Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

420 Crigler-Najjer Type 2 Crohn’s Disease

General Measures

■trial on phenobarbital orally usually improves bilirubin to 2–5 mg/dl

in 7–10 days

■phototherapy and/or double-volume exchange transfusion for ker-

nicterus prevention in infants

specific therapy

n/a

follow-up

■discretional phenobarbital use after neonatal period or if unconju-

gated bilirubin >35 mg/dL

complications and prognosis

■rare kernicterus cases otherwise excellent prognosis

Crohn’s Disease.....................................

CHRISTINE A. CARTWRIGHT, MD

history & physical

■History: diarrhea, abdominal pain, fever, nausea, vomiting, weight

loss, anemia

■Trigger factors: infection, smoking, NSAIDs, stress

■Physical signs: fever, abdominal tenderness and fullness (usually

right lower quadrant)

tests

Basic Tests: Blood

■CBC, ESR, albumin, LFTs

Other Tests:

■stool studies: culture, O+P×3, C. difficile, Giardia EIA antigen

■amebic ELISA serology

■colonoscopy and biopsy

■UGI and SBFT

■abdominal and pelvic CT scan (in some circumstances)

differential diagnosis

■Ulcerative colitis or other causes:

■Infectious diseases (giardiasis, amebiasis, pseudomembranous,

CMV)