crohns
Crohn's disease
introduction
epidemiology
rare, but common in exams as young patients who speak English readily available!
onset usually between 15-40yrs age
the age of onset has a bimodal distribution:
M=F
3-8x risk in Jewish than non-Jews
incidence in USA has been doubling every 10yrs for past 30yrs
in both Europe and North America, higher incidence rates have been characterized in more northern latitudes
prevalence in US ~7 cases per 100,000 population
incidence rates in Europe range from 0.7 to 9.8 cases per 100,000 persons
pathology
clinical features
other complications of Crohns
gallstones are found in 35-60%
malabsorption ⇒ diarrhoea
bowel strictures
fistulae ⇒ UTI, etc
2-3% develop toxic megacolon
risk of large & small bowel cancer in prolonged illness (15-20yrs)
lymphoma of colon may occur
drug Rx related:
Cushing's syndrome, adrenal suppression, immunocompromise, etc from steroids
neuropathy (long term metronidazole)
nephropathy (cyclosporine)
bone marrow suppression (azathioprine)
diagnosis of Crohn's disease:
confirmed by:
sigmoidoscopy
biopsy of perianal lesions/abscesses, rectum or other granulomatous lesions
bowel contrast radiology:
differential diagnosis:
younger patients:
elderly patients:
general Mx of Crohn's disease:
ED Mx of exacerbations of Crohn's disease
exacerbations usually present as increased abdominal pain, anorexia, nausea and, often increased frequency of bowel actions
iv fluids
take bloods for FBE, U&E, CRP, ESR and other Ix (eg. HCG, LFT's) as indicated by clinical assessment - don't forget the abdominal pain could be unrelated to the Crohn's disease and thus consider other causes of
abdominal pain as well as potential complications of Crohn's as outlined above.
discuss with gastroenterology unit
usually require admission and iv
hydrocortisone 100mg qid in addition to usual Crohn's Rx
crohns.txt · Last modified: 2011/04/15 13:39 (external edit)