# Crohn's disease **abdominal complications** - [[Bowel obstruction]] - fistulae - abscesses - perforation - malignancy **extra abdominal complications** - arthritis - amyloidosis - bile salt malabsorption (gallstones more common) - renal calculi - uveitis **management** - cease smoking - sulfasalazine - pred or mesalazine enemas for rectal symptoms - oral budesonide - resistant disease: - infliximab, adalimumab, or certolizumab # Ulcerative colitis - ashkenazi jews 3-5x ↑ incidence - acute exacerbations may be precipitated by infective agents and NSAIDs - smoking moderatly protective - appendictomy before age 20 reduces risk **complications** - toxic megacolon - perforation - haemorrhage / anaemia - electrolyte abnormalities - ↑ risk of carcinoma **extracolonic manifestations** - anaemia - sero negative arthritis (knees, ankles, wrists) - erythema nodosum - [[Eye infections#Episcleritis|Episcleritis]], iritis, [[Eye infections#Iritis / uveitis / choroiditis|uveitis]] - thromboembolic events - anterior uveitis and ankylosing spondyloitis in pts w/ HLA B27 *Toxic megacolon* - neuromuscular tone falls 2/2 inflammation - may be precipitated by hypomotility agents, barium enema, hypokamemia **management** - salicylates - mesalazine (better tolerated and as effective as sulfasalazine - rectal mesalazine 1g/day for mild-mod proctitis - oral 2.5/4.8 g/day for more extensive colitis - sulfasalazine 1-4g/day - steroids - enemas - pred 24-40 mg/day for acute exacerbations - immunosuppressants - azathioprine, infliximab needs regular screening for carcinoma of colon