Biology of Disease

Crohn’s disease is a chronic inflammation, usually of the ileum, although
it can affect any part of the GIT. The inflammation tends to be patchy but
extends throughout the layers of the intestinal wall thickening the wall and
narrowing the lumen. The cause of Crohn’s disease is unclear although viruses
and bacteria have been implicated. Patients with Crohn’s disease suffer from
lack of appetite, abdominal pain, diarrhea and weight loss. A biopsy of the GIT
is used to detect the characteristic changes associated with Crohn’s disease.
Treatment involves using anti-inflammatory drugs, such as 5-aminosalicylic
acid, although surgery may be required in severe cases.

Disorders of the Large Intestine

Ulcerative colitis is characterized by chronic inflammation and ulceration of
the colon that is distinctive, in that it affects only its mucosal lining. The lining
is also affected by numerous hemorrhagic ulcerations. The cause of ulcerative
colitis is not entirely clear but is believed to be autoimmune in origin (Chapter
5 ). Patients with ulcerative colitis suffer from abdominal pain, fever, weight
loss and bloody diarrhea. Diagnosis of ulcerative colitis is made following
colonoscopy where a biopsy from the colon is taken to detect the character-
istic histological changes. Ulcerative colitis is treated with anti-inflammatory
drugs, such as 5-aminosalicylic acid, although surgical removal of the affected
region may be necessary in severe cases.

CASE STUDIES

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Alice, a five-year-old child, presented with loss of weight,

abdominal distension and obvious signs of anemia. Her

stools were loose, bulky, pale colored and had an offen-

sive smell. A variety of clinical tests were ordered with

the following results (reference ranges are shown in

parentheses):

Serum albumin 29 g dm–3 (32–48 g dm–3)

Serum iron 4 μmol dm–3 (10–30 μmol dm–3)

Xylose absorption 0.5 g in 5 h (>1.2 g in 5 h)

Fecal fat 29 g / 3 days (<15 g/3 days)

Jejunal biopsy showed villous atrophy.

Questions

(a) What is the most likely diagnosis?

(b) How should Alice be treated?

CASE STUDY 11.1

It was noticed that Sadaf, a fine art student recover-

ing from an attack of influenza, was slightly jaundiced.

Worried that she may have hepatitis, her doctor asked

her to provide some blood and urine for laboratory

investigation. Test results are shown below (reference

ranges are shown in parentheses):

Serum bilirubin 60 μmol dm–3 (3–20 μmol dm–3)

Serum ALP 74 IU dm–3 (30–90 IU dm–3)

Serum AST 35 IU dm–3 (10–50 IU dm–3)

Hemoglobin 140 g dm–3 (115–155 g dm–3)

Reticulocyte count 1.5 % (1–2%)

Urine bilirubin Negative (Negative)

Question

What is the most probable diagnosis to account for these

signs and symptoms?

CASE STUDY 11.2