Difference between revisions of "Crohn's disease"

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Crohn's disease (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Crohn's disease - colon - high mag.jpg
| Image      = Crohn's disease - colon - high mag.jpg  
| Width      =
| Width      =
| Caption    = Crohn's disease. [[H&E stain]].
| Caption    = Crohn's disease. [[H&E stain]].  
| Micro      =
| Micro      =
| Subtypes  =
| Subtypes  =
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| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      = aphthous ulcer, transmural inflammation, [[creeping fat]], cobblestone appearance, serpiginous ulcers
| Gross      = aphthous ulcer, transmural inflammation, [[creeping fat]], cobblestone appearance, serpiginous ulcers, classically with patchy involvement (unlike [[ulcerative colitis|UC]])
| Grossing  =
| Grossing  =
| Site      = small bowel (esp. [[terminal ileum]]), [[colon]], [[rectum]], [[stomach]], [[duodenum]], [[esophagus]], others
| Site      = small bowel (esp. [[terminal ileum]]), [[colon]], [[rectum]], [[stomach]], [[duodenum]], [[esophagus]], others
| Assdx      =
| Assdx      = [[colorectal adenocarcinoma]] (increased risk)
| Syndromes  =
| Syndromes  =
| Clinicalhx = +/-abdominal pain, +/-diarrhea
| Clinicalhx = +/-family history of [[inflammatory bowel disease]]
| Signs      =
| Signs      = +/-diarrhea, +/-blood per rectum
| Symptoms  =
| Symptoms  = +/-abdominal pain
| Prevalence =
| Prevalence =
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      = segmental bowel wall changes, classically with [[terminal ileum]] involvement
| Endoscopy  = cobblestone appearance, serpiginous ulcers
| Endoscopy  = cobblestone appearance, serpiginous ulcers, patchy involvement, terminal ileum classically affected
| Prognosis  =
| Prognosis  =
| Other      =
| Other      =
| ClinDDx    = [[infectious colitis]], [[ulcerative colitis]]
| ClinDDx    = [[infectious colitis]], [[ulcerative colitis]]
}}
}}
'''Crohn's disease''', abbreviated as '''CD''', is a atype of [[inflammatory bowel disease]]. It is the bread and butter of gastroenterology, and is often seen by pathologists.
'''Crohn's disease''', abbreviated as '''[[CD]]''', is a type of [[inflammatory bowel disease]]. It is the bread and butter of gastroenterology, and is often seen by pathologists.


==General==
==General==
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</ref>
</ref>
**Definition: fat on more than 50% of the intestinal surface.<ref name=pmid15888774/>
**Definition: fat on more than 50% of the intestinal surface.<ref name=pmid15888774/>
***''[[onlinepathology|OP]]'' understands this as ''fat on 50% of the circumference''.
***''[[Libre Pathology|LP]]'' understands this as ''fat on 50% of the circumference''.
**DDx of creeping fat: [[ulcerative colitis]], sclerosing mesenteritis, mesenteric panniculitis, epiploic appendagitis, omental infarction, gastrointestinal complication a renal transplant, idiopathic segmental ureteritis.<ref name=pmid18815796/>
**DDx of creeping fat: [[ulcerative colitis]], sclerosing mesenteritis, mesenteric panniculitis, [[epiploic appendagitis]], omental infarction, gastrointestinal complication a renal transplant, idiopathic segmental ureteritis.<ref name=pmid18815796/>
**Can be seen radiologically.
**Can be seen radiologically.
*Cobblestone appearance -- may be described as such on endoscopy; due to edema.
*Cobblestone appearance -- may be described as such on endoscopy; due to edema.
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*Grossly, the [[margins]] should be clear of disease; the [[surgical clearance]] and microscopic involvement are not considered important.<ref name=pmid6348672>{{Cite journal  | last1 = Hamilton | first1 = SR. | title = Pathologic features of Crohn's disease associated with recrudescence after resection. | journal = Pathol Annu | volume = 18 Pt 1 | issue =  | pages = 191-203 | month =  | year = 1983 | doi =  | PMID = 6348672 }}</ref>
*Grossly, the [[margins]] should be clear of disease; the [[surgical clearance]] and microscopic involvement are not considered important.<ref name=pmid6348672>{{Cite journal  | last1 = Hamilton | first1 = SR. | title = Pathologic features of Crohn's disease associated with recrudescence after resection. | journal = Pathol Annu | volume = 18 Pt 1 | issue =  | pages = 191-203 | month =  | year = 1983 | doi =  | PMID = 6348672 }}</ref>
*The term ''creeping fat'' may be used in the context of a [[vasculitis]] outside of the abdominal cavity.<ref name=pmid18815796>{{Cite journal  | last1 = Golder | first1 = WA. | title = The "creeping fat sign"-really diagnostic for Crohn's disease? | journal = Int J Colorectal Dis | volume = 24 | issue = 1 | pages = 1-4 | month = Jan | year = 2009 | doi = 10.1007/s00384-008-0585-y | PMID = 18815796 }}</ref>
*The term ''creeping fat'' may be used in the context of a [[vasculitis]] outside of the abdominal cavity.<ref name=pmid18815796>{{Cite journal  | last1 = Golder | first1 = WA. | title = The "creeping fat sign"-really diagnostic for Crohn's disease? | journal = Int J Colorectal Dis | volume = 24 | issue = 1 | pages = 1-4 | month = Jan | year = 2009 | doi = 10.1007/s00384-008-0585-y | PMID = 18815796 }}</ref>
===Images===
<gallery>
Image:ResectedIleum.jpg | Ileal resection for CD. (WC)
</gallery>


==Microscopic==
==Microscopic==
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*Mucin preservation at the active sites.
*Mucin preservation at the active sites.
*Focal chronic inflammation without crypt atrophy.
*Focal chronic inflammation without crypt atrophy.
*Pseudopyloric mucous glands ([[AKA]] pyloric gland metaplasia).<ref name=medunigraz>URL: [http://www.medunigraz.at/22698 http://www.medunigraz.at/22698]. Accessed on: 6 August 2013.</ref>
*[[Pseudopyloric mucous glands]] ([[AKA]] pyloric gland metaplasia).<ref name=medunigraz>URL: [http://www.medunigraz.at/22698 http://www.medunigraz.at/22698]. Accessed on: 6 August 2013.</ref>
**Round glands with abundant pale cytoplasm - stubby champagne flute.
**Round glands with abundant pale cytoplasm - stubby champagne flute.
**Usually in the deep aspect of the mucosa.
**Usually in the deep aspect of the mucosa.
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Image:Crohn's disease - colon - high mag.jpg | Colon - high mag.  
Image:Crohn's disease - colon - high mag.jpg | Colon - high mag.  
Image:Crohn's disease - colon - very high mag.jpg | Colon - very high mag.
Image:Crohn's disease - colon - very high mag.jpg | Colon - very high mag.
</gallery>
<gallery>
Image: Small granuloma in colorectal mucosa -- intermed mag.jpg | CD - intermed. mag.
Image: Small granuloma in colorectal mucosa -- high mag.jpg | CD - high mag.
Image: Small granuloma in colorectal mucosa -- very high mag.jpg | CD - very high mag.
</gallery>
<gallery>
Image:Anus ChronDisease 14PY***.jpg|Anus - Crohn Disease (SKB)
Image:Anus ChronDisease MP2 14PY***.jpg|Anus - Crohn Disease (SKB)
Image:Anus ChronDisease MP 14PY***.jpg|Anus - Crohn Disease (SKB)
</gallery>
</gallery>
www:
www:
*[http://www.medunigraz.at/images/content/image/presse/patho-netzwerk/1012_06.jpg Crohn's disease - pyloric gland metaplasia (medunigraz.at)].<ref name=medunigraz>URL: [http://www.medunigraz.at/22698 http://www.medunigraz.at/22698]. Accessed on: 6 August 2013.</ref>
*[http://www.medunigraz.at/images/content/image/presse/patho-netzwerk/1012_06.jpg Crohn's disease - pyloric gland metaplasia (medunigraz.at)].<ref name=medunigraz>URL: [http://www.medunigraz.at/22698 http://www.medunigraz.at/22698]. Accessed on: 6 August 2013.</ref>
*[http://www.medunigraz.at/images/content/image/presse/patho-netzwerk/1012_07.jpg Crohn's disease - pyloric gland metaplasia (medunigraz.at)].<ref name=medunigraz/>
*[http://www.medunigraz.at/images/content/image/presse/patho-netzwerk/1012_07.jpg Crohn's disease - pyloric gland metaplasia (medunigraz.at)].<ref name=medunigraz/>
*[http://ajcp.ascpjournals.org/content/126/3/365.full.pdf Mucous gland metaplasia (ascpjournals.org)].<ref name=pmid16880149>{{Cite journal  | last1 = Goldstein | first1 = N. | last2 = Dulai | first2 = M. | title = Contemporary morphologic definition of backwash ileitis in ulcerative colitis and features that distinguish it from Crohn disease. | journal = Am J Clin Pathol | volume = 126 | issue = 3 | pages = 365-76 | month = Sep | year = 2006 | doi = 10.1309/UAXMW3428PGN9HJ3 | PMID = 16880149 }}</ref>


==Sign-out==
==Sign-out==
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<pre>
<pre>
TERMINAL ILEUM, BIOPSY
TERMINAL ILEUM, BIOPSY
- PATCHY MILD ACTIVE ILEITIS.
- PATCHY MILD ACTIVE ILEITIS.


COMMENT:
COMMENT:
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it cannot be excluded on pathologic grounds.   
it cannot be excluded on pathologic grounds.   
</pre>
</pre>
<pre>
TERMINAL ILEUM, BIOPSY:
- MILD PATCHY ACTIVE ILEITIS WITH MILD CHRONIC CHANGES.
- NEGATIVE FOR DYSPLASIA.
COMMENT:
No granulomata are identified. The villous architecture is largely preserved. Pseudopyloric
mucous glands are present focally.
The changes are compatible with Crohn's disease; however, other causes of inflammation
should be considered clinically.
</pre>
====Classic====
====Classic====
<pre>
<pre>
A. TERMINAL ILEUM, BIOPSY
A. TERMINAL ILEUM, BIOPSY
- MODERATE GRANULOMATOUS ILEITIS.
- MODERATE GRANULOMATOUS ILEITIS.


B. CECUM, BIOPSY:
B. CECUM, BIOPSY:
- MILD PATCHY ACTIVE CECITIS.
- MILD PATCHY ACTIVE CECITIS.


C. SIGMOID COLON, BIOPSY:  
C. SIGMOID COLON, BIOPSY:  
- CHRONIC INFLAMMATORY CHANGES. NO ACTIVE COLITIS.  
- CHRONIC INFLAMMATORY CHANGES. NO ACTIVE COLITIS.  


COMMENT:
COMMENT:
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*[[Inflammatory bowel disease]].
*[[Inflammatory bowel disease]].
**[[Ulcerative colitis]].
**[[Ulcerative colitis]].
*[[Crohn's like reaction]].


==References==
==References==
Michael
49,006

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