Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Inflammatory bowel disease: Crohn's disease
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Introduction
Crohn's disease (CD) is an inflammatory condition that most commonly affects the small intestine. It may, however, affect any part of the GI tract from themouth to the anus. The colon (Crohn's colitis) or the perineum, with or without small-bowel involvement may be affected.
Incidence
Five new cases per 100 000 population per year in developed countries. The incidence is rising rapidly. Crohn's disease is most commonly diagnosed in 20–30 year olds, but shows a biphasic incidence, with a second peak in the sixth decade.
Aetiology
Unknown. Possible causes include infective (there are features that are similar to intestinal tuberculosis), immunological (there are suggestions of impaired cell-mediated immunity, and of autoantibody formation) and diet (possible causation of diet high in refined carbohydrates). In contrast to ulcerative colitis, smoking appears to be a risk factor.
Pathophysiology
Unlike ulcerative colitis, which is confined to the colon, CD can affect any part of the gastrointestinal tract. The disease is characteristically patchy in nature with normal segments of bowel between ‘skip lesions’ of disease. Macroscopically there is aphthous ulceration which progresses to deep fissuring ulcers. This leads to a cobblestone appearance and tight strictures or fistulae may develop. Microscopically there is chronic inflammation of all layers of the bowel wall, with ulceration, micro-abscesses and non-caseating granulomas.
Symptoms and signs
The presentation of CD can vary depending on the areas affected. The most common presenting features are diarrhoea, weight loss, abdominal pain and fever. There may be steatorrhoea if the small bowel is affected, or rectal bleeding in those with Crohn's colitis.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 409 - 412Publisher: Cambridge University PressPrint publication year: 2009