CROHN’S DISEASE (Robbins pp 816)

Epidemiology: Incidence in USA of 3/100K. Peak ages are 10-30 with 2^nd peak btw 50-60. Females affected > males . Whites affected more, Jews affected more, smokers affected more.

Macroscopy:

1) Creeping fat (mesenteric fat wrapping around bowel wall),

2) skip lesions,

3) thickened wall with oedema, fibrosis, hypertrophy of muscle,

4) aphthous ulcers ≫ linear ulcers,

5) Cobblestone appearance,

6) fissures ≫ fistulas/sinus tract,

Microscopy:

1) Neutrophils infiltrating epithelium ≫ crypt abscesses,

2) chronic transmural inflammation ≫ loss of architecture ≫atrophy ≫ pyloric / paneth cell metaplasia,

3) Ulceration ≫ fissures,

4) Non-caseating granulomas (50%).

Clinical features/Treatment: Variable abdominal pain, with associated diarrhea or constipation. Sometimes minute faecal bleeding may be present over long period of time ≫anaemia. Treatment is by immunosuppression or surgery (avoid for most part).

Complications/Sequalae:

1) fissures ≫ fistula,

2) obstruction / adhesions,

3) if terminal ileum affected: a) protein losing enteropathy, malabsorption of vit b12 + bile salts ≫ pernicious anaemia + steatorrhoea,

4) Malignancy (4-5 fold increase),

5) Extraintestinal diseases: ankylosing spondylitis, sarcoilitis, erythema nodosum.

Category: Pathology Notes