![]() ![]() CT studies provide the most consistent results but have the downside of radiation exposure. If the patient can tolerate the contrast load, CT and magnetic resonance enterography are preferred to standard CT and magnetic resonance imaging protocols. 20, 21 They complement endoscopy because they can identify extraluminal pathology and examine the gastrointestinal tract not accessible to endoscopic procedures. These techniques are all useful and provide similar accuracy for making the initial diagnosis, monitoring disease activity, and identifying complications (e.g., fistulas, abscesses). ![]() 15Ĭross-sectional imaging techniques, including computed tomography (CT), magnetic resonance imaging, and ultrasonography, have come to the forefront in the management of Crohn's disease. 1, 2 Measurement of C-reactive protein, fecal calprotectin, and stool lactoferrin can help assess disease activity and potentially limit the need for endoscopy in disease management decisions. Results can provide information to support the diagnosis, identify the severity of disease, or determine alternative diagnoses. 2, 14 When the diagnosis of Crohn's disease is considered, a complete blood count a complete metabolic panel pregnancy test C-reactive protein level erythrocyte sedimentation rate and stool studies for Clostridium difficile, ova and parasites, and culture may be useful. Fecal calprotectin is a reasonable test to rule out Crohn's disease for adults (sensitivity of 83% to 100% specificity of 60% to 100%) and children (sensitivity of 95% to 100% specificity of 44% to 93%) with equivocal symptoms, and may spare them from more invasive testing. Laboratory testing has multiple purposes for the evaluation of Crohn's disease, including diagnosis, monitoring of disease activity, and tracking adverse effects and effectiveness of medications. #COLONOSCOPY FINDINGS SKIN#Important areas to cover are nocturnal symptoms urgency findings food intolerance travel medications (including antibiotic exposure) smoking status family history of inflammatory bowel disease and eye, joint, or skin symptoms. 11 The history should identify findings specific for Crohn's disease, identify alternative diagnoses ( Table 3 1, 2, 12 ), and search for extraintestinal findings ( Table 4 1 ). 10 A case review of 606 children with chronic abdominal pain identified three red flag findings for children: anemia, hematochezia, and weight loss. In order of strength of association, the findings were perianal lesions other than hemorrhoids, a first-degree relative with inflammatory bowel disease, weight loss (5% of usual body weight) in the past three months, abdominal pain for longer than three months, nocturnal diarrhea, fever, no abdominal pain for 30 to 45 minutes after meals, and no rectal urgency. The study identified eight red flag findings for Crohn's disease in adults. 1, 2 A case review of 201 participants compared patients with Crohn's disease and patients without Crohn's disease who had irritable bowel syndrome or were otherwise healthy. Common symptoms include diarrhea, abdominal pain, rectal bleeding, fever, weight loss, and fatigue. Maximizing prevention measures is essential in caring for these patients.Ĭrohn's disease most often presents insidiously but can present as an acute toxic illness. Patients with Crohn's disease are at increased risk of cancer, osteoporosis, anemia, nutritional deficiencies, depression, infection, and thrombotic events. All patients with Crohn's disease should be counseled on smoking avoidance or cessation. For children, enteral nutrition is an option for induction therapy. Patients with higher-risk disease are given biologics, with or without immunomodulators, to induce and maintain remission. Patients commonly receive corticosteroids to treat symptom flare-ups. Treatment decisions are guided by disease severity and risk of poor outcomes. Endoscopy and cross-sectional imaging are used to confirm the diagnosis and determine the extent of disease. Measurement of fecal calprotectin has value to rule out disease in adults and children. Initial laboratory evaluation identifies inflammation and screens for alternative diagnoses. Physical examination should identify unstable patients requiring immediate care, include an anorectal examination, and look for extraintestinal complications. Common presenting symptoms include diarrhea, abdominal pain, rectal bleeding, fever, weight loss, and fatigue. Genetic predispositions to Crohn's disease have been identified, and specific environmental factors have been associated with its development. The prevalence of Crohn's disease is increasing in adults and children. It can cause lesions from mouth to anus and may result in extraintestinal complications. Crohn's disease is a chronic inflammatory condition that affects the gastrointestinal tract. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |