2. ETIOLOGY
• Is a congenital pouch in the small intestine, typically located near the ileocecal
valve. Its etiology is related to incomplete closure of the omphalomesenteric duct
during fetal development, leading to this persistent pouch. It may contain gastric
or pancreatic tissue, causing potential complications such as inflammation or
bleeding.
3. CLASSIFICATION
• Two main classifications are:
• 1. True vs. False Diverticulum:
• True diverticulum contains all layers of the intestinal wall.
• False diverticulum (pseudo-diverticulum) involves only the mucosal and submucosal layers,
often due to herniation of mucosa through a weak point in the muscular layer.
• 11. Rule of 2s:
• Approximately 2% of the population has Meckel’s diverticulum.
• It is typically about 2 inches long.
• Located within 2 feet of the ileocecal valve.
• Often presents by 2 years of age.
• Male-to-female occurrence ratio is about 2:1.
4. SYMPTOMS
Meckel’s diverticulum can be asymptomatic in many cases. However, when symptoms occur,
they may include:
Gastrointestinal bleeding: The most common symptom, often due to ulceration of the gastric
or pancreatic tissue within the diverticulum.
Abdominal pain: Usually in the lower abdomen and can be intermittent or crampy.
Obstruction: In some cases, the diverticulum may cause a blockage in the intestine, leading to
symptoms like nausea, vomiting, and abdominal distension.
Inflammation (diverticulitis): Rare, but when it occurs, it can cause localized pain, fever, and
tenderness.
Perforation: A less common complication, which can lead to peritonitis (inflammation of the
abdominal lining).
5. DIAGNOSIS
• Technetium-99m pertechnetate scan (Meckel’s scan): This nuclear medicine
imaging is particularly useful in detecting gastric tissue within the diverticulum.
The radioactive tracer is taken up by gastric mucosa, making the diverticulum
visible on scans.
• Blood tests: If there’s gastrointestinal bleeding, blood tests may reveal anemia or
other abnormalities.
• Imaging studies: Abdominal imaging, such as CT scans or MRI, may be performed
to visualize the structure and identify complications like obstruction or
inflammation.
• :-ENTEROCLYSIS IF their is absence of ectopic GASTRIC mucosa in
Tc-Pertechnate scan
6. TREATMENT
The treatment of Meckel’s diverticulum with-
HEALTHY BASE:- Diverticulectomy + anastomoses
UNHEALTHY BASE:- Resection+ anastomoses
INCIDENTALLY DETECTED:- During elective surgery should be removed in all the
patients up to 80 years of age as no added morbidity is seen in performing
diverticulectomy
7. COMPLICATIONS
Meckel’s diverticulum can lead to various complications, including:
:-NARROW MOUTHED
:-UNHEALTHY BASE
:-PRESENCE OF ECTOPIC GASTRIC MUCOSA
Hemorrhage, obstruction, diverticulitis, bleeding and perforation
9. ETIOLOGY
The exact etiology of Crohn’s disease is not fully understood, but it is believed to involve a complex interplay of genetic,
environmental, and immunological factors. Some key factors include:
Genetics: There is a genetic predisposition, as individuals with a family history of Crohn’s disease are at a higher risk. Specific
genetic markers, such as mutations in the NOD2/CARD15 gene, have been associated with increased susceptibility.
Immune system dysfunction: Crohn’s disease is considered an autoimmune or immune-mediated disorder. The immune system
mistakenly attacks the gastrointestinal tract, leading to chronic inflammation. Abnormalities in the regulation of immune
responses contribute to this process.
Environmental factors: Environmental factors may trigger or exacerbate the condition in genetically predisposed individuals.
Factors such as diet, smoking, infections, and changes in the gut microbiome have been implicated.
Dysregulation of the gut microbiome: Alterations in the composition of the gut microbiota may play a role in the development of
Crohn’s disease. Changes in the balance of beneficial and harmful bacteria can contribute to an abnormal immune response.
Epigenetic factors: Changes in gene expression that are not related to alterations in the DNA sequence (epigenetic changes) may
influence susceptibility to Crohn’s disease.
The interaction of these factors likely leads to an inappropriate immune response, chronic inflammation, and the characteristic
symptoms of Crohn’s disease, including abdominal pain, diarrhea, and weight loss. While these factors provide insights into the
disease’s development, more research is needed to fully understand the complexity of Crohn’s disease etiology.
10. CLASSIFICATION
Crohn’s disease can be classified based on several factors, including the location of inflammation, the behavior of the disease, and its severity. The commonly used classification
systems are:
1. Location of Inflammation:
Ileal Disease (L1): Inflammation is limited to the ileum (the last part of the small intestine).
Colonic Disease (L2): Inflammation is limited to the colon (large intestine).
Ileocolonic Disease (L3): Inflammation involves both the ileum and the colon.
2. Behavior of the Disease:
Inflammatory (B1): Characterized by mild to moderate inflammation without strictures or fistulas.
Stricturing (B2): Inflammation leading to the development of strictures or narrowing in the intestine.
Penetrating (B3): Inflammation causing the formation of fistulas, abscesses, or perforations.
3. Additional Categories:
Perianal Disease (p): Involvement of the perianal area, which may include fistulas, abscesses, or other complications.
Overall Severity:
Mild (S0): Absence of features like weight loss and complications.
Moderate (S1): Presence of one or more features without severe manifestations.
Severe (S2/S3): Presence of severe symptoms, complications, or systemic manifestations.
11. SYMPTOMS
• Crohn’s disease symptoms can vary widely among individuals, but common signs and symptoms
include:
• Abdominal Pain: Persistent cramping or discomfort, often in the lower right abdomen.
• Diarrhea: Frequent, watery, or bloody stools.
• Weight Loss: Unintentional weight loss due to reduced appetite or malabsorption.
• Fatigue: Chronic inflammation and other aspects of the disease can lead to fatigue.
• Fever: Low-grade fever may accompany periods of active inflammation.
• Abdominal Cramps: Cramps or spasms in the abdominal region.
• Rectal Bleeding: Blood in the stool, which may be visible or detected through tests.
• Loss of Appetite: Reduced desire to eat, often due to abdominal discomfort.
• Perianal Symptoms: Involvement of the perianal area may cause fistulas, abscesses, or other
complications.
• Joint Pain: Inflammation can extend beyond the digestive tract, leading to joint pain.
12. DIAGNOSIS
• Medical History and Physical Examination: A healthcare professional will review your medical history, inquire about symptoms,
and conduct a physical examination.
• Blood Tests: Blood tests may be performed to check for signs of inflammation, anemia, and nutritional deficiencies.
• Stool Tests: Examination of stool samples can help identify the presence of blood, infections, or other abnormalities.
• Imaging Studies:
• A.) Endoscopy: Procedures such as colonoscopy or upper endoscopy may be used to directly visualize the gastrointestinal tract
and take biopsies for analysis.
• B.)Capsule Endoscopy: A capsule containing a tiny camera is swallowed, providing images of the small intestine.
• C.)CT Scan or MRI: These imaging studies can help assess the extent and location of inflammation.
• Biopsy: During endoscopic procedures, small tissue samples (biopsies) may be taken for examination under a microscope to
confirm the presence of inflammation characteristic of Crohn’s disease.
• Double-Balloon Enteroscopy: This specialized endoscopic procedure allows visualization and biopsy sampling of the small
intestine.
• Clinical Evaluation of Symptoms: The presence of specific symptoms consistent with Crohn’s disease, such as abdominal pain,
diarrhea, and weight loss, is considered in the diagnostic process.
• It’s important to note that Crohn’s disease shares some symptoms with other gastrointestinal conditions, making an accurate
diagnosis crucial
13. TREATMENT
• Medications:
• Anti-Inflammatory Drugs: Such as aminosalicylates to reduce inflammation.
• Corticosteroids: Used for short-term control of severe symptoms.
• Immunomodulators: Drugs like azathioprine, 6-mercaptopurine, or methotrexate to modify the immune response.
• Biologics: Target specific pathways in the immune system, like tumor necrosis factor (TNF) inhibitors (e.g., infliximab, adalimumab).
• Nutritional Therapy: Elemental diets or total parenteral nutrition (TPN) may be used to provide nutrients and allow the bowel to rest.
• Dietary Modifications
• Surgery: In cases of complications, strictures, or fistulas, surgical intervention may be necessary. This can involve removing the affected portion of the intestine.
• Symptomatic Relief: Medications for symptom relief, such as anti-diarrheal drugs or pain relievers, may be prescribed.
• Monitoring and Follow-up: Regular monitoring and follow-up with healthcare professionals are crucial to assess disease activity, adjust medications, and address
emerging issues.
14. COMPLICATIONS
• Intestinal Strictures: Chronic inflammation may lead to the formation of scar tissue, causing narrowing (strictures) of
the intestine. This can result in bowel obstruction.
• Fistulas: Abnormal connections between different parts of the intestine or between the intestine and other organs
(such as the bladder or skin) can form. Fistulas may cause leakage of bowel contents into surrounding areas.
• Abscesses: Pockets of infection (abscesses) may develop within the abdomen, often requiring drainage and antibiotic
treatment.
• Perforation: Inflammation can weaken the intestinal walls, leading to perforation and the leakage of bowel contents
into the abdominal cavity. This is a medical emergency.
• Malnutrition: Chronic inflammation and nutrient malabsorption may result in malnutrition and weight loss.
• Anal Complications: Perianal disease, including abscesses, fistulas, and fissures, can occur.
• Osteoporosis: Long-term steroid use and malabsorption of nutrients may contribute to bone density loss.
• Colon Cancer: Individuals with long-standing Crohn’s disease involving the colon have a slightly increased risk of
developing colon cancer.
• Complications Outside the Digestive Tract: Crohn’s disease can affect other parts of the body, leading to
complications such as joint inflammation, skin problems, and eye inflammation.
