crohn's disease by sat

8/2/2019 Crohn's Disease by SAT

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Crohn'sCrohn's DDiseaseisease

endy Satrya Kurniawanendy Satrya Kurniawan


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Definition

Crohn's disease is a chronic, idiopathicinflammatory disease with a propensity to affectthe distal ileum, although any part of thealimentary tract can be involved

United States : 3.6 to 8.8 per 100,000 there are 2-fold to 4- fold increased prevalence in

Ashkenazi Jewish

females > males.

The median age at which patients are diagnosedapproximately 30 years; however, age ofdiagnosis can range from early childhoodthrough the entire life span.


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Higher socioeconomic status increased risk

Most studies have found breast-feeding to beprotective against the development of Crohn's

disease. Crohn's disease is more prevalent among

smokers. Furthermore, smoking is associatedwith the increased risk for both the need for

surgery and the risk of relapse after surgeryfor Crohn's disease.


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Pathophysiology

Crohn's disease is characterized by sustainedinflammation.

Various hypotheses on the roles of environmental andgenetic factors in the pathogenesis of Crohn's diseasehave been proposed.

Many infectious agents have been suggested to be thecausative organism of Crohn's disease.

Chlamydia,

Listeria monocytogenes,

Pseudomonas species, reovirus,

Mycobacterium paratuberculosis, and many others.


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a variety of defects in immune regulatorymechanisms, e.g., overresponsiveness ofmucosal T cells to enteric flora-derived

antigens, can lead to defective immunetolerance and sustained inflammation

Specific genetic defects associated with Crohn'sdisease

For example, the presence of a locus onchromosome 16 (the so-called IBD1 locus)has been linked to Crohn's disease. The IBD1locus has been identified as the NOD2gene.

Pathophysiology


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Pathology

The earliest lesion characteristic is the aphthousulcer. These superficial ulcers are up to 3 mm in

diameter and are surrounded by a halo oferythema. In the small intestine, aphthous ulcerstypically arise over lymphoid aggregates.

Granulomas are highly characteristic of Crohn'sdisease up to 70% of intestinal specimensobtained during surgical resection


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As disease progresses, aphthae coalesce into larger, stellate-shaped ulcers, linear or serpiginous

ulcers.

With advanced disease, inflammation can be transmural.Serosal involvement results in adhesion of theinflamed bowel to other loops of bowel or otheradjacent organs.

Transmural inflammation also can result in fibrosis, with

stricture formation, intra-abdominal abscesses,fistulas, and, rarely, free perforation.

Inflammation in Crohn's disease can affect discontinuousportions of intestine: so-called "skip lesions" that areseparated by intervening normal-appearing intestine.

Pathology


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Crohn's disease vs ulcerative colitis :

inflammation in ulcerative colitis is limitedto the mucosa and submucosa but may

involve the full thickness of the bowelwall in Crohn's disease

inflammation is continuous andcharacteristically affects the rectum in

ulcerative colitis but may bediscontinuous and spare the rectum inCrohn's disease


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Clinical Presentation

Signs and symptoms of Crohn's disease can range from mildto severe and may develop gradually or come on suddenly,without warning. They include:

Diarrhea

Abdominal pain and cramping

Blood in your stool

Ulcers-

Reduced appetite and weight loss

Fistula or abscess


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The distal ileum is the single most frequentlyaffected site, being diseased at some time in

75% of patients with Crohn's disease.

The small bowel alone is affected in 15 to 30%of patients,

Both the ileum and colon are affected in 40 to60% of patients

Colon alone is affected in 25 to 30% of patients.

Isolated perineal and anorectal disease occurs

in 5 to 10% of affected patients. Uncommon sites of involvement include the

esophagus, stomach, and duodenum.


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25% of all patients with Crohn's disease will havean extraintestinal manifestation

Erythema nodosum, Pyoderma gangrenosum Peripheral arthritis, Ankylosing spondylitis, Sacroiliitis Conjunctivitis, Uveitis/iritis Hepatic steatosis, Cholelithiasis Primary sclerosing cholangitis, Pericholangitis Nephrolithiasis

Thromboembolic disease, Osteoporosis Endocarditis, myocarditis, pleuropericarditis Interstitial lung disease Amyloidosis, Pancreatitis

Clinical Presentation


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Pyoderma gangrenosum


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Diagnosis

acute or chronic abdominal pain, especially theright lower quadrant,

chronic diarrhea,

evidence of intestinal inflammation onradiography or endoscopy,

the discovery of a bowel stricture or fistulaarising from the bowel,

and evidence of inflammation or granulomas onintestinal histology.

radiographic, endoscopic, and pathologic tests


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CROHNS DISEASE

Contrast radiographdemonstrating that the lumen

of the terminal ileum isnarrowed and markedlyseparated from thesurrounding small bowel by athickened wall. There are

skip lesions in the colon thathave a cobblestoneappearance.


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Management

Because no curative therapies are available forCrohn's disease, the goal of treatment is topalliate symptoms rather than to achieve cure.

Medical therapy is used to induce and maintaindisease remission.

Surgery is reserved for specific indications

In addition, nutritional support in the form of

aggressive enteral regimens or, if necessary,parenteral nutrition, is used to manage themalnutrition that is common in patient's withCrohn's disease.


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Medical Therapy

Pharmacologic agents used to treatCrohn's disease :

Antibiotics

Aminosalicylates (sulfasalazine)

Corticosteroids

Immunomodulators


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Surgical Therapy

Seventy to 80% of patients with Crohn's diseasewill ultimately require surgical therapy for theirdisease

Surgery is generally reserved for patients whosedisease is unresponsive to aggressive medicaltherapy or who develop complications

One-third of patients with Crohn's disease will

require surgery for intestinal obstruction.Abscesses and fistulas are frequentlyencountered during operations performed forintestinal obstruction in these patients,


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crohn's disease by sat

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