Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 15 2021

Crohn Disease

Images
https://upload.medbullets.com/topic/120182/images/crocolon.jpg
  • Snapshot
    • A 16-year-old girl presents to her gastroenterologist with severe, crampy, abdominal pain and intermittent nonbloody diarrhea. She has also had unexpected weight loss over the past few months. She also reports having irritating sores in her mouth. On exam, she is noted to have aphthous sores on the bucca mucosal, and skin tags around the anus. A colonoscopy a week later shows cobblestone mucosa and non-contiguous involvement of the small intestine, suggesting a diagnosis of Crohn disease.
  • Introduction
    • Overview
      • Crohn disease is an inflammatory bowel disease that can affect any part of the gastrointestinal (GI) tract, including the mouth and the anus
        • characterized by abdominal pain and nonbloody diarrhea
        • classically associated with non-contiguous involvement, or “skip lesions”, along GI tract
  • Epidemiology
    • Demographics
      • onset 15-30 or 60-70s years of age
    • Risk factors
      • family history
  • ETIOLOGY
    • Pathogenesis
      • mechanism
        • chronic Th1-mediated inflammation
          • starts as focal inflammatory infiltrates around crypts, evolves into transmural inflammation and noncaseating granulomas
  • Presentation
    • Symptoms
      • GI symptoms
        • results from transmural involvement
        • abdominal pain
        • bloody or nonbloody diarrhea
        • abscess
        • fistulas
        • strictures
        • malnutrition
      • extraintestinal manifestations
        • arthralgias
        • kidney stones
          • calcium oxalate
        • ankylosing spondylitis
      • systemic symptoms
        • chronic intermittent fever
        • weight loss
        • fatigue
    • Physical exam
      • skin and mucosal findings
        • pyoderma gangrenosum
        • erythema nodosum
        • aphthous stomatitis
        • perianal region
          • skin tags
          • scarring
      • ocular finding
        • episcleritis
        • uveitis
  • Imaging
    • Abdominal radiograph
      • indications
        • assess for bowel obstruction
    • CT of abdomen
      • indications
        • evaluation for obstruction, fistulas, or abscesses
  • Studies
    • Serum labs
      • serology used when endoscopic studies and barium studies are inconclusive
        • anti-Saccharomyces cerevisiae positive
        • anti-neutrophil cytoplasmic antibody negative
      • complete blood cell count
      • elevated inflammatory markers
    • Invasive studies
      • colonoscopy or esophagogastroduodenoscopy
        • indication
          • diagnostic
        • findings
          • cobblestone mucosa
          • transmural inflammation
          • skip lesions
          • bowel wall thickening
          • ulcers
          • fissures
    • Histology
      • noncaseating granulomas
      • lymphoid aggregates
  • Differential
    • Ulcerative colitis
      • key distinguishing factors
        • bloody diarrhea
        • disease affecting colon and always the rectum
        • mucosal and submucosal inflammation only
  • Treatment
    • Medical
      • 5-aminosalicylic acid agents
        • indications
          • mild disease
          • initial therapy
        • drugs
          • mesalamine
            • best initial therapy
          • sulfasalazine
      • corticosteroids
        • indications
          • for flares
      • immunosuppressive agents
        • drugs
          • infliximab
            • good for those with fistula formation
          • azathioprine
            • recurrent symptoms off steroids
      • antibiotics
        • drugs
          • metronidazole/ciprofloxacin
            • perianal involvement
      • anti-diarrheal medications
        • drugs
          • loperamide
      • replace fat soluble vitamins
        • vitamin D
          • can lead to hypocalcemia, hypophosphatemia, and secondary hyperparathyroidism
    • Surgical
      • surgical resection of affected area
        • indications
          • not curative
  • Complications
    • Fistula formation
    • Colorectal cancer
    • Abscesses
    • Strictures
  • Prognosis
    • Unpredictable course of relapses and remissions
Card
1 of 0
Question
1 of 10
Private Note