crohn disease (regional enteritis) sammy termanini 1490
TRANSCRIPT
Crohn Disease(Regional Enteritis)
Sammy Termanini1490
Overview • Life long
inflammatory bowel disease
• Lumen becomes swollen and develops ulcers
• Idiopathic cause
Morphology
• Most common sites of presentation, terminal ileum, ileocecal valve and cecum
• Skip lesions from apththous ulcers • Cobblestone appearance from fissures
between mucosal folds • Intestinal wall is thickened• Creeping fat
Microscopic Features
• Active infection– Abundant neutrophils that infiltrate and damage crypt
epithelium or crypt abscess – Distortion of of mucosal architecture
• Epithelial metaplasia consequence of chronic relapsing infection (pseudopyloric metaplasia)
• Paneth cell metaplasia in left colon, normally absent • Non-caseating granulomas – Absence of granulomas does not preclude diagnosis of
Crohn’s Disease
Non-caseating Granuloma
Clinical Features
• Extremely variable• Usually begins with intermittent attacks of mild
diarrhea, fever and abdominal pain• 20% of cases present with right lower quadrant,
fever and bloody diarrhea mimicking acute appendicitis or bowel perforation
• Periods of active disease interrupted by asymptomatic intervals – Reactivated by physical or emotional stress, specific
dietary items and cigarette smoking
Clinical Features• Iron deficiency anemia may develop• Serum protein loss and hypoalbuminemia, generalized nutrient
malabsorption, or malabsorption of vitamin B12 and bile salts. • Fibrosing strictures of the terminal ileum, require surgical
resection.• Recurs at the site of anastomosis, and almost half require
additional resections within 10 years.• Fistulas develop between loops of bowel and may also involve
the urinary bladder, vagina, and abdominal or perianal skin.• Perforations and peritoneal abscesses are common.
Extraintestinal Manifestations
• Uveitis, migratory polyarthritis, sacroiliitis, ankylosing spondylitis, erythema nodosum, and clubbing of the fingertips,
• Pericholangitis and primary sclerosing cholangitis also occur but are more common in ulcerative colitis.
• Risk of colonic adenocarcinoma increased in patients with long-standing Crohn disease
Diagnosis
• Medical history, physical examination, imaging tests to look at intestines and lab tests
• May go years without diagnosis • Colonoscopy or flexible sigmoidoscopy • Abdominal X-ray• Upper gastrointestinal series or endoscopy • CT scan • MRI
Treatment
• Manage mild symptoms with antidiarrheal medicine (loperamide) • Moderate symptoms use aminosalicylates ,antibiotics to control
inflammation • Severe symptoms treated with corticosteroids, immunomodulator
medicines, or biologics. – First step is to control the disease. When your symptoms are
gone, your doctor will plan your treatment to keep you symptom-free (in remission).
• After symptoms are controlled, treatment focuses on medicine or a combination of medicines that keeps disease in remission
• Some severe cases of Crohn's disease need to be treated in the hospital.
References
• http://www.webmd.com/ibd-crohns-disease/crohns-disease/tc/crohns-disease-treatment-overview
• Kumar,Vinay; Abbas, Abul K.; Aster, Jon C.; Basic Pathology, Robbins; Philadelphia; Elservier Saunders;2013. Print.