41. Clinical Presentations
S CHRONIC INFLAMMATORY DISEASE: fever, malaise,
weight loss, abdominal pain, RLQ mass
S INTESTINAL OBSTRUCTION: Post prandial bloating,
cramping, borborygmy
S FISTULIZATION: Internal, external
S ABSCESS: Fever, chills, tender mass
S PERIANAL DISEASE: Fissure, abscess, fistula
S EXTRAINTESTINAL: Oral, skin, joints, eye, gall
stones, nephrolithiasis, liver
42. Laboratory Diagnosis
S CBC
S Albumin
S ESR, CRP
S Stool RE
S P-ANCA: 10% crohns, 70% UC
S ASCA (antibody to yeast S cerevisiae): 70% crohn, 10%
UC
53. TREATMENT: Corticosteroids
S Dramatically suppress clinical symptoms
S Do not alter underlying disease process
S Prednisone 40-60 mg/day, taper slowly
S Side effects: Osteoporosis, others
S Ileal release preparation: Budesonide 9mg/day, 50-70%
remission in mild to mod
S Persistent symptoms need ASA, AZA,MTX
63. Summary of medical treatment of
Crohn’s disease
S Aminosalisylic acid: ASA
S Corticosteroids: Pred, Budesonide
S Immunosuppressents: AZA, MTX, Cyc
S Antibiotics: Metronidazole, Ciproflox
S TNF antibody: Infliximab
66. MANAGEMENT
S Life long illness, exacerbations, remissions
S Psych social support: patient education
S No specific therapy exists: supportive care;
diarrhea, steatorrhea, pain
S Nutritional support: enteral, parenteral;
Fiber, iron, B12, low fat, MCT supplements
well balanced diets
67.
68.
69. PROGNOSIS
S Prolonged illness
S Proper medical and surgical care help cope with disease
S Anticipate complications and manage
S Avoid side effects of drugs
S Few die of direct effects of disease
80. Shifa Experience
S 85 patients with 8 years follow up
S Diarrhea with blood 100%
S Raised ESR 80%
S Mild disease 55%
S Left sided colitis in 60%
S Medical Treatment response nearly 100%
Khokhar N. Rawal Med J 2005;30:12-15