Pathology: Rectal-sparing, transmural, deep ulceration, fissures, strictures, fistula , aphthous ulceration, skip lesions with microscopic non-caseating granulomas
Aetiology: Unknown aetiology but increased incidence in those with relatives with IBD and increased incidence in smokers
Symptoms: Abdominal pain, fever, malaise, diarrhoea, weight loss, joint pain, back pain
Signs: Abdominal tenderness, perianal fistulas, anal skin tags, pyoderma gangrenosum, clubbing, aphthous ulcers, iritis and erythema nodosum
Investigations: Bloods: FBC shows anaemia, reduced Ferritin, raised CRP / ESR, LFTs
Microbiology: Stool cultures
Imaging: Abdominal X-Ray shows colonic dilatation in acute flares
Colonoscopy to assess large bowel and terminal ileal disease
Barium Follow-Through to assess for small bowel strictures
MRI small bowel shows thickening and strictures
MRI Pelvis in perianal disease assessing for abcess or fistulae
Treatment: Conservative: Smoking cessation, elemental diet
Medical: Steroids to induce remission, maintenance is 5-aminosalicylates (e.g.
mesalazine, sulphasalazine), azathioprine or 6-mercaptopurine, biologic agents such as infliximab and adalimumab are 2nd line
Surgical: Stricture correction, laying open fistulas and resection of diseased bowel
Complications: Abscesses, fistula formation, small bowel obstruction, toxic megacolon, short bowel syndrome, malignancy, primary sclerosing cholangitis
Prognosis: 80% of patients will have surgery at some stage.
Overall mortality is slightly higher than normal population
Figure 3.4 Key Features In Crohn’s Disease
