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afya
Crohns
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''Presentation'' late adolescence or early adulthood non-specific symptoms eg weight loss / lethargy diarrhoea - most prominent symptom in adults. (Crohn's colitis may cause bloody diarrhoea) abdominal pain: most prominent symptom in children perianal disease: e.g. Skin tags or ulcers extra-intestinal features esp with colitis or perianal disease effects terminal ileum and colon commonly but may effect any bit of bowel ''Induce Remission '' Glucocorticoids (oral, topical, IV) or Budesonide elemental diet (esp if not wanting to use steroids eg young kids) 5ASA (mesalazine) - 2nd line but not as good as steroids azothiaprine, methotrexate, mercaptopurine - useful as add on but not monotherapy for inducing remission Infliximab for refractory or fistulating disease metronidazole for isolated peri-anal disease ''Maintenance'' Stop smoking - most useful intervention (Note in UC smoking suppresses Sx) azothiaprine or mercaptopurine 1st, methotrexate 2nd, 5ASA if previous surgery Note 80% of crohns will eventually need surgery Pre Aziothioprine or mercaptopurine need to assess TPMT (thiopurine methyltransferase) activity
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IBD