Crohns Disease (Ileitis, Enteritis)

Last updated 13.02.13

 

Index

 

Definition

-  Idiopathic chronic, transmural inflammatory process of any part of GIT

-  Type of IBD

 

Features

-  Often leads to fibrosis & obstruction

-  20% have relative w IBD

-  Bimodal onset 15-30 yrs & 60-80 yrs

-  Unpredictable flares & remissions

-  80% pts develop complications requiring Sx

-  European > Asian, Blacks..

-  Sites

-  Skip lesions

-  Small intestine 30%

-  Terminal ileum most common site

-  Small intestine alone

-  Colon only 30%

-  Both large & small intestine 40%

-  Stomach (rare)

-  Mouth

-  Oesophagus (very rare)

 

Associated S/S

-  Fever

-  Arthritis

-  Asymmetric larger joints

-  Inflammatory in 7-25% pts

-  May antedate bowel disease by several years

-  Ankylosing spondylitis

-  Psoriatic arthritis

-  Reactice arthritis

-  Sacroilitis

-  GIT

-  Oral ulcers: apthous ulcers

-  Abdo pain: esp RLQ

-  Diarrhoea, steatorrhoea

-  Haematochezia 50%

-  Weight loss

-  30% pts perianal disease

-  Anal fissue

-  Perianal fistulae

-  Abscess

-  Derm

-  Pyoderma gangrenosum

-  Erythema nodosum

-  Sweet syndrome

-  Occular

-  Iritis

-  Uveitis

-  Episcleritis

-  Clubbing

-  Smoking worsens Crohns

 

Complications

-  Thromboembolism x3 risk (PE, DVT)

-  Malabsorption

-  Vitamin B12 deficiency

-  Anaemia

-  Small bowel obstruction: stricture

-  Toxic Megacolon: rare

-  Hepatic

-  PSC 2-8%: biliary colic

-  Autoimmune hepatitis

-  Fistula

-  Enteroenteral

-  Enterovesical

-  Enterovaginal

-  Enterocutaneous

-  Bowel Ca

-  Colorectal

-  Small bowel adenocarcinoma

-  Lymphoma

-  SCC in ass w chronic enterocutaneous fistula

 

Ix

-  FBE

-  RBC: anaemia

-  WBC: inflammation

-  Iron studies: IDA

-  LFTs: primary sclerosing cholangitis (PSC)

-  Sigmoidoscopy & biopsy

-  Stool culture & microsopy

-  AXR: bowel obstruction

 

Mx

-  Infliximab: fistulas

-  Sulfasalazine (sulfonamide Abx)

 

 

 

References

 

eMedicine: emedicine.medscape.com/article/172940-overview