Location of Lesions Academic Notes

‭Location of lesions‬ ‭They preferentially sit on the terminal ileum, the colon and the anus, but can‬ ‭reach the entire digestive tract (from the oral cavity to the anus). The small‬ ‭intestine alone is affected in 30 to 40% of cases; the colon alone in 15 to 25%;‬ ‭the small intestine and the colon in 40 to 55%. The rectum is rarely affected.‬ ‭Distribution of lesions‬‭-They are classically discontinuous,‬‭that is to say‬ ‭separated by intervals of healthy mucosa, and transmural (therefore affecting‬ ‭the muscular layer of the intestinal wall).‬ ‭Types of lesions‬‭-stenosing and/or ulcerated.‬ ‭CD is a chronic condition evolving in flares interspersed with‬ ‭remissions whose duration is unpredictable.‬ ‭General events‬‭-We can observe fatigue, weight loss (10 to 20%) and‬ ‭febrile episodes contemporaneous with progressive flare-up‬ ‭Digestive‬‭manifestations‬‭-Correlated‬‭with‬‭the‬‭location‬‭of‬‭the‬‭lesions,‬‭they‬‭are‬ ‭dominated‬‭by‬‭abdominal‬‭pain‬‭and‬‭diarrhea,‬‭either‬‭watery‬‭and‬‭possibly‬‭bloody‬ ‭in colic forms, or fatty due to malabsorption in extensive intestinal forms.‬ ‭Anoperineal manifestations‬‭-Ulcerations, fissures,‬‭abscesses‬ ‭or anorectal stenosis.‬ ‭Extraintestinal manifestations -‬‭Found in a third of‬‭cases of inflammatory‬ ‭bowel disease, they are potentially very numerous and even reveal CM in 10%‬ ‭of cases:‬ r‭ heumatological‬ ‭manifestations:‬ ‭arthritis‬ ‭(15‬ ‭to‬ ‭20%),‬ ‭ankylosing‬ ‭spondylitis‬ ‭(10%),‬ ‭symmetrical‬ ‭sacroiliitis, osteoporosis;‬ ‭-‬ ‭dermatological manifestations: erythema nodosum (15%),‬ ‭pyoderma gangrenosum (rarer than in UC), oral aphthosis;‬ ‭-‬ ‭-‬ ‭ phthalmological manifestations (1 to 10%): mainly conjunctivitis,‬ o ‭episcleritis, or acute anterior uveitis; demonstrations‬ ‭-‬ ‭ epatobiliary: hepatic steatosis, sclerosing cholangitis, cholelithiasis (10‬ h ‭to 35% of cases if ileal lesions or resection); urinary manifestations:‬ ‭-‬ ‭oxalic lithiasis (10 to 20%); cardiovascular manifestations: infective‬ -‭ ‬ ‭endocarditis, pleuropericarditis;‬ ‭-‬ ‭ ematological manifestations: hypercoagulability (risk of‬ h ‭pulmonary embolism, stroke, or deep vein thrombosis).‬ ‭Basic biological tests‬‭-They usually reveal anemia‬‭(50 to 65% of cases),‬ ‭hyperleukocytosis (20% of cases) and sometimes thrombocytosis.‬ ‭Imaging tests‬‭-They include plain abdominal X-ray,‬‭CT scan, ultrasound, small‬ ‭bowel transit and endoscopic examinations (colonoscopy, ileoscopy).‬ ‭Serologies‬‭-Several serologies sometimes make it possible‬‭to facilitate the‬ ‭positive or differential diagnosis:‬ ‭ nti-Escherichia coli membrane porin C antibody: OmpC is positive‬ a ‭in 55% of CD cases;‬ ‭-‬ ‭anti-Pseudomonas fluorescens transcription factor I2 antibody: anti I2 is‬ ‭positive in 50 to 54% of CD cases; anti-Saccharomyces cerevisiae‬ -‭ ‬ ‭antibodies: ASCA positive in 60 to 70% of CD cases;‬ ‭-‬ ‭ nti-neutrophil cytoplasmic antibodies: pANCA positive in 60 to‬ a ‭70% of UC cases;‬ ‭-‬ ‭Cbir1 antiflagellin antibodies: positive in 50% of CD cases.‬ ‭-‬ ‭However, there are many false positives: 5% for ASCA (2 to 3% for pANCA) in‬ ‭the absence of any inflammatory bowel disease.‬ ‭pANCA‬ ‭Sick‬ ‭e‬ ‭- 5 to 10%‬ ‭MC‬ ‭- 10 to‬ ‭+ 60 to‬ ‭CU‬ ‭15%‬ ‭70%‬ ‭ASCA‬ ‭+ 60 to‬ ‭70%‬ ‭Cancerization‬‭-The major progressive risk of CD is‬‭the appearance of intestinal‬ ‭cancer: either colorectal adenocarcinoma (average risk‬ ‭multiplied by 2.5, but higher in young subjects with mainly colic disease), i.e.‬ ‭cancer of the small intestine. An increased risk of squamous cell carcinoma‬ ‭has also been reported.‬ ‭Other complications‬‭-They are potentially numerous:‬ ‭ stulas (enteroenteric, enterocutaneous, enterovesical or even‬ fi ‭enterovaginal);‬ ‭-‬ ‭abscess: 10 to 30% of cases (especially in the right iliac fossa);‬ ‭-‬ ‭ cclusions: 40% of cases (in ileal forms of MC); perforations: 1 to‬ o ‭-‬ ‭2% (especially of the ileum);‬ -‭ ‬ ‭digestive hemorrhages (especially in‬ ‭rectosigmoid forms).‬ ‭-‬ ‭It is not currently possible to cure a patient with CD; the goal of treatment is‬ ‭therefore to ensure remissions are as long-lasting as possible.‬