CROHN’S DISEASE

Pathophysiology

Predisposing Factors: Precipitating Factors:

o 33 years old o Contaminated water supply
o Female o Fond of eating fried / fatty foods
o Poor personal and household hygiene
o Air pollution or exposure to smoke
o Psychological stress

(+) Diarrhea
Inflammation of the intestinal cell lining impairs absorption of fluid and
nutrients causing electrolyte retention and water accumulation in the
intestinal lumen Fecal contamination of the GUT
causes Urinary Tract Infection

Inflammatory cascade of cytokines, (+) Fever

neutrophils, lymphocytes are initiated (+) Body malaise
(+) Headache

Antigen presenting cells release inflammatory process by activation

inflammatory T helper cells

Inflammatory T helper cells accelerate the inflammatory process

Inflammatory substances
causes inflammation and pain
in joints which may result to
Inflammatory cells recruited by the cytokines release nonspecific
enteropathic arthritis
inflammatory substances including arachidonic acid, metabolites,
proteases, platelet activating factors, and free radicals
(+) Prolonged fever

Increased uptake of antigens which can result in uncontrolled mucosal

inflammation

Partial blockage and gut distention as well as severe intestinal (+) RLQ Abdominal Pain
inflammation (+) Nausea
(+) 5% weight loss

Increased concentrations of bile acids having secretory effects

(+) Slightly icteric sclera
resulting to increased levels of bilirubin and alkaline phosphatase in
(+) Hepatomegaly
the blood

Inflammatory cells invade the deep mucosal layers and begin to

organize into non-caseating granulomas

Granulomas extend through all layers of the intestinal wall and into
the mesentery and the regional lymph nodes

Neutrophil infiltration into the colon crypts forms crypt abscesses,

leading to destruction of the crypt and atrophy of the colon

(+) Hematochezia
(+) Rectal tenderness
Gastrointestinal Bleeding (+) Fresh blood on
examining finger

Decreased blood in circulation (+) Pale conjunctiva

(+) Low platelet count
SYMPTOMS/SIGNS
✓ Prolonged fever
✓ Hematochezia
✓ Pale conjunctiva

LABORATORIES 2 WEEKS AGO:

CBC
Hgb 114 g/L - Low
Hct 0.33 - Low
WBC 6.5 x 105
Neutrophils 0.72 – High
Lymphocytes 0.14 - Low
Basophils 0.02
Eosinophils 0.02
Platelet 122 - Low
CRP and ESR Elevated
ASCA (+)

Urinalysis
pH 5.6
Specific gravity 1.020
RBC 0-2/hpf
WBC 10-16/hpf High
Protein 1+
Leukocyte (-)
Glucose (-)
Squamous cells 7/hpf
Bacteria 110 High
Note: May prompt to repeat UA, the technique may not have been clean catch.

Stool exam
Stool exam None found

RECENT LABORATORIES
Blood culture
Blood culture (+)

Stool culture
Stool culture (-)

CT Scan