Crohn’s disease

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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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

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