Crohn's disease begins with crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers. These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel.

Gross rectal bleeding is rare, except in
75‒85% of cases of Crohn colitis.

Stool analysis and culture to rule out bacterial, fungal, or parasitic infection as the cause for diarrhea

X-ray: On x-ray, bowel wall is affected asymmetrically
and segmentally, with skip
areas between diseased segments.

EGD: Endoscopic appearance is patchy, with
discrete ulcerations separated by segments
of normal-appearing mucosa.

Iron deficiency and macrocytic anemia which result from inflammation of the terminal ileum and poor absorption of folate.

Inflammatory bowel disease affects people of all ages but usually begins before age 30, with peak incidence from 14 to 24. IBD may have a second smaller peak between ages 50 and 70; however, this later peak may include some cases of ischemic colitis.

Hypocalcemia and Vitamin D deficiency, hypoalbuminemia, and steatorrhea resulting from bile salt deficiency

1.5-28% of people with IBD have a first-degree relative who has IBD.

Colonoscopy- reveals ulcers that are either minor erosions or deep longitudinal fissures. Cobblestone appearance is usually found above the rectum and rectosigmoid areas.

The incidence is increasing among Black and Latin American people living in North America

CT is used to identify bowel wall thickening or abscess formation and can be used for guided drainage of abscess.

Inflammatory bowel disease (IBD), which includes Crohn disease and ulcerative colitis, is a relapsing and remitting condition characterized by chronic inflammation at various sites in the gastrointestinal tract, which results in diarrhea and abdominal pain.

Oral contraceptives may increase the
risk of Crohn's disease

Cigarette smoking seems to contribute to development or exacerbation

Non-steroidal anti-inflammatory drugs (NSAIDs) may exacerbate IBD

Negative for antineutrophil cytoplasmic antibodies (pANCA)

NIH Theory: An autoimmune reaction. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohn's disease

People who have a higher socioeconomic status may have an increased risk of Crohn disease

Educate on stress management techniques such as guided imagery and mindfulness

Avoid foods high in fiber, inclding whole grain breads and cereals, fresh fruits and vegetables, seeds and nuts.

Pts can eat canned fruits and vegetables and white breads only

Oral elemental or parenteral nutrition may be necessary if unresponsive to treatment or if growth retardation is treatment

If not in acute attack, may eat what they can tolerate

Female patients before attempting pregnancy or who are pregnant

Cutaneous signs such as: Oral lesions,
erythema nodosum, pyoderma gangrenosum

Ocular Manifestations such as episcleritis, scleritis, iritis, or uveitis

Tapper after 2-4 months

Pts are at higher risk for osteopenia and osteoporosis. Educate on importance of increased weight bearing exercise for bone protection.

Educate on importance of hydration and low oxalate diet to prevent calcium oxalate stones

Antibiotics prevent or treat complications involving infection: abscesses and fistulas. Metronidazole, Cipro, Ampicillin and Tetracycline all show aid in controlling CD ileitis & ileocolonic

PNA

TDAP-tetanus every 10 years

Annual skin exam by dermatologist if immunosuppressed

Alternatively, the patient may reduce the heat-producing chili in the recipe to a level where they no longer experience symptoms.

Good for patient's who are unresponsive to other first line treatments

Good for severe CD pt's who are dependent on high-dose steroids or nonhealing fistulas

Periods of acute exacerbation alternating with complete remission

Can drink liquids, with nutrients or hospital admission with IV therapy

Crohn disease typically affects the ileum and/or colon but spares the rectum

Intermittent areas of diseased bowel are sharply demarcated from adjacent normal bowel (called skip areas)

Epithelioid (sarcoid-like) granulomas are detected in bowel wall or lymph nodes in 25‒50% of cases (pathognomonic).

Side effects from medications that are life threatening

LyfeMD is a virtual solution designed by gastroenterologists and registered dieticians to put the power of diet, nutrition, and lifestyle therapies into the hands of patients

We Can't Wait is the Crohn's & Colitis Foundation's restroom finder app.

Trellus Health is a digital health company founded by experts with over 25 years of treating and healing both the physical and emotional impact of IBD

Can cause bone marrow suppression and life threatening infections

No increase in severe infections or malignancy as this is a Human IG Monoclonal Antibody

Can cause bone marrow suppression & increased risk for life threatening infection.

Can cause progressive multifocal leukoencephalopathy in immunocompromised pts. Common SE: fatigue and allergic reaction

Avoid foods high in fiber: whole grain bread, cereal, fresh fruit & veggies, seeds & nuts

Pt's can have canned fruits and vegetables and should only have white bread.

In-between attacks, pt's can eat whatever they can tolerate

Parental nutrition or oral supplementation for malnutrition pts can sometimes be indicated in severe cases.

This is a life long condition that is not curable, but with proper treatment, support and recourses we can decrease amount of flares pt's experience.

Ask to bring families in during education session, encourage families to be supportive and s/s of decline and when to see help

Proper inflammatory management can reduces the risk of penetrating complications (fistulas/abbesses)