crohn disease

Crohn DiseaseIs a transmural process that can result in mucosal inflammation and ulceration,

stricturing, fistula development and abscess formation.

Dr. Demba Keita

General Considerations 1/3 of cases involved the terminal ileum(ileitis) ½ of all cases involved the small bowl and the colon(ileocolitis) 20% of cases involved the colon only. 1/3 of patients have associated perianal Disease Less than 5% have symptomatic involment of the upper intestinal tract.

Dr. Demba Keita

Clinical Findings(Symptoms and Signs)

• Fevers• The patients general sense of well-being• Weigh Loss, and lost of energy• Abdominal Pain • Number of bowel liquid movements per day• Abdominal Tenderness

Dr. Demba Keita

Clinical Findings (Clinical Constellations)

• Chronic Inflammatory Disease • Intestinal Obstruction • Penetrating Disease and Fistulae• Perianal Disease• Extraintestinal Manifestations

Dr. Demba Keita

Chronic Inflammatory Disease

• Most common form of Crohn • Malaise , weigh loss• In Ileocolitis Diarrhea usually nonbloody and

intermitent • In Colitis there may be bloody diarrhea and fecal urgency

which may mimic the symptoms of ulcerative colitis

Dr. Demba Keita

Intestinal Obstruction• its due to mainly fibrotic stenosis• postprandial bloating• cramping pain• loud borborygmi.

Dr. Demba Keita

Penetrating Disease and Fistulae

• Intra-abdominal retroperitoneal phlegmon or abscess manifested by fever,chills, tender abdominal mass and leukocytosis

• Fistulas-small intestine-the colon.• Fistulas-small intestine-bladder

Dr. Demba Keita

Perianal Disease

• anal fisuras• perianal abscess• fistulas

Dr. Demba Keita

Extraintestinal Manifestations

• Arthralgia • Artritis • Iritis or uveítis• Pyoderma gangrenosum or Eritema Nodosum• Oral Aphthous lesions are common.

Dr. Demba Keita

Laboratory Findings

• Complete blood count • Serum Albumin • Sedimentation Rate • C- Reactive Protein • Fecal Lactoferrin or Calprotectin levels• Stool specimens examinations for pathogens

Specific Diagnostic • Colonoscopy• Endoscopy • Mucosal Biopsies• CT or MRI Enterography or Barrium upper Gastrointestinal Series

Dr. Demba Keita

Complications • Abscess• Obstruction• Abdominal and Rectovaginal Fistulas• Perianal Disease• Carcinoma• Hemorrhage• Malabsorpcion

Dr Demba Keita

Differncial Diagnosis• Irritable Bowel Syndrome• Celiac Disease• Appendicitis• Intestinal Lymphoma• Patients with undiagnose AIDs• Intestinal Tuberculosis• Ischemic Colitis• Diverticulitis with Abscess• NSAID-induced colitis Dr. Demba Keita

Treatment of Active Disease

• Choice of Therapy depend on: 1. Disease Location 2. Severity 3. Patients Age 4. Comorbilities 5. Patients Preference Dr. Demba Keita

A: Nutrition

• Diet

• Enteral Therapy

• Total Parenteral Nutrition Dr. Demba Keita

B. Symptomatic Medication

• Secretory induced Diarrhea responds to Cholestyramine 2-4g, Colestipol 5g, or colesevelam 625mg one to two times daily before meal to bile malabsorbed bile salts.

• Antidiarrheal agents: Loperamide(2-4mg), Diphenoxylate with atropine or tincture of opium(5-15drops) may be needed as needed up to 4times daily.

Dr. Demba Keita

Specific Drug Therapy

• 5-Aminosalicylic and Agents: • Antibiotics• Corticosteriods• Immunomodulating Drugs• Anti-TNF therapies• Anti-integrins Dr. Demba Keita

Indications for Surgery

• Over 50% of patients will need one surgical procedure ,main surgical indications are:

1. Intra-abdominal Abscess 2. Massive Bleeding 3. Symptomatic Refractory internal or Perianal Fistulas 4. Intestinal Obstruction Dr. Demba Keita

Prognosis• Most patients live a productive lives with medical therapies and few die as

direct consequence of the Disease .

Dr. Demba Keita

THANKS