crohn

Question 1

define crohns with specific areas it affects?

Answer 1

IBD characterized by transmural inflammation of GI tract can affect any part with skip lesions but most commonly distal ileum and colon and spares the rectum (unlike UC). patients have flares and remissions.

Question 2

symptoms?

Answer 2

constitutional: fever, fatigue

colicky abdomen pain typically in RLQ, chronic diarrhea, malabsorption (weight loss, failure to thrive, anemia), lower GI bleeding, perianal fistula, skin tags, anal fissures, perianal abscess.

extraintestinal: erythema nodosum, pyoderma gangrenosum, arthritis, apthous ulcers, uveitis

Question 3

diagnosis? findings in pathology?

Answer 3

endoscopy with biopsy: discontinuous areas of inflammation (skip lesions), inflammed and edematous segments in between ulcerated parts, resembling cobblestones, ulcerations.

noncaseating granulomas, creeping fat, lymph node hypertrophy, giant cells

Question 4

medications used?

Answer 4

medications to induce remission (for flares): -steroids (budesonide, prednisolone)
-biologics anti TNF alpha (infliximab, adalimumab)
-5 aminosalicylic acid (sulfasalazine)

medications to maintain remission
-biologics
-immunomodulators (azathioprine, 6 mercaptopurine, methotrexate)
-

Question 5

treatment regimen plan?

Answer 5

mild to moderate: ambulatory pt, normal diet intake, weight loss less than 10%, no major complications ->
-colonic: induce with steroids OR consider sulfasalazine
-distal ileum: budesonide steroid
maintain remission: supportive therapy

moderate to severe: fever, significant weight loss, abdomen pain ->
-steroid PLUS immunomodulator OR biologic
-steroid sparing: immunomodulator AND biologic
-monotherapy with biologic

severe to fulminant: obstruction, fistula, peritonitis, severe fever ->
-steroid

MAINTANANCE : TAPER DOWN STEROID AND CONTINUE REST OF MEDS