crohn disease
TRANSCRIPT
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Crohn DiseaseIs a transmural process that can result in mucosal inflammation and ulceration,
stricturing, fistula development and abscess formation.
Dr. Demba Keita
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General Considerations 1/3 of cases involved the terminal ileum(ileitis) ½ of all cases involved the small bowl and the colon(ileocolitis) 20% of cases involved the colon only. 1/3 of patients have associated perianal Disease Less than 5% have symptomatic involment of the upper intestinal tract.
Dr. Demba Keita
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Clinical Findings(Symptoms and Signs)
• Fevers• The patients general sense of well-being• Weigh Loss, and lost of energy• Abdominal Pain • Number of bowel liquid movements per day• Abdominal Tenderness
Dr. Demba Keita
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Clinical Findings (Clinical Constellations)
• Chronic Inflammatory Disease • Intestinal Obstruction • Penetrating Disease and Fistulae• Perianal Disease• Extraintestinal Manifestations
Dr. Demba Keita
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Chronic Inflammatory Disease
• Most common form of Crohn • Malaise , weigh loss• In Ileocolitis Diarrhea usually nonbloody and
intermitent • In Colitis there may be bloody diarrhea and fecal urgency
which may mimic the symptoms of ulcerative colitis
Dr. Demba Keita
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Intestinal Obstruction• its due to mainly fibrotic stenosis• postprandial bloating• cramping pain• loud borborygmi.
Dr. Demba Keita
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Penetrating Disease and Fistulae
• Intra-abdominal retroperitoneal phlegmon or abscess manifested by fever,chills, tender abdominal mass and leukocytosis
• Fistulas-small intestine-the colon.• Fistulas-small intestine-bladder
Dr. Demba Keita
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Perianal Disease
• anal fisuras• perianal abscess• fistulas
Dr. Demba Keita
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Extraintestinal Manifestations
• Arthralgia • Artritis • Iritis or uveítis• Pyoderma gangrenosum or Eritema Nodosum• Oral Aphthous lesions are common.
Dr. Demba Keita
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Laboratory Findings
• Complete blood count • Serum Albumin • Sedimentation Rate • C- Reactive Protein • Fecal Lactoferrin or Calprotectin levels• Stool specimens examinations for pathogens
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Specific Diagnostic • Colonoscopy• Endoscopy • Mucosal Biopsies• CT or MRI Enterography or Barrium upper Gastrointestinal Series
Dr. Demba Keita
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Complications • Abscess• Obstruction• Abdominal and Rectovaginal Fistulas• Perianal Disease• Carcinoma• Hemorrhage• Malabsorpcion
Dr Demba Keita
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Differncial Diagnosis• Irritable Bowel Syndrome• Celiac Disease• Appendicitis• Intestinal Lymphoma• Patients with undiagnose AIDs• Intestinal Tuberculosis• Ischemic Colitis• Diverticulitis with Abscess• NSAID-induced colitis Dr. Demba Keita
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Treatment of Active Disease
• Choice of Therapy depend on: 1. Disease Location 2. Severity 3. Patients Age 4. Comorbilities 5. Patients Preference Dr. Demba Keita
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A: Nutrition
• Diet
• Enteral Therapy
• Total Parenteral Nutrition Dr. Demba Keita
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B. Symptomatic Medication
• Secretory induced Diarrhea responds to Cholestyramine 2-4g, Colestipol 5g, or colesevelam 625mg one to two times daily before meal to bile malabsorbed bile salts.
• Antidiarrheal agents: Loperamide(2-4mg), Diphenoxylate with atropine or tincture of opium(5-15drops) may be needed as needed up to 4times daily.
Dr. Demba Keita
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Specific Drug Therapy
• 5-Aminosalicylic and Agents: • Antibiotics• Corticosteriods• Immunomodulating Drugs• Anti-TNF therapies• Anti-integrins Dr. Demba Keita
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Indications for Surgery
• Over 50% of patients will need one surgical procedure ,main surgical indications are:
1. Intra-abdominal Abscess 2. Massive Bleeding 3. Symptomatic Refractory internal or Perianal Fistulas 4. Intestinal Obstruction Dr. Demba Keita
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Prognosis• Most patients live a productive lives with medical therapies and few die as
direct consequence of the Disease .
Dr. Demba Keita
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THANKS