ULCERATIVE COLITISCROHN'S DISEASE
Distribution Gastrointestinal disease that is localized to the large intestine or colon
Can either effect entire organ or a portion of it.
Sigmoid colon common
CD can affect any part of the GI tract
Can involve both the large and small intestines
Terminal ileum and ascending colon
Prevalence
More prevalent
Less prevalent
Severity
Less severe than Crohns
More severe than UC
Rectal involvement
Always
Rare
Clinical features
Diarrhea
Bloody
Usually not bloody
Abdominal pain
Crampy pain , often before passing stool
Present
Abdominal mass
Absent
May be Present
Macroscopy
Skip lesions
Absent ( diffuse lesions)
Present ( segmental/ patchy pattern)

Type of ulcer
Pin point
Superficial
Linear
Deep, fissuring
Leading to fistula/abscess
Fistula formation
Absent
Common
Bowel Wall appearance
Thin
Thick
In advanced cases of both the diseases, due to extensive inflammation and fibrosis, the intestine wall become featureless and resembles a lead pipe or hose pipe.
RIGID FEATURELESS PIPE
If the hose pipe appearance is predominantly large intestine , it favors ulcerative colitis

If the hose pipe appearance is predominantly involving small intestine , it favors Crohn’s disease
Cobble stone appearance
Due to deep mucosal ulceration intermingled with nodular submucosal thickening.
Deep ulcers with longitudinal array creates a cobblestone appearance
Absent
Present
Pseudo polyps
They are not polyps in the typical sense.
Present
Residual edematous mucosa sitting, like an island, on a sea of surrounding ulceration.
Not seen
Fat wrapping / creeping fat
Correlates best with transmural inflammation
Abdominal fat migrates to the wall of the inflamed small intestines.
Not seen
Seen
Microscopy
Depth of lesion
Shallow/ mucosal
Mucosal & submucosal
deep/ transmural
Type of inflammatory cells
Acute and chronic
Predominantly chronic
Crypt abscess
Present ,common
Uncommon/ absent
Granulomas
Absent
Present
Non caseating
Serositis
Uncommon
common
Lymphoid response
Uncommon
Common & marked
Fibrosis
Uncommon
Common, resulting in strictures
Complications
Stricture
Absent
Present
Toxic megacolon
More common
Not common
Strictures
Obstruction
Sinus tract
Fistulas
Perianal abscess

Less common
More common
Cancer risk
5- 25%
1-3%

 

 

 

 

Click here to watch the video tutorial on ulcerative colitis and Crohns disease