1. Was it the enchiladas?

2. Hx Study done for suspected Crohn’s Disease Study done for suspected Crohn’s Disease

3. Some features of Crohn’s Skip lesions Skip lesions Patchy sections of inflamed bowel with sections of normal bowel in between the lesions. Patchy sections of inflamed bowel with sections of normal bowel in between the lesions. Can effect any part of the alimentary tract Can effect any part of the alimentary tract Most common site is the terminal ileum Most common site is the terminal ileum Recurrent episodes can result in fibrosis of lesions Recurrent episodes can result in fibrosis of lesions Lesions are transmural = high risk of fistula formation Lesions are transmural = high risk of fistula formation

4. Is this a skip lesion????

5. Hmmmmmm

6. Where is this???

7. Answer: Why, that’s the rectum and sigmoid colon looking rather unhappy Why, that’s the rectum and sigmoid colon looking rather unhappy Looking stenosed most likely due to recurrent exacerbations that start here. Looking stenosed most likely due to recurrent exacerbations that start here. Rectum? Darn near killed ‘em (insert pity laugh here) Rectum? Darn near killed ‘em (insert pity laugh here)

8. Evidence so far Starts in rectosigmoid area and is a contiguous lesion throughout the colon Starts in rectosigmoid area and is a contiguous lesion throughout the colon Not looking like CD, eh? Not looking like CD, eh?

9. Ah HA! What is not involved here?

10. Evidence NOT involving the terminal ileum NOT involving the terminal ileum Contiguous lesion of the colon Contiguous lesion of the colon Starting in the rectosigmoid area Starting in the rectosigmoid area

11. DDx for patient with possible Crohn’s (What else immediately popped into your head?) Looking for the #1 alternative here….. Looking for the #1 alternative here…..

12. Yup, UC is correct Some features of UC Some features of UC Contiguous lesion starting at the rectum (>95%) and spreading proximally Contiguous lesion starting at the rectum (>95%) and spreading proximally Limited to the colon Limited to the colon Recurrent bouts can lead to fibrosis like in CD Recurrent bouts can lead to fibrosis like in CD Incidence is 10-12 per 100,000/yr Incidence is 10-12 per 100,000/yr It likes the white women (30% more according to some reports) and is bi modal in its distribution (15- 25 and 55-65), BUT it can hit at any time. It likes the white women (30% more according to some reports) and is bi modal in its distribution (15- 25 and 55-65), BUT it can hit at any time.

13. QUESTIONS? NO? NO? Good. Good. Thank you Thank you