crohns disease by soran ibrahim khdhir

1. Crohn's disease
By:
“ Sara Ibrahim
“ Soran Ibrahim
6th GM group 614
under guidance of Dr.irena

2. Crohn’s disease is a chronic idiopathic inflammatory
bowel disorder that leads to focal, asymmetric,
transmural, and sometimes granulomatous
inflammation anywhere in the GI tract.
Unlike UC, there is unaffected bowel between areas
of active disease (skip lesions).
It can occur at any age, with the highest peak
incidence
in the 2nd and 3rd decade and a smaller peak in the
5th
to 7th decades of life.
There is a slight female predominance.
Introduction

3. Crohn's disease can be classified with regard to location:
Terminal ileum and cecum (~40%), the most common location.
Small intestine (~30-40%).
colonic (~20%).
Other parts of the the upper gastrointestinal.
Disease behaviour can be classified into inflammatory (luminal),
stricturing, and fistulizing (enteroenteral, enterovesical, enterovaginal,
perianal).
Classification

4. Disease behaviour can be classified into:
• inflammatory (luminal) causes inflammation without causing stricture
or fistulaes.
• Structuring causes narrowing of the bowel which may lead to bowel
obstruction or changes in caliber of the feces.
• fistulizing (enteroenteral, enterovesical, enterovaginal, perianal)
Classification

5. causes
Heredity: it may inherit genes that makes more susceptible to
developing Crohn's disease.
The immune system: when triggered it affects the
gastrointestinal tract causing inflammation that contribute to
symptoms.
Environmental factors: bacteria, virus or some unidentified
factor in the environment that triggers an abnormal immune
response.
Foreign substance: antigens in the environment may also be a
causes of inflammation or it stimulate the body defences to
produce inflammation that contributes with out control.
Smoking: smoker's with Crohn's disease usually have more
severe symptoms that non-smokers.

6. Symptoms:
Diarrhoea usually without blood.
abdominal pain usually (RLQ)
weight loss.
Systemic symptoms: fatigue, fever, anorexia.
Signs: Bowel ulceration abdominal
tenderness/mass
perianal abscess/fistulae/skin tags; anal strictures.
Extraintestinal manifestations in 15% to 20% of
cases
(uveitis, arthritis, oral ulcers) etc…
Clinical Features

7. Risk factors for CD include:
•Age. Crohn's disease can occur at any age, but you're likely to develop the condition
when you're young. Most people who develop Crohn's disease are diagnosed before
they're around 30 years old.
•Ethnicity. Although Crohn's disease can affect any ethnic group, whites have the
highest risk, especially people of Eastern European (Ashkenazi) Jewish descent.
•Family history. You're at higher risk if you have a first-degree relative, such as a
parent, siblings.
•Cigarette smoking. Cigarette smoking is the most important controllable risk factor for
developing Crohn's disease.
•Nonsteroidal anti-inflammatory medications. These include naproxen sodium,
diclofenac sodium and others. While they do not cause Crohn's disease, they can lead
to inflammation of the bowel that makes Crohn's disease worse.
Risk factors

8. Diagnosis of CD is a combination of clinical symptoms, endoscopy, imaging and
histology. Infection should always be ruled out by checking stool studies for common
bacterial pathogens.
• General symptoms
Chronic diarrhea, Abdominal pain, Fever, Weight loss.
• Specific symptoms
≫ Perianal pain, drainage, and fevers are characteristic of perianal fistulas with or
without abscesses.
≫ Dysphagia, odynophagia, chest pain, and gastroesophageal reflux disease suggest
esophageal CD.
≫ Gastric and duodenal CD is marked by epigastric pain, nausea, vomiting, or gastric
outlet obstruction.
≫ Obstructive symptoms can be seen in structuring disease that can affect the upper
and lower GI tracts.
Diagnosis

9. • Laboratory function
≫ Raised inflammatory markers (ESR, CRP).
≫ Fecal calprotectin identifies active disease.
≫ Autoantibody testing in the form of pANCA (antineutrophil cytoplasmic
autoantibodies).
• Endoscopy
≫ Colonoscopy
– abnormalities are patchy or skip, with focal inflammation adjacent to areas of normal
appearing mucosa.
– ulcerations (aphthous ulcers or deep transmuralulcers)
– strictures and fistula
≫ Video- capsule endoscopy:
– evaluates small- bowel CD that cannot be reached with upper or lower endoscopy
– is contraindicated in stricturing CD.
Diagnosis

10. • Histology—endoscopic biopsies
≫ Early CD: acute inflammatory infiltrate and crypt abscesses are seen
≫ Late CD: chronic inflammation, crypt distortion, crypt abscesses, and in some
subjects
non- caseating granulomas are seen
• Imaging
≫ CT or MR enterography
– small- bowel CD: inflammation, extent of disease,
– fistulous tracts (enteroenteral, enterocutaneous, enterovaginal, enterovesical)
– perianal fistulas and/or abscesses (better seen on MRI of the pelvis)
– intra- abdominal abscesses
≫ Upper GI series (barium swallow)
– to assess esophageal, stomach, and duodenal CD
– reveals strictures and fistulas
Diagnosis

11. CD is a multisystem and complex disease that is not medically or surgically curable.
The aim of treatment is induction and maintenance of clinical remission, with the ultimate
goal
of mucosal healing. The choice of medical and/or surgical treatment depends on the
disease severity, location, behavior and complications.
In general:
• Inflammatory CD
≫ Mild-to-moderate disease
– induction: budesonide (terminal ileum and/or right colon) or corticosteroids
– maintenance: immunomodulators and/or biological agents
≫ Moderate- to- severe disease
– induction: budesonide (terminal ileum and/or right colon) or corticosteroids or
biologicals
– maintenance: immunomodulators and/or biologicals
Treatment

12. • Stricturing CD
≫ Fibrostenotic stricture with proximal bowel dilation—surgery
≫ Stricture without proximal bowel dilatation, possibly inflammatory stricture—trial of
corticosteroids or biologicals. If no response, surgery should be considered
• Fistulizing CD
≫ Internal fistulous tracts—biologicals and/or surgery
≫ Perianal fistulizing disease—surgery, antibiotics, biologicals
Treatment

13. Surgical (eventually required in most patients)
A. Reserved for complications of Crohn disease or for those who have persistent
symptoms despite best medical management.
B. Involves segmental resection of involved bowel
C. Disease recurrence after surgery is high. Up to 50% of patients experience disease
recurrence at 10 years postoperatively.
D. Indications for surgery include SBO, fistulae (especially between bowel and
bladder or vagina), disabling disease, and perforation or abscess.
Types of surgery include: Abscess drainage, colectomy, fistula repair,
Ileostomy, proctectomy (anus and colon are removed).
resection (resection a part of the large intestine).
Srictureplasty.
Treatment