Crohn's disease

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Background

  • Can involve any part of the GI tract from the mouth to the anus
  • Bimodal distribution: 15-22yr, 55-60yr
  • Pathology
    • All layers of the bowel are involved
      • Reason why fistulas and abscesses are common complications
    • "Skip lesions" are common

Diagnosis

GI Symptoms

  • Abdominal pain
  • Diarrhea
  • Wt loss
  • Perianal fissures or fistulas

Extraintestinal Symptoms (50%)

  • Arthritis
    • Peripheral arthritis
      • Migratory monarticular or polyarticular
    • Ankylosing spondylitis
      • Pain/stiffness of spine, hips, neck, rib cage
    • Sacroiliitis
    • Low back pain w/ morning stiffness
  • Ocular
    • Uveitis
      • Acute blurring of vision, photophobia, pain, perilimbic scleral injection
    • Episcleritis
      • Eye burning or itching w/o visual changes or pain; scleral and conj hyperemia
  • Dermatologic
    • Erythema nodosum
      • Painful, red, raised nodules on extensor surfaces of arms/legs
    • Pyoderma gangrenosum
      • Violacious, ulcerative lesions w/ necrotic center found in pretibial region or trunk
  • Hepatobiliary
    • Cholelithiasis (33%)
    • Fatty liver
    • Autoimmune hepatitis
    • Primary sclerosing cholangitis
    • Cholangiocarcinoma
  • Vascular
    • Thromboembolic disease

Work-Up

  • Labs
    • CBC
    • Chemistry
  • CT A/P
    • Most useful diagnostic test in pts w/ acute symptoms who have known or suspected Crohn
    • Findings: bowel wall thickening, mesenteric edema, local abscess, fistulas

DDx

  1. Ulcerative colitis
  2. Ischemic bowel disease
  3. Pseudomembranous enterocolitis
  4. Lymphoma
  5. Ileocecal amebiasis
  6. Sarcoidosis
  7. Yersinia

Campylobacter#

Management

  1. Rule-out complications:
    1. Obstruction
      1. Due to stricture or bowel wall edema
    2. Abscess
      1. Can be intraperitoneal, retroperitoneal, interloop, or intramesenteric
        1. More severe abdominal pain than usual
        2. Fever
        3. Hip or back pain and difficulty walking (retroperitoneal abscess)
    3. Fistula
      1. Occurs due to extension of intestinal fissure into adjacent structures
      2. Suspect if changes in pt's symptoms (e.g. BM frequency, amt of pain, wt loss)
    4. Perianal disease
      1. Abscess, fissures, fistulas, rectal prolapse
    5. Hemorrhage
      1. Erosion into a bowel wall vesel
    6. Toxic megacolon
      1. Can be associated w/ massive GI bleeding
  2. Rule-out therapy complications:
    1. Leukopenia /thrombocytopenia
    2. Fever / infection
    3. Pancreatitis
    4. Renal / liver failure

Disposition

See Also

Source

Tintinalli