LITERATURE REVIEW
DIFFERENTIAL DIAGNOSIS OF NON CASEATINGGRANULOMATOUS LUNG DISEASE
– Bacteria - Brucella, Yersinia
– Mycobacteria - tuberculosis, atypical
– Fungi - Histoplasmosis, Coccidiomycosis, Blastomycosis, Cryptococcosis
– Protozoa - toxoplasmosis, Leishmaniasis
– Chemicals - starch, silica
– Neoplasma - seminoma, carcinoma
– Sarcoidosis
– Chronic granulomatous disease of childhood
– Crohns disease
– Wegeners, Churg Strauss
– SLE
– Hypogammaglobulinaemia
– Histiocytosis X
– Primary Biliary Cirrhosis
CROHNS
DISEASE
Overview
–
Onset
in adolescence (15-25 years) with smaller peak at 50-80 years
–
A genetic role exists as there is a 7-22% risk of inflammatory bowel
disease (IBD) in family members of subjects with Crohns disease. If
both parents have IBD then 35% of children will have IBD. Crohns disease
is associated with a greater genetic risk than ulcerative colitis.
–
Crohns disease is associated with Turners, GSD and immunodeficiencies
–
An environmental role exists as there is an increased incidence of Crohns
disease in developed countries
Presentation
–
Mouth to anus
–
Eccentric and segmental
–
Skip lesions
–
Transmural involvement
–
Initial presentation is typically gastrointestinal with 40% ileocolitis
alone (50% terminal ileum only) and 10% colon alone
–
Typically crampy abdominal pain
–
Diarrhoea ± blood
–
Fever, malaise, growth failure
–
Perianal disease, fistulae
–
Extraintestinal findings which correlate with presence of colitis i.e.
oral apthous ulcers, arthritis, erythema nodosum, clubbing, renal stones,
gallstones
DIFFERENTIAL
DIAGNOSIS: Ulcerative colitis
| Feature | Crohns | Ulcerative Colitis |
| Rectal bleed | Occasional | Common |
| Abdominal mass | Common | Nil |
| Rectal disease | Occasional | Universal |
| Ileum involved | Common | Nil |
| Perianal | Common | Unusual |
| Strictures | Common | Unusual |
| Fistulae | Common | Unusual |
| Skip lesions | Common | Unusual |
| Transmural | Common | Unusual |
| Crypt abcesses | Less common | Common |
| Granulomas | Common | Unusual |
| Cancer risk | Slight increase | Great increase |
Findings
on investigation
–
Iron deficiency anemia
–
Elevated platelets
–
Low serum albumin, high stool a1AT
–
AXR: "thumb printing"
–
Upper GI + follow through: "cobblestoning"
–
Barium enema
–
colonoscopy + biopsy
Basic
treatment
–
Nutritional
therapy
–
Prednisone
–
Sulfasalazine
–
Azathioprine
–
Cyclosporine
–
Surgery: has a high recurrence rate
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