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Clinical features of Crohn's disease and ulcerative colits
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Clinical features of
Inflammatory Bowel Disease
Crohn’s Disease• Fibrostenotic Obstructive pattern• Penetrating Fistulous pattern
The site of disease influences the clinical manifestations.
Ileocoltis
• Low grade fever• recurrent episodes of right lower quadrant pain• Prolonged diarrhea not grossly bloody and is
intermittent.• Leukocytosis• Weight loss• High spiking fever s/o intra abdominal abscess
formation • Palpable mass composed of inflamed bowel,
adherent and indurated mesentery, and enlarged abdominal lymph nodes.
• Dysuria and fever – extension of mass
causing obstruction of right ureter
and bladder inflammation• Bowel obstruction features – early stages produce
intermittent obstructive manifestations and increasing symptoms of postprandial pain.
• Enterovesical fistulas typically present as
dysuria or recurrent bladder infections• Enterovaginal fistulas are rare and present
as dyspareunia or as a feculent or foul-smelling,
often painful vaginal discharge.
jejunoileitis• Malabsorption and steatorrhea – due to loss of
digestive and absorptive surface.• Vertebral fractures – vit.D deficiency, hypocalcemia,
and prolonged glucocorticoid use.• Pellagra from niacin deficiency.• Megaloblastic anemia – vit.B12 deficiency• Diarrhea:• (1) bacterial overgrowth in obstructive stasis or
fistulization, • (2) bile-acid malabsorption due to a diseased or
resected terminal ileum, and • (3) intestinal inflammation with decreased water
absorption and increased
ColitisLow-grade feversMalaise DiarrheaCrampy abdominal pain, and Sometimes hematochezia
• Incontinence • Debilitatng rectal pain - hemorrhoids• Malodorous discharge from fistula• Disfiguring scars from active disease and of previous abdominal surgery.
Perianal disease
Gastroduodenal Disease
• nausea, vomiting, and epigastric pain.• H. pylori–negative gastritis• Patients with advanced gastroduodenal CD may
develop a chronic gastric outlet obstruction.
Extraintestinal manifestations1.Musculoskeletal disease: in 9-53% Arthritis- seronegative, transient and non deforming, asymmetric distribution involves large jts of lower extremities.2.Dermatologic disease: 2-34% Erythema nodosum – raised,red,tender nodules appear primarily on ant.surface of lower leg.3.Oral lesions: Apthous ulcers4.Opthalmologic disease: Primary episcleritis Anterior uveitis
5. Urologic disease: Nephrolithiasis Hydronephrosis Enterovescical fistulae6. Hepatobiliary disease: cirrhosis portal vein thrombosis cholangocarcinoma pancreatitis7. Thromboembolic disease: Deep vein thrombsis Pulmonary embolism8. Hematologic manifestations: Iron deficiency anemia, megaloblasrtc anemia Autoimmune hemolytic anemia
Laboratory, Endoscopic,and Radiographic Features
• Elevated ESR and CRP. • In more severe disease - hypoalbuminemia, anemia, and leukocytosis.
Laboratory abnormalities:
Endoscopic features:
rectal sparingaphthous ulcerations, fistulas, and skip lesions.“Cobble stone” appearance.
Radiographic features:
String sign - represents long areas of circumferential inflammation and fibrosis, resulting in long segments of luminal narrowingFilling defects seen on barium enema
CT Enterography:
depicts the smallbowel inflammation associated with CD by displaying mural hyperenhancement, stratification, and thickening; engorged vasa recta; and perienteric inflammatory Changes.
Ulcerative colitis:• Diarrhea - Liquid stools containing blood, pus, often nocturnal and/or postprandial. rectal bleeding, passage of mucus.• Tenesmus• Crampy abdominal pain.• In moderate to severe disease:• anorexia• nausea • vomiting • fever• weight loss
Proctitis - usually pass fresh blood or bloodstained mucus. tenesmus. physical signs – tender anal canal blood on rectal examinationToxic colitis – severe pain and bleedingMegacolon - hepatic tympany
Mild Moderate Severe
Bowel movements
<4 per day 4–6 per day >6 per day
Blood in stool Small Moderate Severe
Fever None <37.5C mean >37.5C mean
Tachycardia None <90 mean pulse >90 mean pulse
Anemia Mild >75% 75%
Sedimentation rate
<30 mm >30 mm
Endoscopic appearance
Erythema, decreased, Vascular pattern, Fine granularity
Marked erythema, Coarse granularity, Absent vascular markings, Contact bleeding No ulcerations
Spontaneous bleeding, Ulcerations
Extracolonic manifestations
• Uveitis – most common• Primary sclerosing cholangitis• Ankylosing spondylitis• Erythema nodosum• Pyoderma gangrenosum • Pleuritis• Spondyloarthropathies
Laboratory abnormalities:
• Elevated ESR , CRP, platelet count.• In more severe disease - hypoalbuminemia, anemia, and leukocytosis.
Radiographic features :
The earliest radiologic change is fine mucosal granularity.When severe – “collar-button” ulcers - Haustral folds become edematous and thickened - the colon becomes shortened and narrowed. - Polyps in the colon may be postinflammatory polyps or pseudopolyps, adenomatous polyps, or carcinoma.
CT findings:
• mild mural thickening (<1.5 cm),• inhomogeneous wall density, absence of small-
bowel• thickening, increased perirectal and presacral fat,• Target appearance of the rectum and adenopathy.
Clinical Features of UC vs CD
Endoscopic and Radiographic Features of UC vs CD