more common in ___
males
where in the GI tract can crohns affect and where is it most common?
can affect any region of the GI tract from the mouth to the anus but most common in terminal ileum and colon
about 50% of people with crohns get _____ disease
perianal
what happens in perianal disease
- get Recurrent abscess formation
- Pain
- Can lead to fistula with persistent leakage
- Damaged sphincters
crohns symptoms are determined by the ___ of the disease
site
what are the sypmtoms of crohns in the small intestine?
- Abdominal cramps (peri-umbilical)
- Diarrhoea, weight loss
what are the sypmtoms of crohns in the colon?
- Abdominal cramps (lower abdomen)
- Diarrhoea with blood
- Weight loss
what are the sypmtoms of crohns in the mouth?
- painful ulcers, swollen lips, angular chelitis
what are the sypmtoms of crohns in the anus?
perianal pain, abscess
what may be found on clinical examination
- Evidence of weight loss
- RIF mass
- Perianal signs - inflammation at or near to the anus, including tags, fissures, fistulas , abscesses
what blood tests would you do?
FBC - may show anaemia, leukocytosis
CRP and ESR- high
platelets
iron studies - anaemia
what other tests would you do?
serum folate and B12 - may be low
stool testing
Metabolic panel
AXR
CT abdomen
MRI
what may be seen on AXR?
small bowel or colonic dilatation, calcification, sacroiliitis, intra abdominal abscess
what may be seen on CT
skip lesions, bowel wall thickening, surrounding inflammation, abscess, fistulae
get ____ ____ in 30-50% of people pathoogicaly
non-caseating granuloma
transmural or mural
transmural inflammtion
pathology summary:
- Ileal and/or colonic chronic active mucosal inflammation including - ____, ___ _____
- _____ inflammation
- Fissuring
- -______ 50%
Ileal and/or colonic chronic active mucosal inflammation including - cryptitis, crypt abscesses
Transmural inflammation
Fissuring
Grnaulomas 50%
what are the highly likely complications
- small bowel obstruction - due to bowel wall thickening
- anaemia
- malabsorption
- fistulas
- short bowel syndrome
what are the moderately likely complications
- perforation
- infective colitis as a result of immunosuppressive therapy
- colorectal cancer
- hepatotoxicity from - methotrxte drug
- pulmonary fibrosis from methotrexate
what are the other complications
- toxic megacolon - rarer than in UC
- Anal disease: sinuses, fissures, skin tags, abscesses, perineum falls apart
- PSC - more in UC though
what is on the differential diagnosis for crohn’s
- Ulcerative colitis
- Infectious colitis
- Pseudomembranous colitis
- Ischaemic colitis
- Radiation colitis
- Yersinia enterocolitica
- Amoebiasis
- Cytomegalovirus colitis
- Colorectal cancer
- Diverticular disease
- Acute appendicitis
- Ectopic pregnancy
what would make you think infectious colitis instead of crohns?
Infectious colitis - history of sick contacts and travel to endemic areas
what would make you think pseudomembranous colitis instead of crohns?
history of antibiotic use
what would make you think CMV colitis instead of crohns?
if they are immunocompromised
