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Difference between revisions of "Crohn's disease"
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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 = | ||
| Line 12: | Line 12: | ||
| 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 | ||
| Line 22: | Line 22: | ||
| Prevalence = | | Prevalence = | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = segmental bowel wall changes | | 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 type 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/> | ||
***''[[ | ***''[[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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Image: Small granuloma in colorectal mucosa -- high mag.jpg | CD - high 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. | 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: | ||