Snapshot 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 ophthous ulcers in her mouth. Introduction Characterized by inflammation of the GI tract with subsequent tissue damage may be infectious in nature May invlove any portion of the GI track usually in intestines (especially the ileoceccal region) NON-contigous pattern Risk factors include family history of IBD most common in whites and Ashkenazi Jews often presents in patients in their early 20's Extraintestinal manifestations include erythema nodosum uveitis arthritis kidney stones Presentation Symptoms (typically in a young man) abdominal pain watery diarrhea low grade fever weight loss obstruction oral manifestations include apthous ulcers perianal fissures/fistulas Intra-abdominal abscess Evaluation Barium enema deep transverse fissures ulcers edema of the bowel Colonoscopy aphthoid, linear stellate ulcers cobblestone mucosa skip lesions Creeping fat on gross dissection is pathognomonic Labs B12 deficiency macro-ovalocytes hypersegmented neutrophils elevated serum methylmalonic acid and homocysteine levels Differential Ulcerative colitis variables that separate UC and Crohn's disease Treatment Management includes prednisone for acute exacerbation sulfasalazine/mesalamine immunosuppresion azathioprine mercaptopurine infliximab monoclonal antibody to TNF-alpha Surgery if refractory disease perforation a risk during surgical excision Complications Intraabdominal abscess evaluate with abdominal CT Vitamin B12 deficiency secondary to ileal resection or decreased absorption of vitamins Evaluate for megaloblastic anemia and subacute combined degeneration of the spinal cord on MRI