6-Month Physical Examination for a Patient with Crohn's Disease, BPH, Hypogonadism, and Osteopenia
A comprehensive 6-month physical examination for a patient with Crohn's disease, BPH, hypogonadism, and osteopenia should include assessment of disease activity for all conditions, with particular focus on Crohn's disease symptoms, bone health parameters, testosterone levels, and urinary symptoms.
Crohn's Disease Assessment
Symptom Evaluation
- Use a standardized tool such as Harvey-Bradshaw Index (HBI) or Crohn's Disease Activity Index (CDAI) to objectively assess disease activity 1
- Document specific symptoms:
- Abdominal pain
- Diarrhea frequency
- Presence of blood in stool
- Abdominal bloating
- Weight changes
- Fatigue
- Fever
Laboratory Tests
- Complete blood count
- Liver profile
- Serum albumin
- Iron studies
- Renal function
- C-reactive protein (CRP)
- Fecal calprotectin or lactoferrin 1
- Vitamin B12 levels (especially with ileal involvement)
Additional Considerations
- If the patient has been on steroids, assess for steroid-related complications
- Evaluate nutritional status including weight, BMI, and dietary intake
- Check for extraintestinal manifestations (joint pain, eye problems, skin lesions)
Bone Health Assessment (Osteopenia)
Laboratory Tests
- Serum calcium and phosphate
- 25-hydroxyvitamin D level
- Parathyroid hormone (PTH) level
- Bone turnover markers (if available):
- Homocysteine levels (high levels strongly associated with osteoporosis in Crohn's disease) 3
Dietary and Lifestyle Assessment
- Calcium intake (aim for 1500 mg daily) 1
- Vitamin D supplementation
- Weight-bearing exercise habits
- Smoking and alcohol consumption 1
Hypogonadism Assessment
Laboratory Tests
- Total testosterone
- Free testosterone or free androgen index
- Gonadotropins (LH, FSH)
- Sex hormone binding globulin (SHBG)
Symptom Assessment
- Energy levels
- Libido
- Erectile function
- Mood changes
- Muscle mass/strength
Benign Prostatic Hyperplasia (BPH) Assessment
Symptom Assessment
- International Prostate Symptom Score (IPSS) questionnaire
- Urinary symptoms:
- Frequency
- Urgency
- Nocturia
- Hesitancy
- Weak stream
- Incomplete emptying
Physical Examination
- Digital rectal examination (DRE) to assess prostate size, consistency, and nodularity 1
- Focused neurological examination to assess sphincter tone 1
Laboratory Tests
- Urinalysis (dipstick or microscopic) to screen for hematuria and UTI 1
- PSA measurement (if patient has at least 10-year life expectancy or if results would change management) 1
General Physical Examination
- Vital signs (blood pressure, heart rate, temperature)
- Weight and BMI calculation
- Abdominal examination for tenderness, masses, organomegaly
- Perianal examination for fistulas, abscesses, or skin tags 1
- Oral examination for Crohn's-related lesions
- Joint examination for arthropathy
- Skin examination for extraintestinal manifestations
- Peripheral edema assessment
Common Pitfalls to Avoid
Overlooking bone health: Patients with Crohn's disease have multiple risk factors for osteoporosis including inflammation, malabsorption, steroid use, and hypogonadism 4. Ensure comprehensive bone health assessment.
Attributing all symptoms to Crohn's disease: Symptoms like fatigue may be due to anemia, hypogonadism, or depression rather than active Crohn's disease.
Missing testosterone deficiency: Low testosterone is common in men with Crohn's disease and can contribute to osteopenia 5. Regular monitoring is essential.
Neglecting medication side effects: Review all medications for potential side effects and drug interactions.
Inadequate monitoring of disease activity: Relying solely on symptoms without objective markers (CRP, fecal calprotectin) may miss subclinical inflammation 1.
By systematically addressing each condition at the 6-month visit, you can effectively monitor disease activity, adjust treatments as needed, and prevent complications across all four health conditions.