Hey everyone, welcome back! Today, let’s break downCrohn disease, ahigh-yield topic, especially when it comes toperianal disease and fistulas.
Crohn disease ischronic, inflammatory, and can affect anywhere from the mouth to the anus—but one of the biggest clues isperianal involvement. If a patient hasskin tags, fissures, or fistulas, think Crohn's! Thesefistulas happen because Crohn’s causestransmural inflammation, meaning the entire intestinal wall is affected, leading to abnormalconnections between the bowel and nearby structures—like theskin, bladder, or other parts of the intestine.
What else should you look for?Right lower quadrant pain, diarrhea (watery or sometimes bloody), and oral aphthous ulcers. On imaging or colonoscopy, you'll seeskip lesions, cobblestone mucosa, and creeping fat. And on biopsy?Noncaseating granulomas—a classic finding!
Now, let’s talktreatment. If it'smild, you might get away with5-ASA drugs like mesalamine. But formoderate to severe disease, you’ll needsteroids, biologics like infliximab, or immunomodulators like azathioprine. Surgery?Only if there’s a complication—like a persistent fistula, stricture, or perforation.
So, the key takeaway? If you seeperianal disease, recurrent fistulas, and RLQ pain in a young patient—Crohn disease should be at the top of your differential.
That’s it for today—keep it simple, stay sharp, and I’ll catch you next time!
