Crohn’s Disease – CLINICAL MANIFESTATIONS

Posted by Alex

The symptoms and signs of CD also are determined by the site and extent of inflammation. Gastroduodenal CD mimics peptic ulcer disease, with nausea, vomiting, and epigastric pain. Patients with small intestinal involvement have abdominal cramping, diarrhea, and abdominal tenderness. The pain and tenderness of CD are due to transmural inflammation. Transmural inflammation leads to fibrosis and narrowing of the intestinal lumen, which produce symptoms of obstruction: nausea, vomiting, waves of abdominal pain, and a reduced output of stool on physical examination. This is appreciated as a thickened, tender loop of bowel or an abdominal mass, if the mesentery is involved. Patients with colonic CD present with abdominal pain, cramping or localized pain, rectal bleeding, and diarrhea.

Weight loss is more common in CD than in UC because of small bowel-related malabsorption or a reduced intake of food to minimize postprandial symptoms. Systemic symptoms, including fever, night sweats, malaise, and arthralgias, are common.

Laboratory features in CD reflect blood loss, malabsorption, protein-losing enteropathy, and elevation of acute phase reactants. Anemia may be due to a deficiency in iron (blood loss or malabsorption), folic acid, or vitamin B12 . Serum albumin and total protein are reduced with either malnutrition or protein-losing enteropathy. Electrolyte abnormalities reflect the severity of diarrhea, and lowered serum calcium may reflect reduced serum albumin, calcium malabsorption, or vitamin D deficiency. Patients with ileal disease often malabsorb fat-soluble vitamins (A, D, E, and K), deficiency of which can produce clinically significant symptoms or signs.