REGIONAL ENTERITIS Crohn's 2

.

MICROSCOPIC FEATURES

Most common finding in the early phase is a marked oedema of  the

affected bowel wall, most marked in the submucosa.

*  There  is dilatation of lymphatics and hyperemia, increase  in

   the proportion of goblet cells.

*  There is a fibrinopurulent exudate on the serosal surface.

*  In  the later phase of the disease, fibrosis of submucosa  and

   subserosa is seen with focal ulcers that rarely penetrate  the

   muscularis  musocae  infiltrations  with  lymphocytes,  plasma

   cells and oesonophils

*  Fibrosis is accompanied by diffuse infiltration of mononuclear

   cells and hyperplasia  of lymphoid follicles.

*  The  muscularis also demonstrates hypertromphy,  fibrosis  and

   cellular infiltrate

*  Granulomas may be present in submucosa, subserosa or  regional

   lymphnodes, these do not caseate.  Mucosa is denuded over wide

   area interspersed with mucosal islands.

*  The  villi are blunted and glands atrophied in  these  mucosal

   islands.

CLINICAL FEATURES

Some  patients present with a fibrile illness  without  abdominal

symptoms or signs

Careful  questioning  usually  elicits  a  history  of  abdominal

discomfort  that increases after eating, mild anorexia and  loose

stools.

In  about  10% of patients mostly young, the onset is  acute  and

mimics acute appendicits.

There is midabdominal or right lower qudarant pain and tenderness

accompanied by low grade fever and

*  Leucocytosis

*  vomiting

*  And occasionally Diarrhoea

*  In  majority  of patients onset is insidious,  protracted  and

   slowly progressive

*  Symptomatic periods are interspered with symptom free periods

*  Pain or abdominal discomfort is the most frequent symptom,  it

   is intermittent and precipated by dietary indiscretion

Gradually  these complaints take on the characteristics of  frank

partial obstruction with distension and visible bowel loops.

Second type of presentation is a constant ache in in the abdomen. 

There is tenderness and a palpable mass.

*  Diarrhoea is a frequent symptom and is present in about 85% of

   patients.

*  Fever is present in about one-third patients, moderate  weight

   loss and easy fatiguability.

Systemic   manifestations   such   as   polyarthritis,   pyoderma

gangrenosum and opthalmic complications are rare.

INVESTIGATIONS

Barium enema with ileocecal reflux demonstrate involvement of the

terminal  ileum,  a thin stream of barium is seen  producing  the

string sign of Kantor.

Thickening of the wall and mesentery increases the space  between

the thickened loops, fistulas may be seen
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