One of the following feature is true regarding Crohn's disease
(A) Presence of Non-caseating granulomas[?]Non-caseating Granuloma of Crohn's disease:oMost valuable diagnostic feature of Crohn's disease is the presence of Non-caseating granuloma (a sarcoid or tuberculoid reaction) in the affected tissue of the bowel wall.oGranumlomas develop in all layers of the intestines from the mucosa to serosa (most frequent in sub mucosa).oGranuloma is defined as a collection of epitheloid cells & with or without giant cells.oNoncaseating granulomas are hallmark of Crohn's disease & found in approximately 35% of casesoMay occur in areas of active disease or univolved regions in any layer of the intestinal wall. These may also be seen in mesenteric lymph nodes.oCutaneous granuloma as form nodules are known as metastatic Crohn's disease.oAbsence of granulomas does not preclude a diagnosis of Crohn's disease.oTransmural involvement is characteristic feature of Crohn's diseaseoSkip lesions is characteristic of Crohn's disease & may help in differentiating from ulcerative colitis.Other Options[?]Ulcerative ColitisoGrossly, ulcerative colitis always involves the rectum and extends proximally in a continuous fashion to involve part or all of the colon.oDisease of the entire colon is termed pancolitis, while left-sided disease extends no farther than the transverse colon. Limited distal disease may be referred to descriptively as ulcerative proctitis or ulcerative proctosigmoiditis.oSmall intestine is normal, although mild mucosal inflammation of the distal ileum, termed backwash ileitis, may be present in severe cases of pancolitis.oSkip lesions are not seen (although focal appendiceal or cecal inflammation may occasionally be present in left-sided ulcerative colitis).oGrossly, involved colonic mucosa may be slightly red and granular or have extensive, broad-based ulcers.oThere can be an abrupt transition between diseased and uninvolved colon.oUlcers are aligned along the long axis of the colon but do not typically replicate the serpentine ulcers of Crohn disease. Isolated islands of regenerating mucosa often bulge into the lumen to create pseudopolyps & the tips of these polyps may fuse to create mucosal bridges. Chronic disease may lead to mucosal atrophy with a flat and smooth mucosal surface that lacks normal folds.oUnlike Crohn disease, mural thickening is not present, the serosal surface is normal, and strictures do not occur. However, inflammation and inflammatory mediators can damage the muscularis propria and disturb neuromuscular function leading to colonic dilation and toxic megacolon, which carries a significant risk of perforation,oSubmucosal fibrosis, mucosal atrophy, and distorted mucosal architecture remain as residua of healed disease but histology may also revert to near normal after prolonged remission.oGranulomas are not present in ulcerative colitis. ULCERATIVE COLITISCROHN'S DISEASEPathology*. InflammationRecurrent acute inflammation with intervening quiescent phaseChronic relapsing inflammation*. General DistributionContinuous involvement of affected part ColonSkip lesions in any part of gastrointestinal tract*. Rectal involvementAlwaysAbout 25%*. Ileal involvementBackwash ileitis onlyInvolved in 80% of cases; exclusive to ileum in 50% of cases*. Depth of wall involvedMucosa onlyTransmural, including serosa*. Mucosal changesWidespread irregular superficial with or without psuedopolypsFissured ulceration causing 'cobblestone appearance*. Granuloma formationAbsentCharacteristic but not always present*. Mesenteric adenopathyReactive hyperplasia onlyLymph nodes often enlarged; granulomas may be present*. Fibrosis of wallMinimalMarkedMain Clinical Features*. DiarrhoeaSevere during acute attacks, often causing incontinenceLess prominent*. Rectal bleedingVery commonLess common*. Abdominal painMild cramping 'pre-defaecation' pain with diarrhoeal attacksDominant feature - persistent or grumbling pain with severe acute attacks*. Abdominal massNoRelatively common*. General debilityLess markedCharacteristic
Presence of Non-caseating granulomas
Associated with Backwash ileitis
Presence of Pseudopolyps
Associated with Broad based ulcers
G.I.T.