Please enable JavaScript.
Coggle requires JavaScript to display documents.
Crohn's Disease - Coggle Diagram
Crohn's Disease
Differential Diagnosis
Intestinal ischaemia
Acute appendicitis
Microscopic colitis
Diverticulitis
Pseudomembranous colitis
Coeliac disease
Infective colitis
Irritable bowel disease
Ulcerative colitis
Anal fissure
Endometriosis
Malignancy
Laxative misuse
Management: Confirmed Crohns
Ensure that the person has follow-up arranged with a gastroenterology specialist, if needed, and encourage the person to attend appointments regularly.
If a shared-care agreement is in place, prescribe and monitor specialist drug treatments, if appropriate, and encourage the person to take their medication regularly as prescribed.
Assess osteoporosis risk
Monitoring may include: ferritin, vitamin B12, folate, calcium, vitamin D and arranging supplementation where appropriate.
Encourage to stop smoking
Assess for features of flare up and manage appropriately. Consider BMI for signs of malnutrition or CPR if flare is suspected.
Provide sources of information and support
Extra-intestinal manifestations - ensure referral to appropriate specialist.
If person taking immunosupressive or biologic therapy ensure they are aware - live vaccines are contraindicated and they are at increased risk of influenza/pneumococcal infection (should receive these vaccinations regularly).
Diagnosis: Investigations
LFTs
Ferritin, Vitamin B12, folate and vitamin D
U&Es
Coeliac serology
Serum inflammatory marker such as CRP and ESR
Stool microscopy and culture
Serum full blood count
Investigations may be normal in a person with active Crohn's disease
Management: Flares and Symptoms
Fistulas - arrange hospital admission/referral to colorectal surgery or seek specialist advice.
Upper gastrointestinal symptoms - if previous investigation been carried out manage underlying cause appropriately, asses for any red flag symptoms, consider is Crohn's affecting stomach/duodenum and manage appropriately. Consider FBC and CRP.
Diarrhoea - exclude alternative diagnosis, suspect bile salt malabsorption if watery diarrhoea with abdominal bloating, diarrhoea may be secondary to drug treatment. If persistent consider symptomatic relief - options include antimotility, anti-spasmodic drugs for pain relief, bulk-forming laxative, bile acid sequestrant. Do not prescribe symptom relief in those who are systemically unwell.
Abdominal/Perianal pain - identify underlying cause where possible and manage appropriately. Offer analgesia to relieve symptoms - consdier paracetamol first line, opiates may be required, avoid NSAIDs. If pain not adequately controlled seek speciallist advice.
If hospital admission not required - consider if symptoms are due to alternative diagnosis and manage appropriately, check adherence to current drug treatment, consider urgent specialist gastroenterologist review or dietician review.
Oral problems - If the person develops suspected oral lesions secondary to Crohn's disease arrange gastroenterology clinic review or referral to a specialist in oral medicine depending on clinical judgement.
Consider if emergency hospital admission required - severe diarrhoea, fever, dehydration, tachycardia, hypotension, suspected intestinal obstruction, cachexia/unintended sudden weight loss, persistent symptoms despite optimal management.
Fatigue - exclude any alternative or contributing factors and manage appropriately. Consider checking FBC, ferritin, vitamin B12, folate.
Risk Factors
No factor has been recognised as the sole cause of the condition.
Family history
Smoking
Infectious gastroenteritis
Appendicectomy
Drugs
Diagnosis: Symptoms
Tenesmus
Blood or mucus in the stool
Faecal urgency
Abdominal pain or discomfort - can be caused by adhesions, fistulas, intestinal obstruction or dilation
Unexplained persistent diarrhoea (frequent loose stools for more than 4-6 weeks) including nocturnal diarrhoea
Non-specific symptoms such as fatigue, malaise, anorexia or fever
Extra-intestinal Manifestations
Aphthous mouth ulcers
Episcleritis
Erythema nodosum
Metabolic bone disease
Pauci-articular arthritis
Diagnosis: Examination
Signs of malnutrition or malabsorption
Extra-intestinal manifestations
Perianal pain or tenderness, anal or perianal skin tad, fissure, fistula or abscess
Abdominal tenderness or mass
Pallor, clubbing, aphthous mouth ulcers
Management: Suspected Crohn's Disease
Following confirmation of the diagnosis in secondary care, arrange to review the person regularly in primary care.
Specialist investigation: colonoscopy, upper intestinal endoscopy, MRI - pelvic and small bowel, small bowel ultrasound, CT scan, abdominal ultrasound and plain abdominal x-rays
If there are suspected extra-intestinal manifestations that cannot be managed in primary care, arrange referral to an appropriate specialist
Arrange urgent referral to secondary care for confirmation of diagnosis and initiation of specialist drug treatment
Emergency admission - systemically unwell and symptoms of bloody diarrhoea, fever, tachycardia or hypotension
Definition: It is a chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract. It involves discrete parts of the GI tract anywhere between mouth to the anus. Extra-intestinal manifestations include abnormalities of the joints, eyes, liver and skin.