Crohn’s Disease - DIAGNOSIS

Posted by Alex

There are no pathognomonic clinical, endoscopic, or histologic features of the idiopathic IBD’s. The physician must therefore consider the entire clinical picture and the evolution of the illness. It is particularly important to exclude other disorders that may mimic the broad range of IBD symptoms and findings. First it is important to establish the presence of intestinal inflammation. A cardinal feature is the exudation of inflammatory cells into the lumen, manifested by fecal leukocytes or red blood cells on stool examination. Symptoms of rectal bleeding, tenesmus associated with the passage of pus, nocturnal pain and diarrhea, fever, night sweats, weight loss, or extraintestinal symptoms or signs generally exclude an uncomplicated “irritable bowel syndrome.” The presence of anemia, electrolyte disorders, hypoalbuminemia, or an elevated erythrocyte sedimentation rate of C-reactive protein is sufficient, but not necessary, to suggest IBD. On physical examination, evidence of significant weight loss or extraintestinal signs, a palpable abdominal mass or tenderness, or significant perianal disease suggests IBD. When suspicion of the diagnosis warrants, endoscopic and radiographic studies, in conjunction with histologic interpretation of biopsy specimens, confirm the diagnosis; the degree of illness at presentation should determine the aggressiveness of the diagnostic workup. Acutely ill patients should be stabilized before invasive studies are pursued.