Incidence
Mean age of onset
Male: Female
Affects
Mortality
Surgery required in
Skip lesions
Mucosal Layers
Complications
pANCA
Race
Protective factors
Pathology
Symptoms
Extra-intestinal
symptoms
Crohn’s
UC
5-10 per 100 000
10 to 20 per 100 000
26
34
Can also present in children – failure to thrive
and also in those in their 60’s
1.2 : 1
1 : 1.2
Any part of GIt, most commonly the terminal
Only colon, usually more distal regions are worse affected
ileum.Also commonly affects the rectum, but not the
colon
Low
Lower
50-80%
20%
Yes
No
Deeper
More superficial
Fistula, abscess, stricture. Most commonly the
Rare. Toxic megacolon
fistulae come from the anus to the peri-anal region
and the produce pus
Negative
Positive
Most common in Caucasians
Most common in Caucasians
High residue, low sugar diet, relatives with Crohn’s
Smoking, appendicectomy, high reside low sugar diet
means you have an INCREASED RISK
Thought to be very similar in both diseases. In genetically susceptible individuals there is anadverse reaction to
bacterial lipopolysaccharide. Normally the reaction against this is self limiting, but in IBD patients once the inflammation
starts it may not stop. Thus ultimately it is a kind ofautoimmune disease – and the inflammation ends up damaging the
gut wall. The diseases follow a relapsing and remising course.
Right iliac fossa mass/pain – this is present even
Diarrhoea due to excess mucus production.often also contains
when there is no abscess, abdominal discomfort,
blood. Abdominal discomfort, bloating . symptoms usually less
blood in the stools, vitamin B12 and iron
severe than Crohn’s
deficiencies – Crohn’s commonly affects the small
intestine and thus can cause malabsorption.
These are generally the same for both conditions. They include; large joint arthritis, irisitis (like conjunctivitis, but
worse), erythema nodosum (red rashes on the shins, more common in UC), ulcers on mucous membranes (mouth and
vagina – more common in Crohn’s), cholangitis, pyoderma gangrenosum – this is nasty dead black pussy necrotic
tissue. Most commonly found on the legs and around the stoma, renal stones, gallstones, fatty liver, fat wrapping –
only occurs in Crohn’s – this is where the messenetric fat spreads around the intestine
Crohn’s disease is associated with an increased risk of bowel cancer –this is typicallyadenocarcinoma of the distal
ileum
Signs
The acute presentation may be mistaken
forappendicitis. However, a good history may
reveal some facts pointing to a background acute
disease.
Barium
swallow
CT
Colonosco
py
Treatment
This is the most useful test. It can
show areas of stricture, shortening of
small bowel, fistulas and abscesses
Will shows areas of wall thickening,
strictures and abscesses
Not that useful but can biopsy. Also
may help you differentiate
pseudopolyps from true polyps
May be few in mild disease.may include weight loss and malaise.
In an acute attackthere can be fever, malaise, iron def anaemia,
raised WBC, platelets and ESR, hypoalbuminaemia
PR
Blood
CT
Thickened bowel wall
Barium
enema
Reduced haustral folds due to fibrosis
CLUBBING!
Cessation of smoking is enough to induce remission in
Mild disease: 5-ASA
many patients. Unlike UC treatment is not given to
Moderate disease: steroid to initiate remission, then 5maintain remission, only to initiate it. 5-ASA compounds are
ASA
not used
Severe disease: trial steroid for 5-7 days. If no
Basically the same as UC, without the 5-ASA.
remission, then operate immediately. Try to maintain
Immunosuppresants used in severe disease 80% of Crohn’s remission with 5-ASA, if not thenimmunosuppressant
patients will end up having surgery. Many require B12 and
may be used.
iron supplements
Steroids are often given as a rectal foam
Low residue diets and low fat diets can help reduce
symptoms.Patients may need to be given supplements of
the fat soluble vitamins (A D E K). patients are often
given antibiotics to reduce the intestinal flora and diarrhoea –
metronidazole
Infliximab is used in patients that don’t respond to other types
of treatment. 70% of Crohn’s patients will respond to it. It is
particularly useful in perianal disease