Crohn's Flashcards
what part of the GI tract can Crohn’s effect?
the entire GI tract
What is meant by Crohn’s being transmural?
it affect the entire thickness of the mucosa
the most common site of the involvement is the distal ileum, therefore pain may be mistaken for
appendicitis
what is the least common site for Crohn’s
the mouth and the upper GI tract, a small number will experience this as a part of the disease
what are apthous ulcers?
canker sores that may present with Crohn’s
1/3 of Crohn’s patient have and associated perianal disease, what may this present as
fistula, fissure, abscess this may be seen on rectal exam along with skin tags
therefore screen those with anal abscesses for Crohn’s
a patient with Crohn’s will complain of what type of pain?
a cramping colicky abdominal pain likely in RLQ
a palpable RLQ fullness/mass may be present
how do symptoms develop in patient with Crohn’s?
symptoms will develop gradually onset and usually be intermittent with periods of exacerbations & relative remission
which severity of Crohn’s involves only inflammation and strictures?
moderate
which severity of Crohn’s involves inflammation, strictures, and fistulae?
severe
what symptom is common regardless of of severity in Crohn’s?
inflammation
nocturnal diarrhea helps distinguish Crohn’s from what condition?
IBS, but up to 10% of those with Crohn’s may not have nocturnal diarrhea
are low grade fever and weight loss often present or not in Crohn’s patients?
they are often present
what type of lesion are common in Crohn’?
skip lesions, disease free areas between diseased part
string sign is often seen in patients with Crohn’s due to what?
inflammation
Arthralgias and arthritis are common in Crohn’s in which joints? and how do they present?
large joints (hips, knees) present with stiffness in the morning and gets better with activity
other clinical presentations with Crohn’s?
Erythema nodosum
Eye conditions
Gallstones
Possible sclerosing cholangitis
why are gallstones related to Crohn’s?
related to bile acid malabsorption in the small intestine
most common extra-intestinal manifestation of Crohn’s?
Arthralgias and arthritis
what skin condition may be present with Crohn’s?
jaundice
a patient present with anemia Janice and weight loss what may you screen for?
Crohn’s, however it is every difficult to diagnosis if it is a patients first exacerbation
why might a biopsy not work for a first exacerbation of Crohn’s?
there must be time for inflammation changes
the colonoscopy may reach why part of the colon to diagnosis possible Crohn’s
terminal ileum
after years of Crohn’s conditions what may develop and present on colonoscopy and biopsy?
granulomas in about 30% of patients
what may be seen on colonoscopy of a patient with Crohn’s?
ulcerations, cobblestoning and possible fistulas
CT scan of abdomen and pelvis with contrast may show what in Crohn’s patients?
Presence of inflammation (thickened walls), abscess, fistulas
a string sign may be seen on
a small bowel follow through
complications of Crohn’s
Fistula, abscess
Obstruction due to inflammation
Perforation from abscess
Nutrient deficiencies (Fe, B12)due to malabsorption in small intestine
what 2 things may make Crohn’s worse?
NSAIDs and Smoking
Crohn’s treatment approach
step-up
what may be used for Crohn flares
antibiotics, budesonide and prednisone
Crohn’s treatment options
5-ASA agents
Immunomodulators
Biologics / TNF blockers such as adalimumab
