Categories: Gastrointestinal

Crohn’s Disease vs. Ulcerative Colitis

Differential Dx of Signs and Symptoms

SYMPTOMS Crohn’s Disease Ulcerative Colitis
Defecation Will present porridge-like stool and possibly fatty diarrhea (steatorrhea) Mucus like and will often PRESENT WITH BLOOD/PUS (90%)
Tenesmus Less Common More Common
Fever Common (Affects everywhere) Less Common (would indicate a severe disease state)
SYSTEMIC MARKERS (CRP, Erythrocyte Sedimentation Rate [ESR], Common (Affects everywhere) Less Common (would indicate a severe disease state)
Weight loss Common Less Common
BOTH: will often have often vomiting, diarrhea and bleeding from the rectum


Differential Dx of Histologic/ Pathologic Findings

FINDING Crohn’s Disease Ulcerative Colitis
Inflammation in Terminal Ileus Usually Almost never
Colon Involvement Usually 100% (50% if just colon/ rectum, 30% until left splenic flexure, 20% is the entire colon)
Rectum Involvement Almost never Always
Continuous or Skipping SKIPPING (skip lesions) CONTINUOUS
Higher Rate Of Primary Sclerosing Cholangitis No YES
Depth of the Disease Transmural Contained within the mucosal layer
Strictures and Fistulas Yes No
Granuloma If present, it will rule out UC and give diagnosis of Crohn’s if symptoms fit Never
Abdominal Masses May have one in RLQ Almost Never
Toxic Megacolon No Yes
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Dr. C Humphreys

Internal Medicine

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