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Crohn's disease (Clinical presentation (Lethargy, Anorexia, Malaise,…
Crohn's disease
Clinical presentation
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Abdominal pain - can present as an emergency with acute right iliac fossa pain mimicking appendicitis
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Diarrhoea with urgency (need to go 5-6 times in 45 mins), bleeding and pain due to deification
Extraintestinal signs; aphthous oral ulcerations, clubbing, skin, joint & eye problems
Complications
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Anal; skin tags, fissure, fistula (between loops of bowel)
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Epidemiology
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Highest incidence and prevalence in Northern Europe, UK and North America
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Treatment
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Anaemia due to iron, B12 or folate should be treated with replacement
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Maintain remission by azathioprine, methotrexate (if intolerant of azathioprine) & anti-TNF antibodies if resistant to corticosteroids
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Diagnosis
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Bloods
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Hypoalbuminaemia present in severe disease as part of an acute phase response to inflammation associated with raised CRP
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Despite terminal ill involvement, B12 anaemia is unusual
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Pathophysiology
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Microscopic
Granulomas present in 50-60% - these are non-caseating epitheloid cell aggregates with Langerhan's giant cells
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Key Facts
A chronic inflammatory GI disease characterised by transmural (goes deep into mucosa) granulomatous inflammation affecting ANY part of the gut from mouth to anus (especially in TERMINAL ILEUM and PROXIMAL COLON)
Unlike in UC, there is unaffected bowel between areas of active disease - these are SKIP LESIONS
Differential diagnosis
Alternative causes of diarrhoea should be excluded e.g. Salmonella spp, Giardia intestinal and rotavirus
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