Let´s talk about Crohn´s disease at first.
Crohn´s disease can occur anywhere through your entire GI system.
It can be in the mouth for all you know.
You can actually find aphthous ulcers. It could be in the esophagus
but most commonly if you locate by the terminal ileum,
that´s where you find it most commonly and therefore with Crohn´s disease
oftentimes issues that you´ll be finding include megaloblastic anemia
and then also steatorrhea due to improper bowel acid type of recycling
or enterohepatic circulation. The signs and symptoms include weight loss,
fever, the abdominal pain, arthritis. The extraintestinal manifestations
that you find with Crohn´s disease include that arthritis, erythema nodosum,
diarrhea and importantly, perianal disease or mouth ulcers.
Remember, I told you Crohn´s disease, it can affect you anywhere through the GI tract.
Subtle presentation: Teenage girls, a systemic onset.
Keep in mind that the extraintestinal manifestation here
could be HLA-B27 type of issues. It could be Reiter's syndrome,
it could be psoriatic arthritis or your ankylosing spondylitis.
Diagnosis: upper GI: thickened folds and narrowing of the distal small bowel
known as your 'string sign'. Colonoscopy and biopsy.
So what you´ll do here is you´ll divide the GI system in two
or really the intestine into your upper and your distal portion.
String sign will be the upper GI, whereas the lower GI
upon colonoscopy and biopsy will show the following.
We have Crohn´s disease in which C as in Crohn´s
will show you cobble stone appearance. Cobble stone appearance,
think of maybe perhaps if this helps you, Wizard of Oz with Dorothy
who is then skipping down the cobble stone.
In other words referring to skip lesions and what skip lesion refers to
is the fact that there is going to be areas that are lesion, areas that are normal,
areas that are lesion, areas that are normal.
You´ll never find a step of pattern but ulcerative colitis,
so therefore as you go through Crohn´s, I´d like for you to compare in your head
what´s also occurring in ulcerative colitis, it´s about time we come to UC,
you'll be in great shape. Now, ulcerative colitis,
would never begin up in the mouth. In fact, it almost always begin in the opposite end.
It will begin by the rectum and then it will move continuously
and ulcerative colitis, you´ll never find skip lesions.
It is continuous proximal growth. We´ll talk about that in a little bit.
Next, in Crohn´s disease, you´ve heard the term 'transmural'
and what that means is trans means all, mural means wall.
The entire wall of Crohn´s disease is affected wherever it might be in the GI tract.
Because of the entire involvement of the wall (transmural),
you oftentimes, you´ll find fistulas and especially your connection from your anus
and notoriously known for non-caseating type of granuloma.
Management: Steroids, anti-inflammatory such as aminosalicylates,
then you have immunomodulators:
azothioprine, metronidazole, cyclosporin, tacromilus
and perhaps even tumor necrosis factor inhibitors, anti-TNF, such as infliximab.
Surgical Management: is only reserved for obstruction.
That´s because here, because its trasmural,
the tissue can quite fragile so you do want to avoid colonoscopies
and surgery especially when you know that the GI tract
could somehow be compromised. We´ll talk about this concept as well later on.
We´ll do diverticular disease, keep that in mind.
For now, much more important that you pay attention to medications here,
immunomodulators and anti-inflammatories, aminosalicylates.
The perianal disease that you would find with Crohn´s disease (transmural),
take a look at the fistula first because there´s transmural type of involvement
of your intestine. You might actually create a fistula through the wall of your rectum.
In addition, it might be anorectal ulcers,
the two things that wanna keep in mind in Crohn´s
that you will never find in ulcerative clients is number 1,
in Crohn´s transmural involvement where as in ulcerative colitis, superficial.
In Crohn´s, you find fistulas and ulcerative colitis you will not.
In Crohn´s you have involvement of the entire GI tract
from the mouth down to perhaps the anus as we´ve seeing here.
Inflammatory bowel disease if it´s the upper GI,
you would expect to find that string sign that I was talking to you about earlier
if you´re dealing with the small intestine and that´s the picture that we´re seeing here
on a radiograph.