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Description
- anywhere from mouth to anus
- commonly
- terminal ileum
- colon
- rectum
- whole thickness of bowel wall involved
- familial clustering
- rarely malignancy
Presentation
- 15-35 year age group
- diarrhoea
- abdominal pain
- weight loss
- malaise
History
Symptoms
- Malaise
- Anorexia
- Fever
- Nausea
- Abdominal pain
- Weight loss
- diarhoea
- rectal bleeding
- Perianal inflammation
- relapsing remitting
- Dry, gritty eyes
- Arthralgia
- Rashes
PMH
PSHx
- surgery for intestinal obstruction
- stricture
- fistula
- failure of medical management
Examination
Investigations
- HB
- FBC
- ESR
- Folate
- B12
- U&Es - electrolyte imbalances
- LFTs - lowered albumin
- CRP raised
- AXR
- Obstruction
- perforation
- toxic dilatation
- Barium meal & enema
- skip lesions
- strictures
- rose-thorn ulcers
- cobblestone mucosa
- Sigmoidoscoy and biopsy
- Colonoscopy and biopsy
- USS
- CT -abscesses
Pathology
- Mouth to anus
- Most frequently terminal ileum
- Thickened, narrowed bowel
- Cobblestone appearance
- Skip lesions
- Inflammation involves all layers
- Granulomas
Complications
- toxic dilatation
- stricture
- internal fistula
- haemorrhage
- abscess formation
- peri-anal complications
- gallstones
- renal calculi
- psychological problems
- risk of carcinoma
Treatment
Indications for surgery
- toxic dilatation
- acute haemorrhage
- perforation
- obstruction
- abscess formation
- fistula formation
- failure of medical treatment
- uncertainty of diagnosis
- prevention/development of carcinoma
Prognosis
- Acute regional ileitis may be cured by right hemicolectomy
- colonic Crohns responds to medical therapy but 50% of patients will need
surgery at some point
- mortality = 14% over 30 years
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