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{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | B01=<div style="float: left; text-align: left; height: 28em; width: 25em; padding:1em;">'''Assess volume status:'''
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❑ General condition <br>
❑ General condition <br>
❑ Blood pressure <br>
❑ Thirst <br>
❑ Thirst <br>
[[Pulse]] <br>
❑ Pulse <br>
❑ [[Blood pressure]] <br>
❑ Eyes <br>
❑ Eyes <br>
❑ Mucosa
❑ Mucosa

Revision as of 17:07, 17 January 2014

Management

The algorithm is based on the American Journal of Gastroenterology guidelines for management of Crohn's disease in adults.[1]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Characterize the symptoms:

Abdominal pain
Chronic diarrhea or nocturnal diarrhea
Nausea
Vomiting
Bloating/Abdominal distention
Constipation/Obstipation
Fever
Malaise
Loss of appetite
Loss of weight
Rectal bleeding
Painful defecation
Altered mental status


Extraintestinal symptoms:


Skin lesions
Oral ulcers
Odynophagia, dysphagia
Joint pains
Burning micturition
Cough, breathlessness
Eye pain, blurring of vision


Obtain detailed history:


❑ Medical and surgical history
❑ Recent medication history
❑ Recent travel history
❑ Family history
❑ Abdominal/pelvic radiation

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess volume status:

❑ General condition
❑ Blood pressure

❑ Thirst
❑ Pulse
❑ Eyes
❑ Mucosa


Examine the patient:


❑ Skin (swelling, pain, erythema or ulceration)
❑ Oral cavity (ulcers)
❑ Respiratory system (wheezing or crackles)
❑ Cardiovascular system
❑ Abdomen (mass, distension or tenderness)
❑ Anorectal (perianal skin tags, sinus tracts or bleeding)
❑ Eye (swelling, pain, edema or vision loss)
❑ Musculoskeletal (Axial, large and small joints)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Confirmatory diagnostic tests:
Colonoscopy and biopsy
❑ Upper GI scopy and biopsy
Computed tomography (CT)
Barium enema(length and location of strictures)
❑ Upper gastrointestinal series with small bowel follow through (SBFT)
Magnetic resonance imaging (enterography)
Wireless capsule endoscopy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Findings suggestive of Crohn's disease:
❑ Discontinuous lesions
❑ Biopsy (Transmural inflammation, noncaseating granuloma)
❑ Cobblestoning (Serpiginous and linear ulcer)
❑ Normal rectum
❑ Isolated terminal ileum involvenent
❑ Aphthous ulcers
❑ Negative stool examination for infectious causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assessment of severity
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild to moderate

❑ Ambulatory patients
❑ Tolerating oral diet
❑ No dehydration
❑ No toxicity
❑ No abdominal tenderness or mass
❑ No obstruction
Weight loss <10 percent

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Moderate to severe

Fever
❑ Intermittent nausea or vomiting
❑ Mild to moderate dehydration
Anemia
❑ Abdominal pain and tenderness
❑ No obstruction
❑ Weight loss > 10 percent

 
 
 
 
 
 
 
 
Severe to fulminant

❑ High fever
❑ Persistent vomiting
❑ Severe dehydration
❑ Significant peritoneal signs
❑ Evidence of abscess
Intestinal obstruction
Cachexia

 
 
 
 
 
 
 
 
 
 
 




References

  1. Lichtenstein, Gary R; Hanauer, Stephen B; Sandborn, William J (2009). "Management of Crohn's Disease in Adults". The American Journal of Gastroenterology. 104 (2): 465–483. doi:10.1038/ajg.2008.168. ISSN 0002-9270.