10-Minute Surgery Class Presentation Outline Topic 1: Crohn’s Disease – Surgical Aspects (5 minutes) Slide 1: Definition & Etiology Definition: Crohn’s disease (CD) is a chronic inflammatory bowel disease characterized by transmural inflammation affecting any part of the GI tract from mouth to anus, with skip lesions (normal mucosa between diseased segments). Etiology (multifactorial): · Genetic: White ethnicity, Ashkenazi Jewish ancestry, family history, NOD2 mutations · Environmental: Cigarette smoking (strongest risk factor), diet high in refined sugar/ultra-processed foods, oral contraceptives, NSAIDs, antibiotic use · Microbiome: Dysregulated immune response to commensal gut flora Slide 2: Pathogenesis (Surgical Relevance) Key concept: CD is a primary mesenteropathy — creeping fat and mesenteric adipose tissue play a role in pathogenesis. Sequence: Transmural inflammation → fibrosis → strictures → obstruction Inflammation → sinus tracts → fistulae (entero-enteric, entero-vesical, perianal) Surgical implications: · Bowel-preserving surgery preferred to avoid short bowel syndrome · Mesenteric excision extent is a hot topic (conflicting evidence) Slide 3: Clinical Presentation Key diagnostic triad: Chronic diarrhea + abdominal pain + weight loss Other features: · Perianal lesions (fissures, fistulae, abscesses) · Blood in stools, fever, fatigue · Abdominal mass, oral lesions · Extraintestinal manifestations: erythema nodosum, pyoderma gangrenosum, arthritis Red flags for surgery: Obstruction, perforation, fistula, abscess, hemorrhage, cancer, failure of medical therapy Slide 4: Diagnosis First-line investigations: · Laboratory: CBC, iron studies, B12, folate, CRP/ESR, fecal calprotectin · Endoscopy: Ileocolonoscopy + biopsy (gold standard for mucosal assessment) · Imaging: MR enterography or CT enterography (assess transmural disease, fistulae, abscesses) · Plain abdominal X-ray: For obstruction/perforation Emerging: Serologic markers, capsule endoscopy Slide 5: Surgical Treatment – Indications & Principles Absolute indications (emergency/urgent): · Perforation, massive hemorrhage, obstruction unresponsive to medical therapy, intra-abdominal abscess · Small bowel/colorectal cancer Relative indications: · Refractory strictures, internal fistulae (entero-enteric, entero-vesical), refractory perianal disease Surgical principles: · Bowel preservation is paramount (avoid short bowel syndrome) · Strictureplasty for fibrostenotic jejunoileal disease · Segmental resection for ileocolic/colonic disease · Laparoscopic approach preferred when feasible Slide 6: Key Surgical Controversies (Quick Mention) Extended mesenteric excision (EME): · Some meta-analyses show reduced surgical recurrence (5% vs 15%) · Others show no difference in outcomes · Bottom line: Still debated; no definitive consensus Make it pretty and colourful with good use of photos
10-Minute Surgery Class Presentation Outline
Topic 1: Crohn’s Disease – Surgical Aspects (5 minutes)
Slide 1: Definition & Etiology
Definition: Crohn’s disease (CD) is a chronic inflammatory bowel disease characterized by transmural inflammation affecting any part of the GI tract from mouth to anus, with skip lesions (normal mucosa between diseased segments).
Etiology (multifactorial):
· Genetic: White ethnicity, Ashkenazi Jewish ancestry, family history, NOD2 mutations
· Environmental: Cigarette smoking (strongest risk factor), diet high in refined sugar/ultra-processed foods, oral contraceptives, NSAIDs, antibiotic use
· Microbiome: Dysregulated immune response to commensal gut flora
Slide 2: Pathogenesis (Surgical Relevance)
Key concept: CD is a primary mesenteropathy — creeping fat and mesenteric adipose tissue play a role in pathogenesis.
Sequence: Transmural inflammation → fibrosis → strictures → obstruction
Inflammation → sinus tracts → fistulae (entero-enteric, entero-vesical, perianal)
Surgical implications:
· Bowel-preserving surgery preferred to avoid short bowel syndrome
· Mesenteric excision extent is a hot topic (conflicting evidence)
Slide 3: Clinical Presentation
Key diagnostic triad: Chronic diarrhea + abdominal pain + weight loss
Other features:
· Perianal lesions (fissures, fistulae, abscesses)
· Blood in stools, fever, fatigue
· Abdominal mass, oral lesions
· Extraintestinal manifestations: erythema nodosum, pyoderma gangrenosum, arthritis
Red flags for surgery: Obstruction, perforation, fistula, abscess, hemorrhage, cancer, failure of medical therapy
Slide 4: Diagnosis
First-line investigations:
· Laboratory: CBC, iron studies, B12, folate, CRP/ESR, fecal calprotectin
· Endoscopy: Ileocolonoscopy + biopsy (gold standard for mucosal assessment)
· Imaging: MR enterography or CT enterography (assess transmural disease, fistulae, abscesses)
· Plain abdominal X-ray: For obstruction/perforation
Emerging: Serologic markers, capsule endoscopy
Slide 5: Surgical Treatment – Indications & Principles
Absolute indications (emergency/urgent):
· Perforation, massive hemorrhage, obstruction unresponsive to medical therapy, intra-abdominal abscess
· Small bowel/colorectal cancer
Relative indications:
· Refractory strictures, internal fistulae (entero-enteric, entero-vesical), refractory perianal disease
Surgical principles:
· Bowel preservation is paramount (avoid short bowel syndrome)
· Strictureplasty for fibrostenotic jejunoileal disease
· Segmental resection for ileocolic/colonic disease
· Laparoscopic approach preferred when feasible
Slide 6: Key Surgical Controversies (Quick Mention)
Extended mesenteric excision (EME):
· Some meta-analyses show reduced surgical recurrence (5% vs 15%)
· Others show no difference in outcomes
· Bottom line: Still debated; no definitive consensus
Make it pretty and colourful with good use of photos
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This guide on Crohn's Disease highlights the surgical challenges associated with the condition. It covers the definition of transmural and skip-lesion inflammation, explores genetic, lifestyle, and microbiome factors, and outlines symptoms and diagnostic processes. The focus then shifts to strategic surgical approaches aimed at preserving bowel function while addressing complications like strictures and fistulae. Finally, it emphasizes the importance of laparoscopy, imaging for complex cases,...