Earliest change seen in Crohn's Disease is
(A) Aphthous Ulcer [?]The earliest lesions are Aphthoid ulcerations & focal crypt abscesses with loose aggregations of macrophages, which form non-caseating granulomas in all layers of the bowel wall.oIn early mild Crohn's disease, the colonic mucosa appears endoscopically normal or small.oPunched-out aphthous ulcers are often seen.oAphthous ulcers are a result of submucosal lymphoid follicle expansion.oIn moderate Crohn's Disease, the aphthous ulcers coalesce into larger ulcers, which may take on the appearance of a star (stellate ulcers).oAs Crohn's disease severity increases, submucosal edema and injury can result in cobblestoning of the mucosa, which is seen more often in Crohn's disease than in ulcerative colitis. Macroscopic Appearance Aphthous ulcerCobblestonePerianal disease*. Mycobacterium*. Paratuberculosis*. E. coli*. Yersinia*. Listeria*. MeaslesSmall Bowel: 70-80%Small & Large Bowel: 50%Large Bowel only: 15-20%*. Inflammatory symptoms*. Obstructive symptoms*. Fistulous symptoms*. Perianal diseases[?]Crohn's Disease:oCD has a unique pattern of mucosal involvement:-Early stages develop aphthous ulcers.-As the disease progresses, these superficial ulcers enlarge and combine to become long and linear.-Larger ulcers can deepen throughout the bowel wall - possibly complicated with fistula and abscess formation.-Longitudinal and transverse linear ulcers can cross over normal, non-ulcerated mucosa to form a cobblestone appearance.-Transmural inflammation can heal, forming scars that lead to strictures.MACROSCOPIC FEATURES OF CROHN'S DISEASE[?]Chron's Disease can affect any part of the gastrointestinal (GI) tract from the mouth to the anus.oSome 30-40% of patients have small bowel disease alone, 40-55% have disease involving both the small and large intestines, and 15-25% have colitis alone.oIn the 75% of patients with small intestinal disease, the terminal ileum is involved in 90%.oUnlike Ulcerative Colitis, which almost always involves the rectum, the rectum is often spared in Chron's Disease.oChron's Disease is segmental with skip areas in the midst of diseased intestine Perirectal fistulas, fissures, abscesses, and anal stenosis are present in one-third of patients with Chron's Disease, particularly those with colonic involvement.oRarely, Chron's Disease may also involve the liver and the pancreas.oIn Chron's Disease early radiographic findings in small bowel include thickened folds & aphthous ulcerations. 'Cobble stoning' from longitudinal & transverse ulcerations most frequently involves the small bowel.
Aphthous Ulcer
Anal fistula
Rose thorn appearance on Barium swallow
Skip lesions
G.I.T.