Internal Medicine

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

Crohn’s Disease 421

■Ischemic colitis

■Radiation

■Drugs

Differences between Crohn’s disease and ulcerative colitis:

■ulcerative colitis: mucosal, diffuse, continuous, involves the rectum,

limited to colon

■Crohn’s: transmural, patchy, skip lesions, discrete ulcers, anywhere

in the GI tract but usually involves the distal ileum and right colon

and spares the rectum; perianal disease, fistulae, abscesses, stric-

tures, obstruction, granulomas

management

What to Do First

■Assess disease location, type, severity and presence of complications

■location: distal ileum and right colon (50%), small bowel alone (30%),

colon alone (20%), perianal (25–30%), or gastro-duodenal (less com-

mon)

■type: inflammatory, stenotic and/or fistulizing

■severity:

➣mild: diarrhea, pain

➣moderate-severe: fever, weight loss, pain, tenderness, nausea,

vomiting, anemia

➣severe-fulminant: despite steroids, fever, persisting nausea and

vomiting, cachexia, signs of obstruction and peritoneal inflam-

mation

■complications: fistulae, abscesses, obstruction, perforation

General Measures

■Complete baseline evaluation: laboratory tests, barium studies,

endoscopy, and in some cases abdominal and pelvic CT scan

specific therapy

Maintenance therapy:

Mild-Moderate Disease

■oral aminosalicylates

■sulfasalazine 2–4 g/d or balsalazide 6.75 g/d (for colonic disease) or

■mesalamine 4–4.8 g/d for small bowel disease

■side effects of sulfasalazine: intolerance to sulfapyridine moiety of

sulfasalazine is common (headache, nausea), as are mild allergic

reactions (skin rash); severe allergic reactions (e.g., fibrosing alveoli-

tis, pericarditis, pancreatitis, agranulocytosis) are rare