??⚕️تفضل ايش المشكله اللي عندك
??دكتور احس بإعياء وتعب والم ببطني
??⚕️ بس ،فيه اعراض ثانيه؟
??ما اشتهي اكل شي و وزني نازل
?: تمام حنا بننتظر التحليل والاشعه ونشوف بالضبط حالتك ??⚕️
( بعد مرور مده زمنيه )⏰
الواضح عندنا انك مصاب بـ ??⚕️
CROHN DISEASE
ايش هذا المرض بالضبط ؟؟؟??
??دكتور احس بإعياء وتعب والم ببطني
??⚕️ بس ،فيه اعراض ثانيه؟
??ما اشتهي اكل شي و وزني نازل
?: تمام حنا بننتظر التحليل والاشعه ونشوف بالضبط حالتك ??⚕️
( بعد مرور مده زمنيه )⏰
الواضح عندنا انك مصاب بـ ??⚕️
CROHN DISEASE
ايش هذا المرض بالضبط ؟؟؟??
1- What is IBD?
- Inflammatory Bowel Diseases
is a term for two conditions (Crohn’s disease and ulcerative colitis) that are characterized by chronic inflammation of the gastrointestinal (GI) tract.(الجهاز الهضمي)
- Inflammatory Bowel Diseases
is a term for two conditions (Crohn’s disease and ulcerative colitis) that are characterized by chronic inflammation of the gastrointestinal (GI) tract.(الجهاز الهضمي)
2- What is Crohn's disease?
is a chronic disease that causes inflammation and irritation in digestive tract.
⁃ Most commonly, Crohn’s affects small intestine and the beginning of large intestine.
is a chronic disease that causes inflammation and irritation in digestive tract.
⁃ Most commonly, Crohn’s affects small intestine and the beginning of large intestine.
? the disease can affect any part of digestive tract, from your mouth to anus.
⁃ Crohn’s disease most often begins gradually and can become worse over time. Patients may have periods of remission that can last for weeks or years.
⁃ Crohn’s disease most often begins gradually and can become worse over time. Patients may have periods of remission that can last for weeks or years.
3- What are the differences between Crohn’s disease and ulcerative colitis?
4- What are the pathology of Crohn’s disease?
Crohn's disease tends to present more frequently with abdominal pain
and perianal disease.
داء كرونز هو الشعور بألم في البطن بشكل متكرر أكثر)
Parent disease: Inflammatory bowel disease
Parent cause of death: Inflammation
Crohn's disease tends to present more frequently with abdominal pain
and perianal disease.
داء كرونز هو الشعور بألم في البطن بشكل متكرر أكثر)
Parent disease: Inflammatory bowel disease
Parent cause of death: Inflammation
5-What are the pathophysiology Crohn’s disease?
begins with crypt inflammation and abscesses,which progress to tiny focal aphthoid ulcers,Extensive inflammation may result in hypertrophy of the muscularis mucosae,fibrosis,and stricture formation which lead to bowel obstruction
begins with crypt inflammation and abscesses,which progress to tiny focal aphthoid ulcers,Extensive inflammation may result in hypertrophy of the muscularis mucosae,fibrosis,and stricture formation which lead to bowel obstruction
6-What causes Crohn’s disease?
The exact cause of CD is unknown
-Factors that seem to play a role include:
Heredity: Crohn's is more common in people who have family members with the disease, The genes may play a role in the susceptibility of CD
بعض مصابين لهم تاريخ عائلي بالمرض
The exact cause of CD is unknown
-Factors that seem to play a role include:
Heredity: Crohn's is more common in people who have family members with the disease, The genes may play a role in the susceptibility of CD
بعض مصابين لهم تاريخ عائلي بالمرض
?Immune system: A virus or bacterium may trigger Crohn's disease,When the immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract as well.
7- Who is more likely to develop Crohn’s disease?
Age: Most people who develop CD are diagnosed before they're around 30 years old
Heredity: the risk increases if there is a close relative having CD
Cigarette smoking is the most important controllable risk factor for developing
Age: Most people who develop CD are diagnosed before they're around 30 years old
Heredity: the risk increases if there is a close relative having CD
Cigarette smoking is the most important controllable risk factor for developing
-NSAIDs : they can lead to inflammation of the bowel that makes CD worse.
There is no evidence that stress or food causes CD although these factors can make the symptoms worse.
There is no evidence that stress or food causes CD although these factors can make the symptoms worse.
8-What are the symptoms of Crohn’s Disease?
- Diarrhea
- Abdominal pain
- Weight loss
- Malnutrition
(دم في البراز Hematochezia --
- Arthritis
- Malaise and Fever
بعض المرضى ليس لديهم اعراض لسنوات و البعض االخر لديهم اعراض مزمنة على الرغم من العالج
- Diarrhea
- Abdominal pain
- Weight loss
- Malnutrition
(دم في البراز Hematochezia --
- Arthritis
- Malaise and Fever
بعض المرضى ليس لديهم اعراض لسنوات و البعض االخر لديهم اعراض مزمنة على الرغم من العالج
9-How do doctors diagnose Crohn’s disease???⚕️?
- Physical exam
a doctor most often checks for
- bloating in abdomen
-listens to sounds within abdomen using a stethoscope
- taps on the abdomen to check for tenderness and pain and to see if liver or spleen is abnormal or enlarged
- Physical exam
a doctor most often checks for
- bloating in abdomen
-listens to sounds within abdomen using a stethoscope
- taps on the abdomen to check for tenderness and pain and to see if liver or spleen is abnormal or enlarged
-Diagnostic tests?
1st investigation to order:
All patients should have a
A. full blood count (FBC) leukocytosis; may be thrombocytosis.
B. comprehensive metabolic panel (CMP) hypoalbuminaemia, hypocholesterolaemia & hypocalcaemia.
1st investigation to order:
All patients should have a
A. full blood count (FBC) leukocytosis; may be thrombocytosis.
B. comprehensive metabolic panel (CMP) hypoalbuminaemia, hypocholesterolaemia & hypocalcaemia.
C.C-reactive protein (CRP)&erythrocyte sedimentation rate (ESR) elevated
D.Stool should be sent for microscopy (including for ova,cysts,and parasites)
D.Stool should be sent for microscopy (including for ova,cysts,and parasites)
F. serum iron studies normal or iron deficiency E. vitamin B12 and folate levels normal or low checked.
G. x-rays not used for diagnostic of CD, but may be suggestive and help in assessing severity.
G. x-rays not used for diagnostic of CD, but may be suggestive and help in assessing severity.
2nd investigation to consider:
1. Ultrasonography of the small bowel and pelvis is an alternative to CT and MRI (particularly useful if pelvic pathology, such as abscess, is suspected).
2. Colonoscopy with intubation of the ileum is the definitive test for diagnosis of CD
1. Ultrasonography of the small bowel and pelvis is an alternative to CT and MRI (particularly useful if pelvic pathology, such as abscess, is suspected).
2. Colonoscopy with intubation of the ileum is the definitive test for diagnosis of CD
3. Technetium-99 labelled white blood cell scanning is used for diagnosis in patients unable to undergo colonoscopy
4. Oesophagogastroduodenoscopy (OGD) should be performed to evaluate patients with predominantly upper GI symptoms.
4. Oesophagogastroduodenoscopy (OGD) should be performed to evaluate patients with predominantly upper GI symptoms.
5 Mucosal bowel biopsies should be obtained from the terminal ileum and each colonic segment to look for microscopic evidence of CD. (The microscopic features that help distinguish UC and CD include granulomas, architectural change, and distribution of disease).
⬇️⬇️⬇️⬇️
⬇️⬇️⬇️⬇️
6. Positron emission tomography (PET) uses fluoro-2-deoxy-D-glucose (FDG) to identify areas of abnormal metabolism, it may have a role as a non-invasive test in early evaluation of CD in patients unable to tolerate endoscopic assessment (e.g., children)
⬇️⬇️⬇️
⬇️⬇️⬇️
7. Wireless capsule endoscopy should be considered when imaging, colonoscopy, and OGD fail to establish a diagnosis.
\
8. Autoantibodies, perinuclear neutrophil cytoplasmic antibodies (p-ANCA)
\
8. Autoantibodies, perinuclear neutrophil cytoplasmic antibodies (p-ANCA)
Emerging test:?
Faecal calprotectin and faecal lactoferrin are stable proteins that are released into faeces when neutrophils gather at the site of any GI tract inflammation.
They may have a role in distinguishing between non-inflammatory bowel disorders
Faecal calprotectin and faecal lactoferrin are stable proteins that are released into faeces when neutrophils gather at the site of any GI tract inflammation.
They may have a role in distinguishing between non-inflammatory bowel disorders
10-What are the Goal therapy for CD?
-Resolution of acute inflammatory processes
-Resolution of attendant complications(e.g fistulas or abscess)
-Alleviation of systemic manifestations(e.g.arthritis)
-Maintainance of remission from acute inflammation,surgical palliation,or cure
-Resolution of acute inflammatory processes
-Resolution of attendant complications(e.g fistulas or abscess)
-Alleviation of systemic manifestations(e.g.arthritis)
-Maintainance of remission from acute inflammation,surgical palliation,or cure
?
What are Non- pharmacological treatment of Crohn's disease?
1- Diet الغذاء الصحي
2-Smoking الابتعاد عن التدخين
3-stress الابتعاد عن الضغوط
What are Non- pharmacological treatment of Crohn's disease?
1- Diet الغذاء الصحي
2-Smoking الابتعاد عن التدخين
3-stress الابتعاد عن الضغوط
?
How do doctors treat Crohn’s disease ?
1- Active Crohn’s disease
2- Maintenance of remission
3- Bowel rest
4- Surgery
How do doctors treat Crohn’s disease ?
1- Active Crohn’s disease
2- Maintenance of remission
3- Bowel rest
4- Surgery
⬇️??
How to managing Crohn’s disease during pregnancy?
(لاينصح بالحمل اثناء المرض)
?
(لاينصح بالحمل اثناء المرض)
?
?Medication
Evaluation of outcome
1- uncomplicated cases of CD need follow-up visits physician every 6 months, complicated cases of CD or on azathioprine or mercaptopurine require visits physician every 3 months.
الحاله المعقدة تحتاج الى متابعة كل 6 اشهر، الحاله غير المعقده ⬅️ الى٣ اشهر
1- uncomplicated cases of CD need follow-up visits physician every 6 months, complicated cases of CD or on azathioprine or mercaptopurine require visits physician every 3 months.
الحاله المعقدة تحتاج الى متابعة كل 6 اشهر، الحاله غير المعقده ⬅️ الى٣ اشهر
Guidelines recommend baseline blood-test screening prior to initiation of all treatments, to exclude sepsis and pre-existing renal or liver impairment.
توصي القايد لاين بفحص الدم قبل بدء بالادوية، لتجنب تعفن الدم ،ضعف الكلى والكبد الموجود لأن الادويه ممكن تسبب سمية للكلى والكبد
توصي القايد لاين بفحص الدم قبل بدء بالادوية، لتجنب تعفن الدم ،ضعف الكلى والكبد الموجود لأن الادويه ممكن تسبب سمية للكلى والكبد
3-immunomodulators (azathioprine, mercaptopurine, methotrexate, and anti-TNF agents), which can produce life-threatening consequences if started without due caution.
مضادات المناعه والتي يمكن ان تنتج عواقب تهدد الحياة اذا بدأت دون توخي الحذر
مضادات المناعه والتي يمكن ان تنتج عواقب تهدد الحياة اذا بدأت دون توخي الحذر
?Immunomodulators should never be started if there is any indication of sepsis.
لا ينبغي ان تبدأ Immunomodulators اذا كان هناك sepsis
لا ينبغي ان تبدأ Immunomodulators اذا كان هناك sepsis
5- Anti-TNF agents are associated with an increased risk of developing TB Patients should be screened with a combination of history-taking,x-rays,interferon-gamma release assay blood test, and tuberculin skin test, so both should be tested for prior to initiation of treatment
cont..
ترتبط العوامل المضادة لـ TNF بزيادة خطر الإصابة بالسل. يجب فحص المرضى عن طريق أخذ تاريخ المريض ، والأشعة السينية للصدر ، واختبار فحص فحص غاما لفيروسات الانترفيرون ، و اختبار جلد السل إذا اعتبرت درجة عالية من الخطورة ، لذلك يجب اختبار كليهما قبل البدء في العلاج
ترتبط العوامل المضادة لـ TNF بزيادة خطر الإصابة بالسل. يجب فحص المرضى عن طريق أخذ تاريخ المريض ، والأشعة السينية للصدر ، واختبار فحص فحص غاما لفيروسات الانترفيرون ، و اختبار جلد السل إذا اعتبرت درجة عالية من الخطورة ، لذلك يجب اختبار كليهما قبل البدء في العلاج
Patients should be monitored for evidence of malabsorption, Serum B12 levels should be monitored in patients with ileal CD and in those with ileal resection
ينبغي مراقبة المرضى للحصول على أدلة لسوء الامتصاص وينبغي مراقبة مستويات B12 للذين يعانون من مرض الكرونز في الاثني عشر
ينبغي مراقبة المرضى للحصول على أدلة لسوء الامتصاص وينبغي مراقبة مستويات B12 للذين يعانون من مرض الكرونز في الاثني عشر
Patients on immunosuppressants and corticosteroids should receive routine evaluation and testing complications of the treatment.
المرضى الذين يأخذون مثبطات المناعة والستيرويدات يحتاجوتن لتقييم روتيني واختبار مضاعفات العلاج.
⬇️⬇️⬇️
المرضى الذين يأخذون مثبطات المناعة والستيرويدات يحتاجوتن لتقييم روتيني واختبار مضاعفات العلاج.
⬇️⬇️⬇️
Bone mineral densitometry scanning [DEXA]
should be considered in all patients with CD, due to the higher risk of osteoporosis.
ينبغي عمل اختبار DEXA للعظام في كل مرضى كرون بسبب خطورة الاصابة بهشاشة العظام
⬇️⬇️⬇️
should be considered in all patients with CD, due to the higher risk of osteoporosis.
ينبغي عمل اختبار DEXA للعظام في كل مرضى كرون بسبب خطورة الاصابة بهشاشة العظام
⬇️⬇️⬇️
Patients at high risk fall into two groups as follows:
1-Patients<65years of age,receiving prolonged courses of corticosteroids>3 months per year
2-Patients who have continuing active disease, are underweight BMI<20 kg/m2,over 75years of age, or with weight loss>10% from baseline
1-Patients<65years of age,receiving prolonged courses of corticosteroids>3 months per year
2-Patients who have continuing active disease, are underweight BMI<20 kg/m2,over 75years of age, or with weight loss>10% from baseline
من لايشكر الناس لايشكر الله حابين نقدم شكر من فريق جرعة ترياق لـ:
هيفاء@antihifaz
الاشراف على المحتوى العلمي وتخطيطه وكتابة محاور الموضوع :
بقيادة
@drantisaad د سعد
ونائبيه :
١- @morooj_3 د مروج
٢-@heroxide د خزنه سعد
هيفاء@antihifaz
الاشراف على المحتوى العلمي وتخطيطه وكتابة محاور الموضوع :
بقيادة
@drantisaad د سعد
ونائبيه :
١- @morooj_3 د مروج
٢-@heroxide د خزنه سعد
من لايشكر الناس لايشكر الله حابين نقدم شكر من فريق جرعة ترياق لـ:
الليدر :
د.هيفاء@antihifaz
والاعضاء :
د.عبدالاله خالد@Phd_aBdulellah
د.فيصل @atorvastatin0
د.رانيا خالد @rania1997301
د.شروق المطيري@Shrooug___
د.سلطان مطلق @smu6laq
د.ساره حكمي@pharmdsarah123
الليدر :
د.هيفاء@antihifaz
والاعضاء :
د.عبدالاله خالد@Phd_aBdulellah
د.فيصل @atorvastatin0
د.رانيا خالد @rania1997301
د.شروق المطيري@Shrooug___
د.سلطان مطلق @smu6laq
د.ساره حكمي@pharmdsarah123
الاشراف على المحتوى العلمي وتخطيطه وكتابة محاور الموضوع :
بقيادة
@drantisaad د سعد
ونائبيه :
١- @morooj_3 د مروج
٢-@heroxide د خزنه سعد
بقيادة
@drantisaad د سعد
ونائبيه :
١- @morooj_3 د مروج
٢-@heroxide د خزنه سعد
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