Crohns Disease: ICM-9CM Code 555.9 Crohns Disease, Unspecified 555.0 Crohns Disease, Small Intestine 555.

1 Crohns Disease Involving Large Intestine 1. May Affect Any Level Of The GI Tract From Mouth To Anus 2. Epidemiology: A. High USA, Great Britian And Scandinavia B. Low In Africa And Asia C. 3-5/100, 000 Population D. Any Age E. Peak Incidence : 2nd-3rd Decade And 6th-7th Decade F. Females Slightly More Than Males G. Whites Five Fold Greater Incidence H. Jewish Population More Than Non Jewish Population 3. Pathology: A. Transmural Inflammation B. Leather Pipe Like Structure C. Non-Caseating Granulomas D Fistulas To Bladder, Intestines, Gyn Tract , Skin Etc E. Skip Lesions F. Fistulas And Sinus Tract Formation G. Crypt Abcesses

4. Clinical: A. Diarrhea B. Crampy Abdominal Pain C. Fever : Days To Weeks D. Melena In 50% Of Cases With Colonic Involvement E. Melena May Be Mild Or Massive 5. Course: A. Remits Spontaneously At Times B. Intervals Between Attacks May Shorten. C. Symptom Free Intervals May Persist For Decades Following Diagnosis D. Some : Active Continuous Disease Following Diagnosis E. Course May Fluctuate Between Years Of Remission And Years Of Relapse 6. Debilitating Consequences Of CD: A. Fistulas To Loops Of Bowel, Bladder,Vagina, Perianal Skin B. Abdominal Abscesses And Peritonitis C. Intestinal Strictures With Obstruction Causing Need For Surgery 7. Extraintestinal Manifestations: A. Iritis, Uveitis B. Migratory Polyarthritis C. Erythema Nodosum D. Hepatic Pericholangitis E. Sclerosing Cholangitis F. Obstructive Nephropathy And Nephrolithiasis G. Predisposition To UTIs. H. Systemic Amyloidosis (Rare And Late)

8. Rx: A. Medical: 1. Sufasalazine 500 mg PO QID Initially, Increased QD By 1 gram Until Therapeutic Dosages Are Reached At 4-6 Grams /Day 2. Mesalamine (Asacol or Rowasa): PO A. Are As Effective As Sulfasalazine Esp In Sulfa Allergic Patients 3. Corticosteroids: A. Prednisone 40-60 mg PO / Day 1.Taper In Approximately 2-3 Months 4. Immunosuppresants: A. Azathioprine ( Imuran) 150 mg/PO OD B. Methotrexate C. Cyclosporine 5. Metronidazole (Flagyl) 50 mg PO QID for Diarrhea 6. Remicade (Infliximab) Tumor Necrosis Factor-Alpha Antibody 7. Natalizumab : Selective Adhesion Molecule Inhibitor 8. Hydrocortisone Enema: (CortEnema) 9. Chronic Rx: 1. Monitor Activity With Symptom Review And Laboratory Tests CBC And Sedimentation Rate 2. Liver Function Tests And Vitamin B12 Levels Once Yearly 3. Surgical Referral For Complications: A. Abscess Formation B. Obstruction C. Fistulas D. Toxic Megacolon E. Refractory Disease F. Severe Hemorrhage 4. Multiple Surgeries Can Result In Short Bowel Syndrome