Crohn Disease Versus Ulcerative Colitis Quiz

Inflammatory Bowel Disease (IBD)

• IBD includes Ulcerative Colitis (UC) and Crohn's Disease (CD)
• UC: inflammation of the mucosa and submucosa of the colon and rectum
• CD: transmural inflammation that can affect any part of the GI tract

Diagnostics

• Fecal leukocytes: to rule out infectious diarrhea
• Colonoscopy: to assess the extent of disease and the presence of any complications

Complications

• Iron deficiency anemia
• Hemorrhage

Crohn Disease vs Ulcerative Colitis

• Crohn Disease:
  • Transmural involvement (intestinal wall from mucosa to serosa)
  • Discontinuous involvement (skip lesions)
  • Can involve any part of the GI tract
  • Colectomy is not curative (recurrences occur)
  • Complications: fistulae and abscesses are more common than in UC
  • Extraintestinal manifestation: more common than in UC
• Ulcerative Colitis:
  • Mucosa and submucosa involvement
  • Confined to colon and rectum
  • Colectomy is curative
  • Continuous involvement (no skip lesions)

Crohn's Disease

• Anatomic distribution:
  • Ileocolic (45%)
  • Small bowel alone (33%)
  • Colon alone (20%)
  • Rectal sparing
• Clinical presentation:
  • RLQ pain (postprandial) and palpable mass
  • Diarrhea (watery)
  • Rectal bleeding
  • Malabsorption and weight loss
  • Fever
  • Growth retardation in children
  • Perirectal fistula
• Extraintestinal manifestations:
  • Skin: erythema nodosum, pyoderma gangrenosum
  • Joints: peripheral arthritis, sacroiliitis, AS
  • Eye: uveitis, episcleritis, iritis
  • Hepatobiliary complications: gallstones, PSC
  • Renal complications: nephrolithiasis, recurrent UTIs

Crohn's Disease Activity Index

• Liquid or very soft stools/day
• Abdominal pain and cramping
• Extraintestinal manifestations
• Complications
• Abdominal mass
• Use of anti-diarrheal medications
• Hematocrit
• Body weight

Extraintestinal Manifestations of IBD

• Eye lesions:
  • Episcleritis: parallels bowel disease activity
  • Anterior uveitis: independent course
• Skin lesions:
  • Erythema nodosum: especially in Crohn disease; parallels bowel disease activity
  • Pyoderma gangrenosum: especially in UC; parallels bowel disease activity in 50% of cases
• Arthritis:
  • Migratory monoarticular arthritis: parallels bowel disease activity
  • Ankylosing spondylitis: patients with UC have a 30 times greater incidence of ankylosing spondylitis than the general population; the course is independent of the colitis
  • Sacroiliitis: does not parallel bowel disease activity
• Thromboembolic-hypercoagulable state: can lead to deep venous thrombosis (DVT), pulmonary embolism (PE), or a cardiovascular accident (CVA)
• Idiopathic thrombocytopenic purpura
• Osteoporosis
• Gallstones in Crohn disease (ileal involvement)
• Sclerosing cholangitis in UC

Test your knowledge on the key differences between Crohn disease and ulcerative colitis, including their involvement, location, and complications. Questions cover topics such as transmural involvement, mucosa and submucosa, and distinguishing features of each condition.