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LITERATURE REVIEW

DIFFERENTIAL DIAGNOSIS OF NON CASEATING
GRANULOMATOUS LUNG DISEASE

– Bacteria - Brucella, Yersinia
– Mycobacteria - tuberculosis, atypical
– Fungi - Histoplasmosis, Coccidiomycosis, Blastomycosis, Cryptococcosis
– Protozoa - toxoplasmosis, Leishmaniasis
– Chemicals - starch, silica
– Neoplasma - seminoma, carcinoma
– Sarcoidosis
– Chronic granulomatous disease of childhood
– Crohns disease
– Wegeners, Churg Strauss
– SLE
– Hypogammaglobulinaemia
– Histiocytosis X
– Primary Biliary Cirrhosis

CROHNS DISEASE
Overview
– Onset in adolescence (15-25 years) with smaller peak at 50-80 years
– A genetic role exists as there is a 7-22% risk of inflammatory bowel disease (IBD) in family members of subjects with Crohns disease. If both parents have IBD then 35% of children will have IBD. Crohns disease is associated with a greater genetic risk than ulcerative colitis.
– Crohns disease is associated with Turners, GSD and immunodeficiencies
– An environmental role exists as there is an increased incidence of Crohns disease in developed countries

Presentation
– Mouth to anus
– Eccentric and segmental
– Skip lesions
– Transmural involvement
– Initial presentation is typically gastrointestinal with 40% ileocolitis alone (50% terminal ileum only) and 10% colon alone
– Typically crampy abdominal pain
– Diarrhoea ± blood
– Fever, malaise, growth failure
– Perianal disease, fistulae
– Extraintestinal findings which correlate with presence of colitis i.e. oral apthous ulcers, arthritis, erythema nodosum, clubbing, renal stones, gallstones

DIFFERENTIAL DIAGNOSIS: Ulcerative colitis

Feature Crohns Ulcerative Colitis
Rectal bleed Occasional Common
Abdominal mass Common Nil
Rectal disease Occasional Universal
Ileum involved Common Nil
Perianal Common Unusual
Strictures Common Unusual
Fistulae Common Unusual
Skip lesions Common Unusual
Transmural Common Unusual
Crypt abcesses Less common Common
Granulomas Common Unusual
Cancer risk Slight increase Great increase

Findings on investigation
– Iron deficiency anemia
– Elevated platelets
– Low serum albumin, high stool a1AT
– AXR: "thumb printing"
– Upper GI + follow through: "cobblestoning"
– Barium enema
– colonoscopy + biopsy

Basic treatment
– Nutritional therapy
– Prednisone
– Sulfasalazine
– Azathioprine
– Cyclosporine
– Surgery: has a high recurrence rate


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