Valentina Miacci

VI anno 2018/2019
Definition of Croh’s Disease

C
rohn’s disease is a type of
infiammatory bowel
disease (IBD) that may
affect any part of the
gastrointestinal tract
from mouth to anus.
Crohn's disease involves the
mucosa and also deeper
layers of the intestinal
 Familiar 50% ileocaecal
Tendencies 30% only terminal ileum
Incidence 20% colon only
5% anorectal, oral
50/100000

More
in Caucasians
EPIDEMIOLOGY
and
Jewish population
Age on set
15-40
50-60
The incidence Male:Female ratio
is rising 1,1-1,8 : 1
 If you live in an urban area
or in an industrialized country,
you're more likely to develop
Crohn's disease
Environmental factors,
including a diet high in fat
or refined foods,
may play a role in Crohn's disease.

Cigarette smoking is While they do not cause

the most important controllable Crohn's disase,
risk factor they can lead
for developing to inflammation
Crohn's disease. of the bowel
that makes
Crohn's disease worse
 Signs and Symptoms
Signs and symptoms
depend on which part of
gastrointestinal tract is
affected.
The most common are:
• Diarrhea +/- blood and
mucus
• Abdominal pain
• Weight loss
• Fever
• Anemia linked to rectal
bleeding
Crohn’s disease is
also characterized
by extraintestinal
manifestation.
 Diagnosis :
Procedures
• Clinical history and physical examination
• Laboratory tests: infiammatory markers, antibodies
• Endoscopy + biopsy
( the use of colonoscopy/gastroscopy
depends on which tract
is affected by the disease)
• Barium Enema ( not used anymore )
• CT scan

• MRI ( this exam is indicated in young patients)

• Enteroscopy
 How to identify?
Macroscopic features
CD is a transmural process - Superficial ulcerations
characterize mild disease - “Cobblestone" appearance
is characteristic of CD - Active CD is characterized
by focal inflammation and formation of fistula tracts,
which resolve by fibrosis and stenosis and
obstructions of the bowel.
Microscopic features
The earliest lesions are aphthous ulcerations
and focal crypt abscesses with loose
aggregations of macrophages which form non
caseating granulomas in all layers of the bowel
wall - Granulomas are a pathognomonic feature
of CD - Other histologic features of CD include
submucosal or subserosal lymphoid aggregates.
 Complications
• Fistulas ( enterovescical, enteovaginal, etc)
• Abscess ( collection of pus that has
formed as a result of fistula due to an
infection)
• Bowel obstruction ( the most common
complication in crohn’s disease that occurs
in up to 30% of people)
• Peritonitis, due to bowel perforations
 CD TREATMENT
D
I
S
• Mesalazina
E
A
• Azatioprina or 6-mercaptopurina
S
E • Corticosteroids
S • Metrotrexate ( immunosoppressive
E
V action)
E
R • Surgery
I
T
Y
 Case report
• A 19-year-old male presents with 5 year history of abdominal pain, diarrhea and recent weight
loss over the past three months.

• The patient reports that he has experienced abdominal pain with occasional diarrhea since he
was in middle school but he often passed it off as the stomach flu. Currently, he has 10 episodes
of diarrhea per day with no blood and he wakes up with abdominal pain and diarrhea about 3
times per night. He does not report any urgency, incomplete emptying or incontinence. There is a
low grade temperature of 99.7°F on most days. His weight has dropped by 18 pounds, and has
been more pronounced in the past month.

• On further questioning, the patient describes a foul-smelling leakage from the perineum which
is greenish yellow on most days for the past two weeks. He has previously noted severe rectal
pain on passage of stool in the distant past. Otherwise, he has back stiffness in the mornings
and some arthralgias of the knees, elbows and hands for the past two years.

• Currently, he is on no medications except for Advil that he takes as needed for headaches and
joint pain. He has started to take it more often this past year.

• There is a family history of Crohn’s disease in his uncle and in two of his cousins. There is no
family history of GI cancers or celiac disease. He started smoking one-quarter of a pack of
cigarettes since entering college. He also reveals that this year has been especially stressful
because he broke up with his long term girlfriend from high school and is starting to deal with a
demanding course load in engineering.
• On physical exam vital signs are normal; there is no tachycardia; he appears thin. There
is no jaundice or lymphadenopathy appreciated. The cardiovascular and respiratory exam
was unremarkable. On abdominal exam, bowel sounds were present and the abdomen was
benign except for some mild tenderness in the right lower quadrant. No skin lesions
could be appreciated. The rectal exam showed a perianal fistula at the 3 o'clock position
that drained pus on gentle pressure.

• The laboratory workup reveals a WBC of 12.3 k/uL, Hb 9.8 g/dL and Plt 480 k/uL.
Electrolyte analysis revealed potassium of 3.2 mmol/L. The other electrolytes and liver
enzymes were otherwise normal. Stool cultures for cultures and sensitivity, ova and
parasites, cytomegalovirus (CMV) and Clostridium difficile were all negative.

• Special investigations: Colonoscopy + biopsy

DIAGNOSIS : CROHN’S DISEASE!!!

 GLOSSARY
Quic kTime™ e un
dec ompres sore
s ono nec es sari per visualiz zare ques t'immagine.

• Inflammation : redness, swelling, and fever in an area of the body, in

reaction to an infection or injury
• Anemia: Pathologya condition of the body in which the hemoglobin of
red blood cells has been reduced, leading to weakness and paleness.
• Erythema : Pathologyabnormal redness of the skin due to local
congestion, as in inflammation.
• Gallstone : an abnormal stony mass in the gallbladder or the bile
passages.
• Stomatitis : inflammation of the mouth.
• Phlebitis : inflammation of a vein, often occurring in the legs and
involving the formation of a thrombus, characterized by swelling, pain,
and change of skin color
• Enema : the injection of a fluid into the rectum to cause a bowel
movement.
• Biopsy : Removal of a sample of tissue for study, usually under a
microscope.
• Anus : The opening at one end of the digestive tract from which
waste is expelled
• Colon : The last three or four feet of the intestine (except for the
last eight inches, which is called the rectum). Synonymous with the
"large intestine" or "large bowel.“
• Colonoscopy : An outpatient procedure in which a physician inserts
in the rectum and advances it to the large intestine (colon) to view
the rectum and entire colon.
• Diarrhea : A condition in which bowel movements are passed more
often than usual and in a liquid state.
• Fistula : An abnormal connection that forms between two internal
organs or between two different parts of the intestine. This is a
common complication of Crohn's disease.
• Rectal bleeding: A symptom of digestive problems rather than a
disease. Bleeding can occur as a result of a number of different
conditions
 References
• Unigastro, Manuale di Gastroenterologia
• Pubmed
• Wikipedia
• Youtube
• Medical News Today
• https://www.crohns.net/blog/post/what-
is-crohns-disease
• http://www.wordreference.com/definition