2-4mg), Diphenoxylate with atropine or
tincture of opium(5-15drops) may be needed as needed up to 4times daily.
Dr. Demba Keita

17. Specific Drug Therapy
• 5-Aminosalicylic and Agents:
• Antibiotics
• Corticosteriods
• Immunomodulating Drugs
• Anti-TNF therapies
• Anti-integrins
Dr. Demba Keita

18. Indications for Surgery
• Over 50% of patients will need one surgical procedure ,main surgical
indications are:
1. Intra-abdominal Abscess
2. Massive Bleeding
3. Symptomatic Refractory internal or Perianal Fistulas
4. Intestinal Obstruction
Dr. Demba Keita

19. Prognosis
• Most patients live a productive lives with medical therapies and few die as direct
consequence of the Disease .
Dr. Demba Keita

20. THANKS