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 gallstones due to poor bile acid absorption at the ileum 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 / adaliumumab good for those with fistula formation necessary for disease remission antibodies targeted against tumor necrosis factor alpha 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
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.GI.15.8) 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 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: Tested Concept QID: 101065 Type & Select Correct Answer 1 Fistulas 75% (49/65) 2 Toxic megacolon 6% (4/65) 3 Widening of the intestinal lumen 6% (4/65) 4 Plummer-Vinson syndrome 6% (4/65) 5 Paneth cell metaplasia 5% (3/65) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (M1.GI.13.89) 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: Tested Concept QID: 101146 Type & Select Correct Answer 1 Left lower quadrant pain 3% (6/207) 2 Jaundice 2% (5/207) 3 Loss of large bowel haustra 7% (14/207) 4 Mucosal and submucosal ulcerations 18% (38/207) 5 Perianal fistula 67% (139/207) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (M1.GI.13.27) 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? Tested Concept QID: 101084 FIGURES: A Type & Select Correct Answer 1 Ulcerative colitis 8% (7/92) 2 Irritable bowel syndrome 2% (2/92) 3 Celiac disease 10% (9/92) 4 Hirschprung disease 4% (4/92) 5 Crohns disease 70% (64/92) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (1) Login to View Community Videos Login to View Community Videos Crohn's Disease Chris Battista Gastrointestinal - Crohn Disease D 4/1/2013 66 views 4.7 (3)