Name: Cabanilla, Jan Ezra T.

Case: CROHN’s DISEASE

Yr/Block: LEVEL-3 B

Part I. Description
Etiology and Pathophysiology

Signs and Symptoms The pathophysiology is multifactorial and

involves genetic predisposition, infectious,
 Diarrhea immunological, environmental, and dietary. The
 Fever characteristic transmural inflammation can include
 Fatigue the entire GI tract from mouth to the perianal area;
 Abdominal pain and although most frequently involve terminal ileum
cramping and right colon. The initial lesion starts out as an
 Blood in your stool infiltrate around an intestinal crypt. This goes on to
 Mouth sores develop ulceration first in the superficial mucosa
 Reduced appetite and and involves deeper layers. As the inflammation
weight loss progresses, non-caseating granulomas form
 Pain or drainage near or involving all layers of the intestinal wall. It can
around the anus due to develop into the classic cobblestone mucosal
inflammation from a appearances and skip lesions along the length of the
tunnel into the skin intestine sparing areas with normal mucosa. As the
(fistula) flare of Crohn settles, scarring replaces the inflamed

Medical Management

The medical treatment is broadly grouped into two classes:

Mild to moderate disease can be treated by oral mesalamine, immunomodulators such as
thiopurines (mercaptopurines, azathioprine), methotrexate, and steroids.
Moderate to severe disease (including fistulizing disease) will be best treated using a
combination of immunomodulators and biologics (infliximab, adalimumab, golimumab,
vedolizumab) or biologics alone.

Surgical Management
 Internal Bypass - In the first stage, the small bowel was transected proximal to the
diseased ileum, the distal ileal limb was oversewn, and an anastomosis was constructed
between the proximal bowel limb and the transverse colon. During the second stage,
the bypassed segment was resected.
 External bypass - Even for free perforation of the small bowel, resection of the
perforated segment with exteriorization of the proximal bowel as an end stoma is
standard practice.
 Resection - resection is the procedure of choice for Crohn's disease of the small bowel,
especially when it is the patient's first operation.
 Resection margins - The presence of residual microscopic Crohn's disease at the
resection margins does not increase recurrence rates significantly.
 Laparoscopy - As experience with laparoscopy for Crohn's disease increases, the role
of this approach broadens as the contraindications lessen and benefits emerge.
Part II. Presentation
Etiology and Pathophysiology
Signs and Symptoms

Medical Management

Surgical Management