Laboratory Tests

• Ulcerative colitis: Leukocytosis, decreased hematocrit/hemoglobin, elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), guaiac-positive stool, (+) perinuclear antineutrophil cytoplasmic antibodies (pANCA; up to 70% of patients)

• Crohn's disease: Leukocytosis, decreased hematocrit/hemoglobin, elevated ESR or CRP, guaiac-positive stool, (+) anti-Saccharomyces cerevisiae antibodies (up to 50% of patients), hypoalbuminemia with severe disease

Liver and biliary manifestations of IBD include an increased incidence of gallstone formation in patients with CD and development of sclerosing cholangitis or cholan-giocarcinoma in patients with UC. Patients with UC are also at increased risk for development of colorectal cancer. Ongoing inflammation due to active IBD may induce a hypercoagulable state, resulting in higher rates of both arterial and venous thromboembolism. Likewise, inflammation and recurrent blood loss may result in the development of chronic anemia. Patients with IBD also have higher rates of osteopenia, osteoporosis, and fractures, which are most strongly associated with use of corticost-17

eroids.

A serious complication of UC is toxic megacolon, defined as dilation of the transverse colon of greater than 6 cm (2.4 in.). Patients with toxic megacolon typically manifest systemic signs of severe inflammation such as fever, tachycardia, and ab-

3,13

dominal distention. ' Surgical intervention, including colonic resection, may be necessary to acutely manage toxic megacolon.

Formation of strictures, abscesses, fistulae, and obstructions in patients with CD is possible. Patients with CD may develop significant weight loss or nutritional deficiencies secondary to malabsorption of nutrients in the small intestine, or as a conse quence of multiple small- or large-bowel resections. Common nutritional deficiencies encountered in IBD include vitamin B12 fat-soluble vitamins, zinc, folate, and iron. Malabsorption in children with CD may contribute to significant reductions in growth and development.

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