Crohn's what?

Many medical students who slogged through General Surgery will often wonder why we were taught Crohn's disease and Ulcerative colitis at all, since both are ridiculously rare in Singapore.

here are a few pointers to remember:
1. Ulcerative colitis is a diffuse inflammatory disorder which commonly affects the mucosa of the colon and rectum (10% may have terminal ileitis or reflux ileitis). Surgery = curative
2. Crohn's disease is a CRTSG: chronic relapsing transmural segmental granulomatous inflammatory disorder of the GIT which can involve anywhere along the GIT. Surgery = relief

Epidemiology:
UC: Bimodal peaks at 15-30/50-70, with female predominance (though slight) at 1.3x>males
CD: 20-40 years old with equal gender distribution

Presentation:
UC: abdominal pain, rectal bleeding, bloody diarrhea, tenesmus, weight loss
CD: colicky abdominal pain, non-bloody diarrhea, ANORECTAL LESIONS, weight loss, INTERMITTEN PERIODS OF DISEASES

Gross Pathology:
UC: continous disease, friable mucosa, stovepipe narrowing, pseudopolyps, granular irregularities
CD: segmental disease, longitudinal fissures, cobblestone appearance, focal strictures, bowel wall hypertrophy

Microscopically:
UC: mucosal involvement only, goblet cell loss, crypt abscesses, infiltration of plasma cells
CD: transmural involvement, granulomatous process, mesenteric adenopathy

GI distribution:
UC: usually limited to the rectum&colon, <5%>10% terminal ileitis
CD: 30% small bowel only, 15% colon only, 55% small bowel and colon. 50% perianal disease

Complications:
UC: toxic megacolon, perforations, scerosing cholangitis, less extraintestinal problems, malnutrition
CD: abscesses, fistulas, intestinal obstruction (?focal strictures) extraintestinal problems mroe common

Surgical intervention:
UC: curative
CD: not curative