Aidan at 19:08, 16 March 2026

2026-03-16T19:08:01Z

← Older revision		Revision as of 19:08, 16 March 2026
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	* Diarrhea frequency, consistency, bloody, steatorrhea		* Diarrhea frequency, consistency, bloody, steatorrhea
	* Ileitis and ~~Colitis~~: diarrhea, abdominal pain, weight loss, fever		* Ileitis and colitis: diarrhea, abdominal pain, weight loss, fever
	* Crampy abdominal pain		* Crampy abdominal pain
	* Bleeding less common than UC		* Bleeding less common than UC
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	* Consider other causes		* Consider other causes
	** Food poisoning: restaurant, foods		** [[Food poisoning]]: restaurant, foods
	** Infectious: travel history, contacts, HIV risk factors, Yersinia, TB		** Infectious: travel history, contacts, [[HIV]] risk factors, [[Yersinia]], [[TB]]
	** Ischemic: CAD and cardiac risk factors		** Ischemic: [[CAD]] and cardiac risk factors
	** Drug induced: recent antibiotics		** Drug-induced: recent antibiotics
	* Complications of IBD		* Complications of IBD
	** General: fever/chills/weight loss		** General: fever/chills/weight loss

Aidan at 15:48, 3 June 2021

2021-06-03T15:48:11Z

Show changes

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-23T12:36:48Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 12:36, 23 July 2020
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	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Diarrhea frequency, consistency, bloody, steatorrhea		* Diarrhea frequency, consistency, bloody, steatorrhea

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2020-07-04T01:17:29Z

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== Differential Diagnosis ==

* Irritable bowel syndrome (IBS)
* Lactose intolerance
* Infectious colitis
** Bacteria
*** Shigella, Salmonella, Campylobacter, Escherichia coli O157:H7, Yersinia
*** Clostridium difficile
*** Ileocecal tuberculosis
*** Chlamydria (more common), syphilis, and gonorrhea
** Protozoa
*** Parasites, including Giardia
*** Ileocecal amebiasis
** Viruses
*** CMV (in immunocompromised)
** Common variable immunodeficiency (CVID)
* Ulcerative colitis: from rectum extending proximally
* Others: appendicitis, diverticulitis, ischemic colitis, carcinoma with obstruction, lymphoma, chronic mesenteric ischemia, endometriosis, and carcinoid

=== Comparison to UC ===

{|
! '''Feature'''
! '''Crohn'''
! '''UC'''
|-
| Symptoms
| Abdo pain/cramping, diarrhea +/- blood
| Tenesmus, bloody stool, mucous
|-
| Distribution
| Discontinuous with skip lesions; 80% TI, 50% ileocolonic, 30% isolated ileal, 20% isolated colonic
| Continuous; 30% pancolitis, 50% proctosigmoiditis
|-
| Muscosa
| Transmural inflammation
| Mucosal inflammation
|-
| Extraintestinal manifestations
| More skin (pyoderma, EN), arthritis, osteopenia, fistulas, strictures
| More PSC, more ophtho, arthritis, osteopenia
|}

== Clinical Presentation ==

* Diarrhea frequency, consistency, bloody, steatorrhea
* Ileitis and Colitis: diarrhea, abdominal pain, weight loss, fever
* Crampy abdominal pain
* Bleeding less common than UC
* Fistulae: enteroenteric, enterovesicular, fistulae to psoas abscess
* Associated symptoms: aphthous ulcers, dysphagia, odynophagia, gastric outlet obstruction, fat malabsorption and steatorrhea, perianal disease

=== History ===

* Consider other causes
** Food poisoning: restaurant, foods
** Infectious: travel history, contacts, HIV risk factors, Yersinia, TB
** Ischemic: CAD and cardiac risk factors
** Drug induced: recent antibiotics
* Complications of IBD
** General: fever/chills/weight loss
** HEENT: eye for uveitis, episcleritis
** Chest: pulmonary fibrosis
** GI: PSC with elevated ALP, steatorrhea causing malnutrition, Vit D deficiency
*** Massive hemorrhage, acute perforation, fistula, abscess, toxic megacolon
** Renal: oxalate stones due to increased oxalate absorption (Ca bound to free fatty acids)
** MSK: arthritis (large joints, ank spondylitis), osteoporosis
** Skin: erythema nodosum, pyoderma gangrenosum
** Heme: venous thromboembolism, vit B12 deficiency (ileal disease)
* PMH, Meds, Allergies, Smoking, Alcohol
* Family history of IBD

=== Physical ===

* Vitals: may be volume depleted or febrile
* H&N: uveitis, episcleritis, oral ulcers, lymphadenopathy
* Resp: pulmonary fibrosis
* GI: abdo pain, liver, jaundice, spleen, masses, acute abdomen
* MSK: arthritis, osteoporosis
* Skin: erythema nodosum, pyoderma gangrenosum

== Management ==

* Mild
** Colonic: sulfasalazine
** Ileocolic: controlled-release budesonide
** Azathioprine or methotrexate for maintenance
* Fistulas
** Infliximab or other anti-TNF-alpha biologic
*** Add antibiotics for perianal fistulas
** May be able to use antibiotics alone for simple fistulas
* Active
** Oral corticosteroids for remission followed by azathioprine for maintenance
*** Can also consider methotrexate for maintenance
** If refractory, use infliximab

== Further Reading ==

* [https://doi.org/10.1038/ajg.2018.27 ACG Guidelines for the Management of Crohn’s Disease in Adults]. ''Am J Gastroenterol''. 2018 Apr;113(4):481-517.
* [https://doi.org/10.1053/j.gastro.2016.10.038 AGA Guideline on the Management of Crohn’s Disease After Surgical Resection]. ''Gastroenterology''. 2017 Jan;152(1):271-275.
* [https://www.ncbi.nlm.nih.gov/pubmed/19319383 CAG Clinical Practice Guidelines: The use of tumour necrosis factor-alpha antagonist therapy in Crohn’s disease]. ''Can J Gastroenterol''. 2009 Mar;23(3):185-202.

[[Category:Gastroenterology]]

Crohn disease - Revision history

Aidan at 19:08, 16 March 2026

Aidan at 15:48, 3 June 2021

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

Maintenance script: Imported from text file