Posted: April 30th, 2022

Differential diagnosis

Differential diagnosis
Crohn’s disease is a kind of chronic inflammatory bowel disease (IBD) that causes digestive issues such as digestive system inflammation. Geographic location, incorrect food, genetics, and inappropriate immunological responses are some of the reasons related with it (Seyedian et al., 2019). Crohn’s disease can mimic other conditions, making it difficult to diagnose. This disorder causes pain, diarrhea, fever, and other symptoms. It usually affects the mouth, anus, and the entire gut layers.
The initial differential diagnosis is Ulcerative Colitis (UC), which is a type of IBD that can also cause gastrointestinal inflammation. Diarrhea, abdominal pain, rectal bleeding, and weight loss are all symptoms of UC. Symptoms are often “limited to the colon and are found mostly in particular regions of the large intestine, including the colon and rectum” (Seyedian et al., 2019).
Celiac disease is the second possible diagnosis. According to Caio et al. (2019), this is an autoimmune disorder characterized by “a unique serological and histological profile caused by gluten intake in genetically predisposed people.” Gluten is a protein that is alcohol-soluble and found in a variety of cereals, including wheat, rye, barley, spelt, and others. Diarrhea, lethargy, weight loss, bloating, gas, abdominal discomfort, nausea, and vomiting are all symptoms.
Diverticulitis, described as an inflammation of the diverticulum in the colon, is the third differential diagnosis for this illness. It can be acute or chronic, and it is most specifically described as “obstruction of the diverticulum sac by fecalith, which produces low-grade inflammation, congestion, and additional obstruction by irritation of the mucosa” (Rezapour et al., 2017). Multiple factors, including colonic wall shape, colonic motility, genetics, fiber intake, vitamin D levels, obesity, and physical activity, can all contribute to this condition.
Results of the physical examination
When assessing a Crohn’s disease patient, it is critical to pay attention to several parameters, including temperature, weight, nutritional status, the presence or absence of abdominal discomfort or a mass, perianal and rectal examination results, and extraintestinal signs (Ghazi, 2019). Some physical examination findings range from fullness to distinct masses, particularly in the right lower quadrant of the abdomen, which often involves the ileal section of the colon. Other lumps may be felt as a result of thickened or matted bowel loops.
More information can be offered after inspecting the perianal area to raise the possibility of inflammatory bowel disease. Skin tags, fistulae, ulcers, abscesses, and scarring are all possibilities. Furthermore, a rectal examination can Help assess sphincter tone and detect gross abnormalities of the rectal mucosa. Other extraintestinal signs of Crohn’s disease include skin, joints, mouth, eyes, liver, or bile ducts, as well as arthritis and arthralgia. Finally, “skin and oral mucosa examination may reveal mucocutaneous or aphthous ulcers, erythema nodosum, and pyoderma gangrenosum” (Ghazi, 2019). Other symptoms include pallor in anemic patients, jaundice in patients with cholestasis, and episcleritis.
Diagnostic examinations
Crohn’s disease can be diagnosed based on clinical, laboratory, histologic, and radiologic findings. To confirm the diagnosis, several procedures may be performed.
A colonoscopy is the preferred test for assessing disease activity in patients with this illness. To examine the phenotypic, another option is to use complementary cross-sectional imaging. When a colonoscopy is “unable to definitively confirm Crohn’s disease or in the presence of upper GI symptoms,” an upper GI endoscopy and histologic Assessment may be recommended (Ghazi, 2019). To check for intestinal obstructions, simple radiography or a CT scan of the abdomen may be ordered. They can also be utilized to look for any form of intra-abdominal abscess in the pelvis. CT enterography or MRI can now replace small intestinal follow-up studies since they Help distinguish between inflammation and fibrosis. Finally, an MRI of the pelvis or endoscopic ultrasounds can be used to evaluate perianal fistulae and determine the existence of pelvic or perianal abscesses.
In addition to diagnostic procedures, various laboratory values may aid in the diagnosis of Crohn’s disease. CRP and ESR levels have been linked to disease problems. Endoscopic visualization and biopsy are used to make a complete diagnosis, particularly a “colonoscopy with intubation of the terminal ileum that is used to evaluate the extent of the disease, demonstrate strictures and fistulae, and obtain biopsy samples to help differentiate the process from other inflammatory, infectious, or acute conditions” (Ghazi, 2019).
Treatment Strategy
It is vital to note that Crohn’s disease treatment is determined by the illness site, pattern, activity, and severity. One specific therapeutic goal is to achieve “the greatest possible clinical, laboratory, and histologic management of the inflammatory illness with the fewest adverse drug effects” (Ghazi, 2019). Another purpose is to allow the patient to operate normally on a daily basis, as well as to promote growth in youngsters through enough nourishment.
According to Veauthier and Hornecker (2018), the goal of Crohn’s disease management is to first treat the inflammatory process, as well as the related comorbidities, while establishing and sustaining remission. Antibiotics should only be used to address problems like abscesses and fistulas. Some pharmacological therapies include the use of corticosteroids, immunomodulators, and biologics. Corticosteroids are often administered in the form of tapering courses of prednisone, beginning with 40 to 60 mg dependent on the severity of the symptoms, lowering by 5 mg until 20 mg is reached, then decreasing by 2.5 to 5 mg until cessation is accomplished. Thiopurines and methotrexate are immunomodulators that can be used to induce remission. Monoclonal antibodies, such as anti-TNF drugs, anti-integrin medicines, and anti-interleukin antibody treatment, can Help induce remission and should be maintained. If the disease is limited to the ileocecal region, early resection may be an option depending on the severity of the symptoms and the disease progress (Veauthier & Hornecker, 2018).
References
Caio, G., Volta, U., Sapone, A., Leffler, D. A., De Giorgio, R., Catassi, C., & Fasano, A. (2019). Celiac disease: A comprehensive current review. BMC medicine, 17(1), 142. https://doi.org/10.1186/s12916-019-1380-z
Ghazi, L. J. (2019). Crohns disease clinical presentation. Medscape. https://emedicine.medscape.com/article/172940-clinical#b3
Rezapour, M., Ali, S., & Stollman, N. (2018). Diverticular disease: An update on pathogenesis and management. Gut and liver, 12(2), 125–132. https://doi.org/10.5009/gnl16552
Seyedian, S. S., Nokhostin, F., & Malamir, M. D. (2019). A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. Journal of medicine and life, 12(2), 113–122. https://doi.org/10.25122/jml-2018-0075
Veauthier, B., & Hornecker, J. R. (2018). Crohn’s disease: Diagnosis and management. American Family Physician, 98(11), 661-669. – essay writers

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