internal medicine

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👨‍⚕Q. How to assess the activity of Crohn’s disease? A. Signs of activity are: 1. Clinical: ✓ Eye signs—episcleritis, conjunctivitis and iritis ✓ Mouth—aphthous ulcer ✓ Skin—erythema nodosum and pyoderma gangrenosum ✓ Arthralgia of large joints ✓ Fatty…

Q. What are the types of arthritis in Crohn’s disease?

👨‍⚕Q. How to assess the activity of Crohn’s disease? A. Signs of activity are: 1. Clinical: ✓ Eye signs—episcleritis, conjunctivitis and iritis ✓ Mouth—aphthous ulcer ✓ Skin—erythema nodosum and pyoderma gangrenosum ✓ Arthralgia of large joints ✓ Fatty liver or liver abscess or portal pyemia ✓ Mesenteric or portal vein thrombosis ✓ Venous thrombosis (in other veins). 2. Morphology—by radiological or endoscopy 3. Laboratory: ✓ Low albumin (due to protein losing enteropathy) ✓ High ESR ✓ High C-reactive protein (CRP). 4. Scanning with white cell labelled with 111Indium or 99mTc to locate active site.

A. In smokers, the incidence of Crohn’s disease is high. But there is increased risk of ulcerative colitis in nonsmoker or ex-smokers.

Q. What is the relation of smoking in IBD?

✨A. Actual causes unknown. Probable factors are: ✓ Genetic and familial ✓ Diet—high sugar and fat, but low residue diet ✓ Smoking ✓ Probable association with mycobacteria and measles virus (not proved) ✓ Abnormal immunological response Appendicectomy is protective of ulcerative colitis, but may increase the risk of Crohn’s disease or may result in more aggressive disease. ¯ Oral contraceptive pill increases the risk of Crohn’s disease.

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👨‍⚕Q. What are the causes of Crohn’s disease "factors" ?

🧑‍⚕A. As follows: ✓ Intestinal obstruction ✓ Enteric fistula to bladder or vagina ✓ Abscess formation ✓ Perianal disease (fissure, skin tag, fistula, perianal abscess, hemorrhoid) ✓ Carcinoma (rare, may occur if Crohn’s disease involves the colon) ✓ Toxic dilatation of the colon (more common in ulcerative colitis) ✓ Malabsorption syndrome.

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👨🏽‍⚕Q. What are the complications of Crohn’s disease?

Ophthalmologist: Eyes—conjunctivitis, episcleritis, uveitis or iritis. 👨‍⚕️ Dentist (Oral Medicine): Mouth—aphthous ulcer and thickened lip. 👨‍⚕️ Dermatologist: Skin—erythema nodosum, pyoderma gangrenosum or fistula in abdominal wall. 👨‍⚕️ Rheumatologist: Bones and joints—acute peripheral arthritis (occurs in 15 to 20%, related to active disease, treatment of Crohn’s disease improves the condition. In severe case, even colectomy improves arthritis). Sometimes, ankylosing spondylitis or sacroiliitis and clubbing may also occur. 👨‍⚕️ Colorectal Surgeon/Gastroenterologist: Perianal region—perianal fistula, skin tag and abscess. 👨‍⚕️ Hepatologist: Liver or hepatobiliary—fatty liver, pericholangitis, sclerosing cholangitis (common in ulcerative colitis), autoimmune hepatitis, cirrhosis of liver, granuloma, liver abscess or portal pyemia, gall stone and cholangiocarcinoma. 👨‍⚕️ Nephrologist: Kidney—nephrolithiasis (oxalate stone), hydronephrosis and pyelonephritis. 👨‍⚕️ Hematologist/Internal Medicine: Others—amyloidosis and venous thrombosis.

👨‍⚕Q. What are the extra-intestinal manifestations of Crohn’s disease?

Q. What is Crohn’s disease? What are the presentations? 🧑🏼‍⚕A. Crohn’s disease is a chronic inflammatory disease of unknown etiology involving any part of gastrointestinal tract, commonly the terminal ileum. It is slightly common in female, M:F = 1:1.2, more in young (mean age is 26 years). Common presentations are as follows: ✓ Frequent diarrhea ✓ Abdominal pain (colicky) ✓ Weight loss ✓ Failure to thrive in children ✓ Other systemic features are malaise, lethargy, low grade fever, anorexia, nausea, vomiting ✓ Extra-intestinal manifestations ✓ Sometimes, it may present with acute emergency like acute appendicitis. If laparotomy is done, terminal ileum looks edematous and red ✓ Sometimes, the patient may present with recurrent aphthous ulceration of mouth, mass in right iliac fossa (due to inflamed loops of bowel matted together or abscess), anal fissures or perianal abscess.

👨‍⚕Q. What is Crohn’s disease? What are the presentations?