Crohn's Disease

Etiology

  • Autoimmune
  • Genetic
  • Other
  • Environmentally triggered
  • Transmural involvement
  • Can affect anywhere in GI tract mouth-to-anus

Risk Factors

  • Family history
  • Smoking and appendectomy increase risk
  • Northern Europeans and North Americans
  • Peak onset 15-30

Symptoms

  • Fever
  • Abdominal pain
  • Wt loss
  • Peri-rectal dz
  • Sub-acute symptoms, along a spectrum from mild to severe
  • Diarrhea→ though can be less prominent than with UC
  • Nocturnal diarrhea
  • Mucous and sometimes bloody stools
  • Cramps, constipation
  • Fatigue and feeling poorly overall
  • Fistulas, bowel obstruction
  • Extra-Intestinal: skin disorders, joint pain, low back/hip pain (ankylosing spondylitis/scroiliitis), eye/visual sx (episcleritis, scleritis, uveitis), RUQ pain/jaundice (primary sclerosing cholangitis)
  • DVT: risk markedly increased w/IBD flair, immobility and/or hospitalization

Physical Exam Findings

  • Aphthous ulcers
  • Sometimes abdominal mass
  • Peri-rectal disease (fissure, fistulas, ulcers)
  • Erythema nodosum
  • Pyoderma gangrenosa
  • Peripheral arthritis
  • Low back, SI joint pain
  • RUQ pain/jaundice
  • Eye pain, redness, decline in vision

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