Snap Shot A 15-year-old girl presents with severe, crampy, abdominal pain, and associated diarrhea. This is not her first episode. She reports another episode 7 weeks ago and several before that. The diarrhea is bloody. She also complains of painful oral lesions, which have been present for two days. A sigmoidoscopy was performed. On exam she has two small aphthous ulcers in her mouth. Introduction Definition characterized by inflammation of the GI tract with subsequent tissue damage may be an abnormal response to normal intestinal bacterial flora may invlove any portion of the GI track usually in intestines (especially the ileocecal region) NON-contiguous pattern Epidemiology risk factors most common in whites and Ashkenazi Jews often presents in patients in their early 20's Associated conditions erythema nodosum uveitis migratory polyarthritis ankylosing spondylitis calcium oxalate renal calculi due to ↑ absorption of oxalate Presentation Symptoms RLQ colicky abdominal pain watery diarrhea weight loss obstruction low grade fever Physical exam aphthous ulcers in mouth perianal fissures / fistulas Evaluation Barium enema linear ulcers edema of the bowel bowel wall thickening ("string sign") Colonoscopy with biopsy aphthoid, linear stellate ulcers cobblestone mucosa skip lesions creeping fat on gross dissection is pathognomonic microscopic appearance transmural inflammation noncaseating granulomas lymphoid aggregates Treatment Pharmacologic corticosteroids sulfasalazine/mesalamine immunosuppresants includes azathioprine cyclosporine infliximab monoclonal antibody to TNF-alpha Surgical colon resection indications only in refractory disease complications perforation, a possible risk during surgical excision Complications Strictures Malabsorption due to bile salt deficiency resulting in nutritional depletion Cancer less likely than with ulcerative colitis
QUESTIONS 1 of 4 1 2 3 4 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.GI.89) A 27-year-old female has a history of periodic bloody diarrhea over several years. Colonoscopy shows sigmoid colon inflammation, and the patient complains of joint pain in her knees and ankles. You suspect inflammatory bowel disease. Which of the following would suggest a diagnosis of Crohn disease: Review Topic QID: 101146 1 Left lower quadrant pain 1% (1/153) 2 Jaundice 3% (4/153) 3 Loss of large bowel haustra 5% (8/153) 4 Mucosal and submucosal ulcerations 22% (34/153) 5 Perianal fistula 67% (103/153) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (M1.GI.8) A 22-year-old Caucasian female presents with severe right lower quadrant pain, malaise, and diarrhea. The physician performs an endoscopy and finds disease involvement in the terminal ileum, noting that that the disease process is patchy with normal intervening mucosa. The entire wall of the region is thickened and inflamed, which may directly lead to formation of: Review Topic QID: 101065 1 Fistulas 93% (14/15) 2 Toxic megacolon 0% (0/15) 3 Widening of the intestinal lumen 0% (0/15) 4 Plummer-Vinson syndrome 7% (1/15) 5 Paneth cell metaplasia 0% (0/15) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (M1.GI.27) A 28-year-old Caucasian women with a 10 pack-year history of smoking presents with diarrhea and right, lower quadrant colicky pain. You note tender, red nodules on her shins. Radiograph imaging after barium study is shown in Figure A. What is the most likely diagnosis? Review Topic QID: 101084 FIGURES: A 1 Ulcerative colitis 14% (4/28) 2 Irritable bowel syndrome 0% (0/28) 3 Celiac disease 7% (2/28) 4 Hirschprung disease 4% (1/28) 5 Crohns disease 64% (18/28) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5
Crohn's Disease Gastrointestinal - Crohn Disease - EducationalPresentation Crohn's Disease 4/1/2013 34 views