This document provides information on Crohn's disease and ulcerative colitis. It discusses the definition, symptoms, diagnosis, and treatment of Crohn's disease, including that it is a chronic inflammatory bowel disease that can affect any part of the GI tract. It also summarizes ulcerative colitis as an inflammatory disease confined to the colon and rectum, noting its symptoms include bloody diarrhea and abdominal pain. The document provides details on evaluating and managing both conditions medically or surgically.

1. Ajdabya University – Medical College
General Surgery Department
Dr. Abdulgadir M. Abdulrahman, MD
Inflammatory Bowel Disease (IBD)
Crohn's disease(CD) & Ulcerative colitis(UC)

2. Crohn’s Disease
• Definition : is an idiopathic chronic ,
granulomatous disease that can affect any
part of the GI tract from Mouth -to -Anus .
• This incurable, slowly progressive disease is
characterized by episodes of Exacerbation and
Remissions.
• The incidence is 4/100.000 , with a Bimodal
age distribution at :
• (15 to 29) and (55 to 70)years old .

3. Etiology of Crohn’s Disease
• The cause of CD. is Unknown .
• (Genetic vs. Environmental ) factors .
• Genetic : CD. is 25 times more common with
Family History+ 60 % in monozygotic twins .
• Environmental: Smoking ?

4. Bowel involvement in Crohn’s Disease
• NB: the Terminal ileum is the most common
site of disease and is involved in 75% of the
cases
• Patterns of CD ;Three patterns :
• 1- Ileo-colic disease (40%) of patients
• 2-Small- bowel Only (30%) of patients
• 3-Colonic disease (30%) of patients

5. Patterns of CD ;Three patterns :
1-Ileo-colic disease (40%)
2-Small- bowel Only (30%)
3-Colonic disease (30%)

6. Histology of CD.
• Grossly: the diseased bowel is
• thickened , Creeping fat ,Corkscrew vessels
and Shortened fibrotic mesentery containing
Enlarged Lymph Nodes
1- Bowel Thickening
2- Creeping fat ,
3- Shortened fibrotic mesentery

7. Histology of CD.
• Mucosal changes :
1-Pinpoint Hges , 2- Apthous ulcerations , 3- Deep linear fissures
4- Cobble stoning . 5- Segmental - Skip lesions ,
6- Full thickness bowel involvement ( Transmural inflammation )
= sinuses –fistulas ,7-Granulomas (40-60%)

8. Clinical Presentation of CD
Intestinal :
1-Diarrhea*(not bloody )
2-Abdominal pain
3-Weight loss
4-Anorectal=Fissure/fistulas
5- Constitutional:
malaise/ fever
Extra-intestinal
 Eyes =Conjunctivitis, Iritis,
Uveitis
 Skin= Pyoderma
ganrenosum , Erythema
nodosum , Aphtuos stomatitis
 M.sk = Arthritis
 Hepato-Biliry : sclerosing
cholangitis , Cirrhosis, liver
failure
Highly variable
No Pathognomonic phys. signs to CD

9. Examination of CD case
General Exam: Aphtuos stomatitis (ulcer)
Clubbing , Legs Pyoderma ganrenosum ,
Erythema nodosum ,
Abdominal Exam: A Palpable Mass =thick
edematous bowel, phlegmon, or abscess
Rectal exam : Multiple lesions, lateral anal
fissures ,deep ulcers of the Perianal skin and
anal canal and anal strictures

10. A.. Erythema nodosum:: characteristic red nodular areas on the shins
B.. Pyoderma ganrenosum:: early lesion presents as a pustular and
violaceous plaque with incipient breakdown
C.. Multiple active and healing lesions of Pyoderma ganrenosum

11. Imaging of CD
• 1-Contrast study:
• SBFT, SBE, Water –souluble 2- Endoscopy
• 3-CT-Scan Abdomen with Enteroclysis or
Enterography ( Oral contrast )
• 4- MRI .

12. Differential Diagnosis of CD
• 1-Ulcerative Colitis (UC)
• 2-Appendicitis
• 3-infection ileitis
• 4-others

13. Complications of Crohn’s disease
1-Instetinal Obstruction
2-Bleeding (GI Bleeding )
3- Intractability (failure of medical treatment )
4- Abscess, Fistulas / Stricture ( inflamm. vs
Fibrotic )
5- Perforation / Peritonitis / Acute Toxic colitis

15. Management of Crohn’s disease
1- Adequate Nutrition
2- Medical treatment
3-Surgery , indications : 1- Medical intractability
2- intestinal obstruction
3- Perforation / peritonitis
4- Bleeding
5-Acute toxic colitis

16. Medical Mx of CD
• 1-Mild-to-Moderate disease :
• Oral Aminosalisylate (Sulfasalzine 3-6gms/dayor
Mesalamine1 gm 1x4/day )
• For Ileal/ colonic & perianal disease add
Metronidazole 500 mg 1x3 /day .
• 2- Severe disease = Exclude active infection or
Abscess + Steroid therapy :
• Oral Prednisolone 40-60 mg /day( OPD) or IV-
Hydrocortisone 50-100mg - 6 hourly / day
(Admission in patients )
Disease location
Severity
Complications
Response to ttt. should be within 7 days
Infliximab( Remicade ):monoclonal Ab against TNF is effective in CD with flares & fistulas

17. Surgical therapy of CD.
• The most common indication for surgery iis disease activity that has
• been intractable (which is hard to define) to medical therapy..
• – persistent/progression of symptoms despite adequate medical therapy
• – dependence upon high dose steroids to maintain remission
• – significant treatment-related complications and side effects
• • Colitis/ileo--colitis/ileitis not responding to therapy
• • Obstruction (( e.g.: small bowel strictures))
• • Unequivocal dyspllasiia iin pattiientts wiitth llong--sttandiing colliittiis
• • Suspicion of a malliignantt sttriictture
• • Fistula nott responding to medical therapy
• • Toxic colliittiis/megacolon
• • Intra--abdominal abscesses ((which are most likely due to severe
• disease or ‘‘walled off’’ perforation)
• • Perianal disease (may require surgical drainage)

18. Prognosis of Crohn’s disease
• CD. is a chronic, relapsing, pan –intestinal
disease has No Cure and requires chronic,
• life –long treatment with operation( surgery )
reserved for the severe complications .
• Recently genetic ( NOD2/CARD15) has been
identified inpatients with CD.

21. UC
• Ulcerative colitis (UC) is a mucosal
inflammatory condition of the GI tract
confined to the colon and rectum.
• UC. is an inflammatory disease of the rectum
extending for a variable degree proximally in
the Colon .
• Females > males
• Age of incidence : 20 to 40 years
• Etiology : Unknown ; HLA-27 ass.

22. UC Pathology
• Site : Rectum & Sigmoid colon +/_ Whole colon =
Pan-colitis .
• Gross: Edematous mucosa / Bleeding petechial
Hges. / Extensive Ulcerations/ Pseudo polyps
• Microscopic :
• 1- Crypt abscesses
• 2- Ulcers lined with granulation tissues
• 3-smooth, thin atrophic bowel wall .

23. UC Presentation
Common symptoms associated with UC include
urgency, diarrhea, tenesmus and hematochezia
(Blood) and Mucous
+/- Cramping Abdominal pain
Constipation in 15–20% of patients
Examination :
Tender Left Iliac Fossa
Rectal Exam: Blood on Exam gloves /Edematous
Rectal mucosa
Fever/ Toxemia.

24. The extra-intestinal manifestations:
ass with UC

25. Diagnosis of UC
1- Sigmoidoscopy ( Diagnostic)/ +/_Biopsy
2- Colonoscopy ( Contra-indicated in acute toxic
colitis )= Surveillance T/O Colon cancer (8-10)
yrs
3- Barium Enema ( Contra-indicated in acute
toxic colitis )

26. Imaging in UC
Barium enema radiograph
from a young girl with
chronic ulcerative colitis.
Note the
– shortening of the colon
– loss of haustral markings,
– gives the colon a
characteristic “ lead-pipe”
appearance..

27. Case Challenge
• 55 years old male Patient with history of
ulcerative colitis presented with abdominal
pain and bloody diarrhea.
• The looked sick , Febrile (39) , PR:110/min,
BP:90/60mmHg .
• The abdominal examination: revealed a
distended and mildly tender abdomen with
hypoactive bowel sounds.

28. Abdomen X-ray

29. TOXIC MEGACOLON
• Plain films of the abdomen
showed:
two characteristic features of
ulcerative colitis:
1-megacolon, with the transverse
colon (normal diameter up to 6
cm) dilated to the height of 2.5
vertebrae (vertical arrows)
2– burned-out chronic colitis, with the
left side of the colon showing
foreshortening and a loss of
haustra (arrowheads).

30. Indications for Surgery in UC

32. Thank You