Gastrointestinal System Disorders Q 32

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Which area of the alimentary canal is the most common location for Crohn’s disease?

  

    A. Ascending colon

    B. Descending colon

    C. Sigmoid colon

    D. Terminal ileum

    

    

Correct Answer: D. Terminal ileum

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Studies have shown that the terminal ileum is the most common site for recurrence in clients with Crohn’s disease. The terminal ileum is involved in 50-70% of children. Although any area of the GI system may be affected in patients with Crohn disease, the most common site of the chronic inflammatory process is the ileocecal region, followed by the colon (about 20%), the small intestine alone (about 30%), the stomach (rarely), and the mouth. The esophagus is very rarely involved. The other areas may be involved but aren’t as common.

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Option A: More than half of these patients also have inflammation in various segments of the colon, usually the ascending colon. Gastric inflammation, duodenal inflammation, or both may be observed in as many as 30-40% of children with Crohn’s disease. The primary pancreatic manifestation is pancreatitis.

Option B: About 45% of cases of Crohn disease occur in the ileum and colon, 20% solely in the colon, 33% in the small bowel, and 5% in the gastroduodenal region and perianal region alone (fistula, abscess, anal ulcer or stricture, or fissure). Nearly 20-23% of patients with large bowel or small bowel disease have perianal complications, which may precede the development of intestinal symptoms and manifest as simple skin tags, anal fissures, perianal fistulae, or abscesses.

Option C: Bowel obstruction is caused initially by significant edema of the mucosa and associated spasm of the bowel. Obstruction is intermittent and can often be reversed by means of conservative measures and anti-inflammatory agents. With further disease progression, the obstruction becomes chronic because of fibrotic scarring, luminal narrowing, and stricture formation.

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