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CROHN’S DISEASE
NEHA BETTY ISSAC
Introduction
Crohn’s disease is a type of inflammatory bowel disease (IBD).
It is a
• Chronic
• Multifocal
• Relapsing and
• Progressive
Inflammatory bowel disease – can involve any region of GIT
• Hence called regional enterocolitis
Morphology
Gross morphology
• Sites
• Anywhere from mouth to anus
• Most commonly in
• Terminal ileum
• Ileocaecal valve
• Cecum
• Number: multiple, sharply demarcated – skip lesions
• Adhesions: involved loops may adhere to eachother
• Mucosal lesions
aphthous ulcer  fissures 
fistula
• Mucosa shows oedema and loses
normal mucosal fold
• Cobble stone appearance
(oedematous islands of normal
mucosa between ulcers)
• Intestinal wall – fibrotic
thickening – rubbery – narrow
lumen – string sign
• Serositis – red, opaque,
hyperemic
Microscopy
• Mucosal ulcers and inflammation
mucosa and submucosa show oedema,
lymphocytes and plasma cell infiltrates – aphthous
ulcers
• Crypt abscesses
Clusters of neutrophils within the crypt – damage
crypt epithelium
• Branching of mucosal crypts due to repeated
cycles of crypt destruction and regeneration
• Epithelial metaplasia
• Pseudo-pyloric metaplasia – looks like gastric
antrum – development of glands
• Paneth cell metaplasia – usually absent in colon
• Non caseating granulomas
• Submucosal granuloma
• Poorly differentiated
• Focal aggregates of epithelioid cells
• Surrounded by thin rim of lymphocytes
• Multinucleated giant cells may be present
• Chronic inflammation involving all layers of the intestinal wall
• Lymphoid aggregates in submucosa or subserosa
Clinical Features
• Intestinal:
• Mild diarrhoea
• Fever
• Abdominal pain
• Extraintestinal:
• Uveitis
• Migratory polyarthritis, Ankylosing spondylitis, sacroiliitis
• Erythema nodosum
• Clubbing of fingers
• About 20% present with
• Acute right lower quadrant pain
• Fever
• Bloody diarrhoea
• Periods of active disease are interrupted by asymptomatic periods
• Disease may be reactivated by smoking, specific diets and other
triggering factors
Lab findings
• Blood investigation
• ESR elevated
• CRP elevated
• Hypoalbuminemia
• Anaemia
• Leucocytosis
• Barium study: string finding
• Histopathology: microscopic features
displayed
String sign
Complications
• Iron deficiency anaemia
• Malabsorption
• Stricture formation
• Fistula formation
• Acute complications
• Development of carcinoma
• Systemic amyloidosis Rare
Summary
CROHN’S DISEASE.pptx

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CROHN’S DISEASE.pptx

  • 2. Introduction Crohn’s disease is a type of inflammatory bowel disease (IBD). It is a • Chronic • Multifocal • Relapsing and • Progressive Inflammatory bowel disease – can involve any region of GIT • Hence called regional enterocolitis
  • 4.
  • 5. Gross morphology • Sites • Anywhere from mouth to anus • Most commonly in • Terminal ileum • Ileocaecal valve • Cecum • Number: multiple, sharply demarcated – skip lesions • Adhesions: involved loops may adhere to eachother
  • 6.
  • 7. • Mucosal lesions aphthous ulcer  fissures  fistula • Mucosa shows oedema and loses normal mucosal fold • Cobble stone appearance (oedematous islands of normal mucosa between ulcers) • Intestinal wall – fibrotic thickening – rubbery – narrow lumen – string sign • Serositis – red, opaque, hyperemic
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Microscopy • Mucosal ulcers and inflammation mucosa and submucosa show oedema, lymphocytes and plasma cell infiltrates – aphthous ulcers • Crypt abscesses Clusters of neutrophils within the crypt – damage crypt epithelium • Branching of mucosal crypts due to repeated cycles of crypt destruction and regeneration
  • 13. • Epithelial metaplasia • Pseudo-pyloric metaplasia – looks like gastric antrum – development of glands • Paneth cell metaplasia – usually absent in colon • Non caseating granulomas • Submucosal granuloma • Poorly differentiated • Focal aggregates of epithelioid cells • Surrounded by thin rim of lymphocytes • Multinucleated giant cells may be present
  • 14. • Chronic inflammation involving all layers of the intestinal wall • Lymphoid aggregates in submucosa or subserosa
  • 15. Clinical Features • Intestinal: • Mild diarrhoea • Fever • Abdominal pain • Extraintestinal: • Uveitis • Migratory polyarthritis, Ankylosing spondylitis, sacroiliitis • Erythema nodosum • Clubbing of fingers
  • 16. • About 20% present with • Acute right lower quadrant pain • Fever • Bloody diarrhoea • Periods of active disease are interrupted by asymptomatic periods • Disease may be reactivated by smoking, specific diets and other triggering factors
  • 17. Lab findings • Blood investigation • ESR elevated • CRP elevated • Hypoalbuminemia • Anaemia • Leucocytosis • Barium study: string finding • Histopathology: microscopic features displayed
  • 19. Complications • Iron deficiency anaemia • Malabsorption • Stricture formation • Fistula formation • Acute complications • Development of carcinoma • Systemic amyloidosis Rare