Crohn’s disease

223 Crohn’s disease



Instruction


These patients have chronic diarrhoea.


Examine this patient’s face (Patient 3).


Examine this patient’s abdomen (Patients 1 and 2).


Comment on this patient’s perianal area (Patient 4).



Salient features



History




• Loose stools or diarrhoea which is not usually bloody


• Abdominal discomfort or pain


• Anorexia, malaise and weight loss


• Perianal inflammation and pain (Fig. 223.1)


• Joint pains, eye complaints, skin changes.


image

Fig. 223.1 Perianal skin tags.


(With permission from Sohn et al. 2010.)



Examination




• Mass in the right iliac fossa (Patient 1)


• Multiple fistulous openings in the right iliac fossa (Patient 2)


• Swollen lips (Patient 3)


• Multiple perianal fistulous tracts (Patient 4).


Proceed in all four patients by examining:



• The mouth for:


• Aphthous ulcers

• Uveitis

• Anaemia

• Arthropathy.

• Skin lesions (erythema nodosum, pyoderma gangrenosum)


• Liver disease.


Remember: Crohn’s disease may affect any part of the GI tract from the mouth to the anus but has a tendency to involve the terminal ileum. The inflammation is transmural (extending through all layers of bowel) with relatively normal bowel in between (skip lesions).



Diagnosis


Patients 2 and 4 have multiple anal fistulae (lesions) caused by Crohn’s disease (aetiology), indicating that the disease is active (functional status). Patients 1 and 3 also have Crohn’s disease.



Questions




Mention some complications




• Toxic megacolon (Fig. 223.2)


• Iritis


• Arthritis


• Erythema nodosum


• Pyoderma gangrenosum.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Crohn’s disease

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