Types of Crohns disease

Colonic disease

The commonest symptoms of extensive colonic involvement are diarrhoea and general malaise, often associated with anorexia and weight loss. Unlike the pattern in small intestinal Crohn's disease, obstructive symptoms are uncommon, though vague persistent abdominal discomfort is often a feature. Left-sided disease is commoner in older patients and symptoms can mimic diverticular disease, with attacks of pain in the left lower abdominal quadrant and intermittent diarrhoea. Crohn's colitis may be complicated by colonic perforation leading to an acute abdominal emergency.

Perianal disease

Perianal disease is present in more than two-thirds of patients with Crohn's disease, though it is often painless and asymptomatic. Perianal disease only becomes painful when there is local abscess formation or active anal fissure.

Small bowel disease

Ileal disease presents with abdominal pain, diarrhoea and an abdominal mass. Severe symptoms with general malaise, anorexia, weight loss and peripheral oedema, together with a low serum albumin, may occur. Occasionally patients present with fever and right lower quadrant abdominal pain as a result of localised peritonitis.

Gastroduodenal Crohn's disease

Crohn's disease affecting the gastroduodenal region occurs in fewer than 5% of patients and is usually associated with macroscopic disease in other parts of the gastrointestinal tract. Symptoms may resemble that of peptic ulcer disease and include epigastric pain, nausea and postprandial vomiting.

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