Crohn's Disease

:- Crohn’s disease(regional enteritis) is an idiopathic inflammatory bowel disease characterized by transmural non caseating granulomatous inflammation.

Crohn’s disease
Acute
Acute onset resembling appendicits
Chronic
Chronic ill health
Low grade fever
Recurrent attacks of abdominal pain and diarrhoea
Tender mass in the right iliac fossa

Crohn’s disease of the terminal ileum.

Heredity: It may inherit genes that make more susceptible to
developing Crohn’s disease.
The immune system: When triggered, it affects the gastrointestinal tract, causing inflammation that contributes to symptoms
Environmental factors: Bacteria, a virus, or some unidentified factor in the environment that triggers an abnormal immune response
Foreign substances (antigens) in the environment may also be a cause of inflammation, or it stimulate the body’s defenses to produce inflammation that continues without control.
Smoking : smokers with Crohn's disease usually have more severe symptoms than non-smokers.

:- Any where in the gut from mouth to anus.
Most common-
Ileo-colic(80%)
Terminal ilum(30%)
Right colon (20%)
Distibution
:- Segmental ditribution with skip lesions.
Crohn’s disease may involve any portion of the gastrointestinal tract but affects most commonly 15-25 cm of the terminal ileum which may extend into the caecum and sometimes into the ascending colon:

:- The symptoms of crohn’s disease depend on where the disease occurs in the bowel and its severity.
- Symptoms can include:
Chronic diarrhea(bloody and contain mucus or pus)
Weight loss
Fever
Abdominal mass and tenderness feeling of a mass or fullness in the abdomen
Rectal bleeding
Constipation
Abdominal pain
vomiting

symptoms that may associated with Inflammatory Bowel Disease:
Fever
Loss of appetite
Weight loss
Fatigue
Night sweats
Inflammation may also cause a fistula to develop

COLONOSCOPY is the best for making the diagnosis of Cohn’s disease, as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of disease involvement.
CT AND MRI are useful for evaluating the small bowel with enteroclysis. They are useful for looking for intra-abdominal complications of crohn’s disease such as abscess, fistulae.
Barium enema, in which barium is inserted into the rectum and fluoroscopy is used to image the bowel. They are useful for identifying anatomical abnormalities when strictures of the colon are too small for a colonoscope to pass through.

Blood tests
COMPLETE BLOOD COUNT(CBC)- May reveal anaemia
ESR(Erythrocyte sedimentation rate) and CRP (C-reactive protein)- Help to assess the degree of inflammation.
ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES(ANCA)- To identify inflammatory disease of intestine.

Antibiotics
:- Metronidazole, ciprofloxacin, and other antibiotics may be used when
infections occur, or to treat complications of Crohn’s disease
Aminosalicylates (5-ASAs)
:- Given either orally or rectally, these drugs work to decrease inflammation in the lining of the intestines
Corticosteroids (Steroids)
:- Given orally, as an injection, rectally, or intravenously, these medications help reduce inflammation by suppressing the immune system
Immune modifiers (Immunomodulators)
:- Given orally or injected, these medications suppress the body’s immune response so that it cannot cause ongoing inflammation.
Biologic therapies (Biologics)
:- Given intravenously or injected, this class of drugs suppresses the immune system to reduce inflammation by targeting a specific pathway

1. Intestinal complications
Stricture
Fistula
Perforation
Abscess
Neoplasm
2. Systemic complications
Arthritis (it is an informal way of referring to joint pain or joint disease.)
Oxalate stones
Ankylosing spondylitis( it is a type of arthritis that affects the spine)
Uveiitis (it is inflammation of the uvea, the middle layer of the eye
between the retina and the sclera (white of the eye), and can lead to vision
loss if left untre.)

Sclerosing episcleritis( in which peripheral cornea is
opacified by fibrosis and lipid deposition with neighboring scleritis may occur particularly with herpes
zoster scleritis. Sclerosing keratitis may present with crystalline deposits in the posterior corneal lamellae.)
Sclerosing cholangitis(it is a chronic liver disease characterized by a progressive course of cholestasis with
inflammation and fibrosis of the intrahepatic and extrahepatic
bile ducts.)
Erythema nodosum( it is initially managed by identifying
and treating any underlying condition present. Simultaneously, treatment is directed toward the inflamed skin from
the erythema nodosum. Treatments for erythema
nodosum include anti-inflammatory drugs, and corticosteroids by mouth or local injection.)

3. Postoperatives complications
Anastomotic recurrence
Anastomotic fibrostenosis
Adhesion obstruction
Other complication are:
Arthritis
Gall stones
Inflammation of the eye and mouth
Kidney stones
Liver disease
Skin rashes or ulcers