Crohn’s Disease

What is Crohn’s Disease?

Crohn’s disease is an inflammatory bowel disorder (IBD) that can affect any part of the
gastrointestinal tract from the mouth to the anus but most commonly affects both the large
intestine and small intestine.
What areas of the intestines are affected?

• Second most common area affected is the small intestine.

Who is at risk?
Factors associated with Crohn’s disease:

Genetic predisposition
Those who have a parent or sibling with Crohn’s disease have a 20% (1in5) chance of
developing the disease.
Altered immune response to normal bowel flora
The immune system is triggered by a pathogen like Mycobacterium paratuberculosis,
Pseudomonas, & Listeria.
Pathophysiology of Crohn’s disease
The inflammation process of Crohn’s disease begins in the Intestinal submucosa
spreads inward and outward to (see picture on the next slide) involve the mucosa
and serosa.
Layers of Intestinal wall
Microscopic view of the Intestinal wall layers
The ulcerations of Crohn’s diseases produce fissures that extend inflammation into lymphoid
tissue.
The typical lesion is GRANULOMA as described with a “cobblestone” appearance from
projections of inflamed tissue surrounded by ulceration.
Endoscopy revealed linear ulceration and a cobblestone-like appearance of the sigmoid
colon, which is a typical Crohn’s Disease.
A non-caseating granuloma was observed in the lamina propia upon endoscopic biopsy.
Fistulae may form in the perianal area between loops of intestine or extend into the bladder.
Stricture may develop promoting obstruction. Smoking increases the risk of developing severe
disease.
Chron’s Disease

Clinical Manifestations
(Signs and Symptoms)
Fever
Diarrhoea
Colonic Bleeding
Weight loss
Lower Abdominal Pain
Mouth sores
Pain or drainage near or around the anus
If the Ileum is involved, the individual may be Anemic as a result of mal-absorption of vitamin
B12
Deficiency in Folic acid and vitamin D may also occur
Proteins may be lost and leads to hypoalbuminemia.
People with severe Crohn’s disease may
also experience:
Inflammation of skin, eyes and joints
Inflammation of the liver or bile ducts
Delayed growth or sexual development in children.
Assessment and Diagnostic Findings
1.) Blood tests
Test for anemia or infection
Fecal occult blood test
2.) Colonoscopy

Allows the doctor to view the entire colon and the very end of the ileum using a thin, flexible,
lighted tube with an attached camera.
3.) Computerized Tomography (CT)
- This test looks at the entire bowel as well as at tissues outside the bowel.
4.) Magnetic Resonance Imaging (MRI)
Use for evaluating the fistula around the anal area (pelvic MRI) or the small intestine (MR
enterography)
5.) Capsule endoscopy
For this test, you will swallow a capsule that has a camera in it. The camera takes pictures of
your small intestines, which are transmitted to a recorder you wear on your belt.
6.) Balloon assisted enteroscopy
- For this test, a scope is used in conjunction with a device called an overtube. This enables the
doctors to look further into the small bowel where standard endoscope don’t reach.

Immunosuppressant drugs
Azathioprine- It works by suppressing the bloodcells that cause inflamation.
Infliximab- A medication used to treat a number of auto immune diseases.
Methotrexate- is a drug that suppresses the body’s natural immune responses and may
suppress inflamation associated with crohn disease.
Loperamide- Cramps and diarrhea may be relieved by oral administration of loperamide 2 to 4
mg or antipasmodic drugs.

Hydrophilic Mucilloids (methycellulose)- help prevent anal irritation by increasing stool

firmness.
Mild to moderate Disease
Ambulatory patient who tolerate oral intake and have no signs of toxicity, tenderness mass or
abstruction. 5-ASA (MESALAMINE) is commonly used as first line treatment.
Pentasa is favored for small-bowel disease.
Asacol is favored for distal ileal and colonic disease.

Moderate to severe disease

Patients without fistulas or abscess but with significant pain, tenderness, fever or vomiting or
those who have not responded to treatment for mild disease often have rapid relief of
symptoms when given corticosteroids either oral or parental.
An antimetabolic (azathioprine) can be used as 2nd line therapy after corticosteroids and even as
first line theraphy in preference to the corticosteroids.