Inflammatory Bowel Disease

Inflammatory Bowel Disease

Crohn’s Disease


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 

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