Chrons Disease

Question 1

Epidemiology

Answer 1

between the ages of 15 and 30 years and mainly in women between the ages of 60 and 70 years.

more common in white patients

The disease may occur at any age, but
adolescence and early adulthood are the
prevalent age groups.

Risk factors are family history of Crohn’s
disease or Jewish ancestry.

The incidence is 7 out of 10,000 people.

Question 2

Aetiology

Answer 2

The exact cause is unknown, but genetic factors seem to play a role.
• Chronic ulcerative colitis occurs in the same
families.

Overactive immune response triggered by virus, bacteria, smoking

Question 3

Pathogenesis

Answer 3

chronic transmural inflammatory disease that usually affects the distal ileum and colon but may occur in any part of the GI tract.
crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers. These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel.

Question 4

Natural History

Answer 4

Crohn disease is typically characterized by periods of remission and relapse. In the first year after diagnosis, the relapse rate approaches 50%, with 10% of patients

Question 5

Clincical Manefestations

Answer 5

The most common initial manifestation is chronic diarrhea with abdominal pain, fever, anorexia, and weight loss.

The abdomen is tender, and a mass or fullness may be palpable.

Extraintestinal symptoms, particularly arthritis, may occur.

In children, extraintestinal manifestations frequently predominate over GI symptoms; arthritis, FUO, anemia, or growth retardation may be a presenting symptom, whereas abdominal pain or diarrhea may be absent.
Patients with severe flare-up or abscess are likely to have marked tenderness, guarding, rebound, and a general toxic appearance. Stenotic segments may cause bowel obstruction, with colicky pain, distention, obstipation, and vomiting

Question 6

Symptoms

Answer 6

chronic diarrhea with abdominal pain, fever, anorexia, and weight loss

• abdominal mass
• Borborygmus (rumbling gas in stomach)
• clubbing of the fingers or toes
• gastrointestinal bleeding
• foul smelling stools
• tenesmus ( - painful stools)

Additional symptoms that may be
associated with this disease
• bloody stools
• joint pain
• incontinence
• swollen gums
• constipation
• bloated feeling

Children - systemic symptoms

Question 7

Signs

Answer 7

The abdomen is tender, and a mass or fullness may be palpable.

Question 8

Complications

Answer 8

Extensive inflammation may result in hypertrophy of the muscularis mucosae, fibrosis, and stricture formation, which can lead to bowel obstruction.

Abscesses are common, and fistulas often penetrate into adjoining structures, including other loops of bowel, the bladder, or psoas muscle. Fistulas may even extend to the skin of the anterior abdomen or flanks. may occur to the bladder, vagina, or the skin, anal.

Surgical treatment of complications such as an
obstruction may be necessary

Chronic malabsorption may cause nutritional deficiencies, particularly of vitamins D and B12

increased risk of cancer - small bowel
or colorectal carcinoma.

Question 9

Prognosis

Answer 9

50% higher mortality
perianal fistulas and abscesses occur in 25 to 33% of cases; these complications are frequently the most troublesome aspects of Crohn disease.