Internal Medicine

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

Crohn’s Disease 423

■oral prednisone with gradual tapering – usually faster at higher doses

and slower at lower doses

■short-term side effects include acne, night sweats, sleep and mood

disturbances, appetite stimulation

■long-term side include hypertension, diabetes, acne, osteoporosis,

osteonecrosis, glaucoma, cataracts, depression and obesity

■Budesonide (9 mg/d); Caution: may not be as effective as prednisone

and has long-term steroid toxicities

■There is no place for frequent or long-term systemic steroids (includ-

ing budesonide) in the management of IBD because the adverse

effects outweigh the potential benefits.

Severe-Fulminant Disease

■hospitalization for IV steroids, antibiotics and bowel rest

■surgical consultation if evidence for obstruction

■abscess drainage (open or percutaneous)

■if chronically obstructed: elective surgery

■?cyclosporine for fistulizing disease

■side effects of cyclosporine include nephrotoxicity, seizures, hyper-

tension, opportunistic infections, hirsutism, tremor and gingival

hyperplasia

follow-up

■Frequent visits to assess symptoms and laboratory tests, particularly

CBC and LFTs

complications and prognosis

■Intestinal complications:

➣obstruction

➣perforation

➣abscess

➣fistulae

entero-enteric

entero-vesical

entero-cutaneous

mesenteric

retroperitoneal

perianal

■Related to small bowel pathophysiology:

➣gallstones

➣malabsorption