Chron's disease

• Facts:
  Type of inflammatory bowel disease
  Can affect any part of the GI tract
  Most commonly limited to terminal ileum
• History / PE:
  Aphthous ulcers
  Abdominal pain
  Weight loss
  Chronic diarrhea
• Diagnosis:
  Transmural colon involvement
  Noncaseating granulomas
  Skip lesions
  Cobblestone appearance of colon
  Fistulas, fissures
  Perianal disease
• Treatment:
  1) Immunosuppressive agents (6-MP, azathioprine, MTX)
  2) 5-ASA derivatives (mesalamine, sulfasalzine)
  3) Steroids (excaerbations)
  4) Antibiotics (Flagyl for anal disease)
  5) Infliximab (TNF alpha antibody)
• Notes:
  Indications for surgery
  
  1) Intestinal obstruction (MC indication)
  2) Anorectal abscess
  3) Abdominal abscess
  4) Fistulas
  5) Intractable disease
• Associated With:
  Ulcerative colitis and Chron's disease
  
  Ankylosing spondylitis
  Pyoderma gangreosum
  Colorectal carcinoma (UC >>Chron's)
  
  
  Chron's disease ONLY
  Amyloidosis
  Fistulas
  Skip lesions
  Nephrolithiasis
  Mimic appendicitis
• Differential Diagnosis:
  Ulcerative colitis