At the completion of this chapter, the learner will be able to:

Section 1: Crohn's Disease
1.0 Define Crohn's disease.
1.1 Explain the pathology of Crohn's disease.
1.2 Identify the anatomic distribution of Crohn's disease.
1.3 Describe the epidemiology of Crohn's disease throughout the world.
1.4 Explain the etiology of Crohn's disease.
1.5 Describe the clinical features of Crohn's disease.
1.6 Discuss the following complications as related to Crohn's disease:

      1.6.1 Small bowel obstruction
      1.6.2 Fistulas and fissures
      1.6.3 Perforation
      1.6.4 Gastrointestinal blood loss
      1.6.5 Malignant neoplasms
      1.6.6 Extraintestinal manifestations
1.7 Describe the diagnosis process for Crohn's disease, including the
      following:

      1.7.1 Laboratory investigations
      1.7.2 Radiologic findings
      1.7.3 Histologic examination
1.8 Explain treatment therapy for Crohn's disease, including the following:

      1.8.1 Supportive therapy
      1.8.2 Nutritional therapy
      1.8.3 Drug therapy
            1.8.3.1 Corticosteroids
            1.8.3.2 Mesalamine
            1.8.3.3 Immunosuppressive agents
            1.8.3.4 Metronidazole
      1.8.4 Surgical treatment
      1.8.5 Treatment for maintenance or remission of inactive Crohn's
               disease
      1.8.6 New therapeutic approaches

Section 2: Ulcerative Colitis
2.0 Define ulcerative colitis.
2.1 Explain the pathophysiology of ulcerative colitis.
2.2 Identify the clinical features of ulcerative colitis, including the
      following:

      2.2.1 Severe ulcerative colitis
      2.2.2 Moderate ulcerative colitis
      2.3.2 Mild ulcerative colitis
2.3 Describe the diagnosis process for ulcerative colitis, including the
      following:

      2.3.1 Physical examination
      2.3.2 Laboratory investigations
      2.3.3 Endoscopic findings
      2.3.4 Radiologic findings
2.4 Describe the method for distinguishing between ulcerative colitis and
      Crohn's disease of the colon (Crohn's colitis).

2.5 Discuss therapy for ulcerative colitis, including the following:

      2.5.1 Reasons for hospitalization
      2.5.2 Supportive therapy
      2.5.3 Nutritional therapy
      2.5.4 Drug therapy
            2.5.4.1 Corticosteroids
            2.5.4.2 Mesalamine derivatives
            2.5.4.3 Immunosuppressive agents
            2.5.4.4 Metronidazole
      2.5.5 Surgical therapy
2.6 Describe the following complications as related to ulcerative colitis:
      2.6.1 Minor local complications
      2.6.2 Major local complications
            2.6.2.1 Toxic megacolon
            2.6.2.2 Cancer of the colon
            2.6.2.3 Colonic stricture
            2.6.2.4 Massive colonic hemorrhage
      2.6.3 Systemic complications
            2.6.3.1 Hepatocellular disease
            2.6.3.2 Hematologic abnormalities
            2.6.3.3 Joint manifestations
            2.6.3.4 Skin manifestations
            2.6.3.5 Ocular manifestations

LEARNER WORKBOOK

EXERCISE 1
1.1 What is Crohn's disease?

      Answer (section 1, p306)  

1.2 Briefly describe the pathology of Crohn's disease.

      Answer (section 1.1, p306-307)  

1.3 Patients' with Crohn's disease can be divided into three categories.
      What are these and what is the percentage of occurrence for each?

      Answer (section 1.2, p307-308)  

1.4 What are the clinical features of Crohn's disease?

      Answer (section 1.5, p309-310)  

1.5 List five mechanisms responsible for malabsorption and malnutrition in
      Crohn's disease.

      Answer (table 3, p310)  

1.6 Briefly describe five complications associated with Crohn's disease.

      Answer (section 1.6, p312-314)  

1.7 How is Crohn's disease diagnosed? Briefly discuss differential
      diagnosis, laboratory investigations, radiologic findings, and histologic
      examination.

      Answer (section 1.7, p314-316)  

1.8 Briefly discuss drug therapy for Crohn's disease, including the following:

      1.8.1 Corticosteroids
      1.8.2 Mesalamine
      1.8.3 Immunosuppressive agents
      1.8.4 Metronidazole

      Answer (section 1.8, p319-321)

EXERCISE 2
2.1 What is ulcerative colitis?

      Answer (section 2, p323)  

2.2 Briefly describe the pathophysiology of ulcerative colitis.

      Answer (section 2.1, p323-324)  

2.3 What are the clinical features of ulcerative colitis?

      Answer (section 2.2, p324-325)  

2.4 Ulcerative colitis can be classified according to grade of clinical
      severity: severe, moderate, or mild. Briefly discuss each.

      Answer (section 2.2, p325-327)  

2.5 Complete the following table :

Endoscopic grading of activity in ulcerative colitis:
Activity	Appearance
Quiescent
Mildly active
Moderately active
Severe

      Answer (table 8, p328)  

2.6 What are the indications for colonoscopy?

      Answer (table 9, p329)  

2.7 Describe the method for distinguishing between ulcerative colitis and
      Crohn's disease of the colon.

      Answer (table 11, p333)  

2.8 List three reasons for hospitalization of a patient with ulcerative colitis.

      Answer (section 2.5.1, p330, 333)  

2.9 Briefly discuss drug therapy for ulcerative colitis, including the following:

      2.9.1 Corticosteroids
      2.9.2 Mesalamine derivatives
      2.9.3 Immunosuppressive agents

       Answer (section 2.5.4, p334-337)

2.10 Distinguish between minor local and major local complications in
       ulcerative colitis.

        Answer (section 2.6, p338-342)