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Investigations
in
Crohn ‘ s
Disease
“
BLOOD EXAMINATION
STOOL EXAMINATION
SEROLOGY
RADIOLOGY
ENDOSCOPY
BIOPSY
INVESTIGATIONS
OVERVIEW
FULL BLOOD
COUNT
ANAEMIA
LEUCOCYTOSIS
LOW SERUM ALBUMIN
Raised ESR
Raised CRP
 BLOOD CULTURE (Febrile patients)
 Fecal CALPROTECTIN
- A Calcium & Zinc binding protein found in
cytosol of NEUTROPHILS
- Not elevated in Functional /Non-inflammatory
disorders
- Sensitive in IBD & useful to distinguish form
IRRITABLE BOWEL SYNDROME
 STOOL CULTURE (Excl. superimposed infection)
STOOL EXAMINATION
5
Fecal CALPROTECTIN
SEROLOGY
ASCA – Anti Saccharomyces
cerevisiae Antibody for CD
pANCA - Perinuclear Anti-Neutrophil
Cytoplasmic Antibodies for UC
Antibodies to E.coli OmpC
(Outer membrane porin protein C)
ENDOSCOPY
EARLY FINDINGS
 APHTHOUS
ULCERATIONS
 LONGITUDINAL
ULCERS (in progression of CD)
 COBBLESTONE APPEARANCE
 SKIP LESIONS
 PSEUDOPOLYPS
LATE FINDINGS
 STRICTURE
FORMATION
 FISTULAS
 INFLAMMATORY
MASSES
 ABSCESSES
8
COBBLESTONE
APPEARANCE
9
LONGITUDINAL ULCERS
10
APHTHOUS ULCERATIONS
11
PSEUDOPOLYPS
CAPSULE
ENDOSCOPY
╺ Allows direct visualization of
the entire mucosa
╺ HIGHER DIAGNOSTIC YIELD in
detecting lesions than CT & MR
Enterography (RADIOLOGY) in
CROHN’S Disease
╺ Capsule Retention
12
13
ENDOSCOPIC
DILATION
To dilate Ileal or colonic strictures
(≤ 4 cm respond better)
Only Fibrotic Strictures ; not those
with Active INFLAMMATION
 Barium follow through & Enema
RADIOLOGY
14
 The radiographic “String
sign” represents long areas
of circumferential
inflammation and fibrosis,
resulting in long segments
of luminal narrowing
RADIOLOGY
 MRI ENTEROGRAPHY
 CT ENTEROGRAPHY (expertise)
 ABDOMINAL X-RAY (AB obstruction)
 ULTRASONOGRAPHY (thickened bowel & stricture)
- show Extra-Intestinal and
Pelvic manifestations
- distinguish Inflammatory from
Fibrotic strictures
BIOPSY
o NON-CASEATING
GRANULOMA (35%)
o CRYPT ABSCESSES
o TRANSMURAL ULCERS
o DISTORTION OF MUCOSAL
ARCHITECTURE
o PANETH CELL METAPLASIA IN
LEFT COLON
Rectal biopsy: A Granuloma
DIFFERENTIAL
DIAGNOSES
• Other causes of right iliac fossa
mass : caecal carcinoma, appendix
abscess
• Infection (TB ,Yersinia, actinomycosis)
• Mesenteric Adenitis
• Pelvic Inflammatory Disease
• Lymphoma
18
DISEASES THAT MIMIC IBD
19
DISEASES THAT MIMIC IBD
THANK YOU

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Investigations CROHNS Disease.pptx