crohn disease

1. Definition it is a conditions characterized by chronic idiopathic I
inflammation of bowel.
. Inflammation limited to mucosal layer of colon.
Full thickness inflammation involving any part of the Gl
tract mouth to anus)

3. CD vs UC

4. EPIDEMIOLOGY
• It can affect any part of GIT from mouth to anus.
• most common in North America and Northern Europe
with annual incidence of 8 per 100 000.
• Prevalence of around 145 per 100 000 in UK.
• most commonly diagnosed between the ages of 25 and
40 years.
• especially prevalent 3 to 5times higher in the ashkenazi
Jews.

5. EPIDEMIOLOGY
Cosnes et al, 2011

6. AETIOLOGY
• Exact cause unknown.
• Family history.
• Genetic.
• environment.
• Infection.
• Smoking.

7. RISK FACTORS

8. PATHGENESIS OF CD

9. CLINICAL FEATURES
• Anorexia, Nausea ,vomiting.
• Fever.
• Diarrhea.
• blood in stool.
• Colicky abdominal pain.
• Weight loss.
• Perianal disease.
• Intestinal obstruction.
• Peritonitis.

10. CLINICAL FEATURES
• Gut perforation
• Enterocutaneous fistula
• Perianal fistula.
• Rectal bleeding
• Growth failure
• Malnutrition, vitamin deficiencies

11. Extraintestinal manifestations
• Amyloidosis.
• osteoporosis
• Joint pain.
• Iritis. uveitis
• aphtous ulcers, dysphagia.
• Sclerosing cholangitis.
• erethema nodosum. pyoderma gangrenosum

13. PATHOLOGY
• characterized by skip lesions, adhesions &
fistulas between gut loops.
• cobblestone appearance on endoscopy and
contrast studies.
• creeping fat appearance on inflamed part of
bowel.

14. PATHOLOGY
• Aphthous ulcerations.
• mucosal ulceration
• Focal crypt abscesses.
• giant cell Granuloma.
• Submucosal or subserosal lymphoid aggregates.
Fissure,fistula,abscess formation

15. Clinical Features
Clinical Feature Ulcerative Colitis Crohn's
Inflammation Superficial,
continuous
Full thickness, patchy
Mucosal Ulcers
Superficial Deep, linear
Involvement Rectum, colon mouth to anus
Extra-intestinal Yes Yes
Fistulas No Yes
Symptoms Bloody diarrhea,
urgency
Diarrhea, pain, weight loss

16. Normal colon

18. WORK UP
• BLOOD TESTS
• ENDOSCOPY
• ULTRASOUND STUDY
• CT SCAN
• MRI

19. LABORATORY TESTS
CBC,RFT,LFT,CRP.
ESR-elevated
Anemia
Leukocytosis
hypoalbuminemia
Stool RE

20. Colonoscopy

24. CT Enterography

25. Medical TREATMENT

26. MEDICAL TREATMENT
• Antibiotics. metronidazole, ciprofloxacin
• Antidiarrheal Agents. Loperamide,diphenoxylate.
• Bile acid sequestrants .cholestyramine, colestipol
• Anticholinergic agents.dicyclomine,hyoscyamine,
propantheline

27. MEDICAL TREATMENT
5-ASA AGENTS
• Mesalamine. small bowel
• Mesalazine Asacol,Pentasa
• Olsalazine (5-ASA dimer cleaves in colon)

28. MEDICAL TREATMENT
2-CORTICOSTEROID
• induce remission in 70–80% of cases .
• Not used for maintenance.
• Prednisone (40-60 mg/day) acute episode.
• Budesonide ileal or right-side colonic disease

29. MEDICAL TREATMENT
3-immunosuppressive agents .
• Mercaptopurine used for maintenance theraphy
• Cyclosporine used for remission.

30. MEDICAL TREATMENT.
4-MONOCLONAL ANTIBODIES
Suppress cell mediated immunity,
Infliximab pediatric Crohn disease.
adalimumab TNF-α blocker.
Natalizumab, Vedolizumab
binds α4β7 and α4β1 receptors WBCs
Less side effects
Contraindications Active infection, tuberculosis ,history of
malignancy

31. Indications of surgery in CD
recurrent intestinal obstruction.
persistent or massive acute bleeding.
perforation of the bowel.
failure of medical therapy.
steroid dependent disease.
intestinal fistula.
perianal disease (abscess, fistula, stenosis).
malignant change.

32. OPERATIONS DONE for CD
• Strictureplasty
• Ileocaecal resection
• Segmental resection
• Proctectomy and proctocolectomy.
• Colectomy and ileorectal anastomosis
• Subtotal colectomy and ileostomy
• Temporary loop ileostomy.

33. INDICATIONS OF ILEOSTOMY
• current high-dose steroid therapy (≥10mg prednisolone
for ≥4 weeks before surgery);
• current preoperative monoclonal antibody therapy;
• preoperative significant weight loss (>10% premorbid
weight).
• pre-existing abdominal sepsis (notably abscess or fistula);
• serum albumin <32 g/L.