Topic
Review Topic
0
0
Questions
5
0
0
Evidence
4
0
0
Videos
1
Snapshot
  • A 18-year-old boy presents to his primary care physician for abdominal pain, diarrhea, and chronic fatigue. He reports that he has nonbloody diarrhea for the past few weeks. He could not identify any “bad” foods, and nobody else around him has the same symptoms. His aunt has a history of inflammatory bowel disease, but he is unsure which specific disease. He is noted to be underweight on physical exam. Laboratory results show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein.  He is scheduled for a colonoscopy with biopsy to confirm the diagnosis.
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 years of age or 60-70s years of age
    • risk factors
      • family history
  • Pathogenesis
    • mechanism
      • chronic Th1-mediated inflammation
        • starts as focal inflammatory infiltrates around crypts, evolves into transmural inflammation and noncaseating granulomas
  • Prognosis
    • unpredictable course of relapses and remissions
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
        • 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
  • Surgical
    • surgical resection of affected area
      • indications
        • not curative
Complications
  • Fistula formation
  • Colorectal cancer
  • Abscesses
  • Strictures
 

Please rate topic.

Average 4.7 of 9 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (5)
Lab Values
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/L
Female: 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/mL
Female: 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/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative 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/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 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/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 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/min
Female: 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 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 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

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

You have 100% on this question.
Just skip this one for now.

(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
Type in at least one full word to see suggestions list
1

Fistulas

96%

(24/25)

2

Toxic megacolon

0%

(0/25)

3

Widening of the intestinal lumen

0%

(0/25)

4

Plummer-Vinson syndrome

4%

(1/25)

5

Paneth cell metaplasia

0%

(0/25)

M1

Select Answer to see Preferred Response

SUBMIT RESPONSE 1

You have 100% on this question.
Just skip this one for now.

(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:
Type in at least one full word to see suggestions list
1

Ulcerative colitis

10%

(4/40)

2

Irritable bowel syndrome

0%

(0/40)

3

Celiac disease

12%

(5/40)

4

Hirschprung disease

5%

(2/40)

5

Crohns disease

65%

(26/40)

M1

Select Answer to see Preferred Response

SUBMIT RESPONSE 5

You have 100% on this question.
Just skip this one for now.

(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
Type in at least one full word to see suggestions list
1

Left lower quadrant pain

2%

(3/161)

2

Jaundice

2%

(4/161)

3

Loss of large bowel haustra

6%

(9/161)

4

Mucosal and submucosal ulcerations

22%

(36/161)

5

Perianal fistula

66%

(106/161)

M1

Select Answer to see Preferred Response

SUBMIT RESPONSE 5
ARTICLES (4)
VIDEOS (1)
Topic COMMENTS (7)
Private Note