Crohn Disease Symptoms and Severity

Crohn Disease - Manifestations

• Crohn disease is a chronic inflammatory bowel disease impacting the GI system.
• Symptoms vary widely, influenced by the location and severity of GI involvement.
• Common symptoms:
  • Persistent diarrhea
  • Abdominal pain and tenderness, often relieved by defecation
  • Fever, fatigue, and weight loss
  • Anorectal lesions (e.g., fissures, ulcers, fistulas, abscesses)

Crohn Disease - Severity

• Crohn disease severity is assessed using the:
  • Crohn’s Disease Activity Index (CDAI)
  • Harvey-Bradshaw index
• Both indexes correlate and can be used to classify disease severity:
  • Clinical remission: CDAI < 150
    • Asymptomatic without inflammatory sequelae.
    • Achieved spontaneously or through medical/surgical intervention.
  • Mild Crohn disease: CDAI 150-220
    • Ambulatory, tolerating an oral diet.
  • Moderate Crohn disease: CDAI 220-450
    • Requires medication to manage symptoms.
  • Severe Crohn disease: CDAI > 450
    • Persistent symptoms despite medication.
    • May involve hospitalization due to fever, vomiting, obstruction, abscess, or other complications.

Crohn Disease - Complications

• Intestinal obstruction: Common complication caused by bowel inflammation and scarring leading to fibrosis and stricture.
  • Symptoms: Abdominal distention, cramping pain, hyperactive bowel sounds (borborygmi), nausea, and vomiting.
• Fistulas: May be asymptomatic, especially when occurring between loops of small bowel.
• Abscess: Formed by fistulization, causing chills, fever, abdominal mass, and elevated white blood cell count.
  • Fistulas between the small bowel and colon can exacerbate diarrhea, weight loss, and malnutrition.
• Bladder involvement: Recurrent urinary tract infections (UTIs).
• Bowel perforation: Uncommon, but can lead to generalized peritonitis.
• Massive hemorrhage: Uncommon complication.
• Colorectal cancer: Increased risk with long-standing Crohn disease.

Hemorrhage

• Symptoms include pale mucous membranes, thirst, light-headedness, hypotension, reduced urine output
• Treatment includes blood transfusions, iron supplements, IV fluids, possibly surgery to remove damaged bowel, possibly vasoconstrictive medications

Megacolon

• Symptoms include fever, tachycardia, hypotension, dehydration, abdominal tenderness and cramping, change in the number of stools per day
• Treatment includes fecal disimpaction, enemas, suppositories, bowel decompression, colonoscopic decompression, bowel habit retraining, total abdominal colectomy

Diarrhea

• Symptoms include frequent loose stools, abdominal cramping, abdominal tenderness, stool that may or may not contain blood, thirst, dehydration, hypovolemia, malnutrition
• Treatment includes monitoring of intake and output, IV fluid, antidiarrheal medications (should be avoided in severe UC), possible guaiac testing

Fistulas

• Symptoms may include being asymptomatic between bowel loops, between bowel and bladder—frequent UTIs, between bowel and abdominal cavity—abscess, chills and fever, a tender abdominal mass, leukocytosis, between small bowel and colon—weight loss, malnutrition, possible exacerbation of diarrhea
• Treatment includes symptomatic treatment: antibiotics, antidiarrheal medication, IV fluid support, possible dissection of section of bowel with fistula if tissue cannot be repaired

Explore the symptoms and severity of Crohn disease in this quiz. Learn about common manifestations such as diarrhea and abdominal pain, as well as how to assess the disease severity using established indices. Test your knowledge and understanding of this chronic inflammatory bowel condition.