By F. Ernesto. Goucher College. 2019.

Hypertrophic obstructive cardiomyopathy: This hereditary lesion has an auto- somal dominant pattern and patients have positive family history of the same disorder or a history of sudden death propranolol 40mg line. Children with this disorder have a harsh systolic ejection murmur that is exaggerated with standing up or performing Valsalva maneuver propranolol 80 mg fast delivery. Echocardiogram is the study of choice to evaluate this condi- tion order propranolol with a mastercard, referral to a pediatric cardiologist should be done to evaluate patient and his/ her family order on line propranolol. Case Scenarios Case 1 History: A 14-year-old girl previously healthy comes to your office complaining of chest pain that started 6 months ago. Pain lasts for few seconds, sometimes related with exercise but without difficulty in breathing. Medical attention was sought due to chest pain and desire to join school’s basketball team. Physical exam: Vital signs are within normal limits, physical examination is normal except for tenderness when palpating the left 3, -4, -5 costochondral junctions. Diagnosis: History and the physical examination are highly suggestive of costo- chondritis. The nature of pain, lack of any significant findings through history and physical examination and the ability to induce chest pain while pressing on affected costochondral junctions point to the diagnosis of costochondritis. Treatment: Reassurance that the pain is benign and is not related to the heart is essential. Pain and inflammation of the affected costochondral junction can be eliminated through a 5–7 days course of nonsteroidal anti-inflammatory agent such 420 I. Case 2 History: A 6-year-old boy presents to the emergency room with a 1 day history of severe chest pain localize to the left side of the chest. The mother states that the child was noted to have fever and decrease in appetite of 1 day duration. Past medical history is significant for surgical repair of sinus venosus atrial septal defect 2 weeks ago. Surgical repair was uneventful and the child was discharged home 4 days after surgery in stable condition. Vital signs dem- onstrate rapid respiratory and heart rates, normal oxygen saturation and normal blood pressure measurements. Diagnosis: the past medical history and finding of friction rub is suggestive of pericarditis. The cause of pericarditis and chest pain in this child is post-pericardiotomy or Dressler’s syndrome. Treatment: In view of the small volume of pericardial effusion, compromise of cardiac output is not a present concern. If pericardial effusion continues to enlarge despite medical therapy then pericardiocentesis can be used to remove pericardial fluid. Chapter 36 Innocent Heart Murmurs Ra-id Abdulla Key Facts • Innocent heart murmurs are encountered in 50% of all children. Instead, mild turbulence of blood flow, combined with the rapid heart rate and thin chest wall in children allow nor- mal blood flow through normal cardiovascular structures to be audible. Heart murmurs resolve spontaneously as child grows older with slower heart rate and thicker chest wall. Narrowing of passageways of blood results in turbulence which is characterized by eddies or recirculation. Eddies produces vibrations which can be heard through auscultation and in severe cases palpable as a thrill. On the other hand, laminar flow of blood is relatively silent and not audible through auscultation. Narrowing of blood vessels or cardiac valves results in rapid change (drop) in pressure, also referred to as pressure gradient, this causes fluid to accelerate which in turn results in eddies or recirculation phenomenon. Eddies produce the vibrations which result in murmurs or when significant a thrill which can be felt by hand through palpation. Types of Innocent Heart Murmurs Innocent heart murmurs are defined by the cardiac structure producing the murmur. Different types of innocent heart murmurs are caused by different physiological processes (Table 36. When examining a child with a heart murmur features of pathological murmurs should be carefully examined to rule out presence of con- genital heart disease (Table 36. Heart murmurs conforming to any type of inno- cent heart murmurs do not necessarily require referral to a pediatric cardiologist. On the other hand, lack of clarity of the nature of the murmur examined or in the presence of any feature that may indicate that the murmur is pathological in nature, referral to a pediatric cardiologist for further evaluation is necessary (Table 36. History or physical examination consistent with pathological murmur History of frequent respiratory infections or history of atypical reactive airway disease Patients with syndromes which may be associated with heart diseases such as trisomy 21, Turner syndrome, Noonan syndrome, William’s syndrome Family history of congenital heart disease Change in nature of murmur, such as becoming louder, or becoming systolic and diastolic Evidence of cardiac disease by chest X-ray or electrocardiography Peripheral Pulmonary Stenosis This is the most common type of innocent heart murmurs in newborn children and infants younger than 2 months of age. Turbulent blood flow in relatively small peripheral pulmonary arteries cause this type of innocent heart murmur. The pulmonary arteries while in-utero carry small volume of blood to the collapsed lungs. Approximately 5–10% of blood ejected from the right ventricle travels through the pulmonary circulation; while the majority of blood ejected from the right ventricle crosses the patent ductus arteriosus to supply blood to the descending aorta. Immediately after birth the entire right ventricular output is ejected to the right and left pulmonary arteries, thus increasing blood flow through each pulmonary artery by approximately sevenfold. This will result in relative stenosis of these normal pulmonary arteries which require approximately 6–8 weeks to reach a size suitable for this increase in blood flow thus resulting in elimination of this innocent heart murmur by 6–8 weeks of age. The murmur is systolic ejection in type, typically 1–2/6 in intensity, although it may be as loud as 3/6. The murmur is best heard over the left upper sternal border with radiation into one or both axillae. Physiologic Pulmonary Flow Murmur Blood flow through the pulmonary valve may be audible in children due to relative hyper- dynamic status of blood circulation secondary to faster heart rate as well as thin chest wall allowing easier detection of normal blood flow through the pulmonary valve. This type of murmur is typically 1–2/6 in intensity and occasionally as loud as 3/6. The murmur is heard best over the left upper sternal border in supine position and is significantly reduced in intensity or completely resolves when the child sits or stands up as well as with 424 Ra-id Abdulla Valsalva maneuver due to reduction in blood volume returning to the chest (decrease in pre-load). Stills Murmur Stills murmur is similar to physiologic pulmonary flow murmur, but in this case the murmur is due to blood flow across the aortic valve. The murmur is due to relative hyper- dynamic status of blood circulation secondary to faster heart rate as well as thin chest wall allowing easier detection of normal blood flow through a normal aortic valve. This type of murmur is typically 1–2/6 in intensity and occasionally as loud as 3/6. The murmur is heard best over the right upper sternal border in supine position and is significantly reduced in intensity or completely resolves when the child sits or stands up as well as with Valsalva maneuver due to reduction in blood volume returning to the chest (decrease in pre-load). Venous Hum This is a soft continuous murmur heard over the lateral aspect of the neck generated by blood flow in the internal jugular vein. The close proximity of the internal jugu- lar vein to the skin allows normal blood flow to be heard through auscultation even though there is no significant turbulence. Venous hum is soft, typically 1–2/6 in intensity and heard throughout systole and most diastole. An important distinction between venous hum and murmur produced by a patent ductus arteriosus or collateral vessels include the following: – Intensity: Venous hum murmur is soft, while that of patent ductus arteriosus is harsh. Mammary Soufflé This murmur is caused by engorged arteries in the breasts due to rapid growth such as seen during pregnancy or adolescence. The murmur is systolic or continuous and heard over a wide area over the anterior chest. These murmurs tend to be 1–2/6 in intensity and do not change with Valsalva maneuver or patient’s position. The child is thriving well with no significant medical problems except for reactive airway disease with occasional need for albuterol inhalation. Physical examination: Heart rate was 100 bpm, regular, respiratory rate was 30/min and blood pressure in the right upper extremity was 90/55 mmHg. Child appeared in no respiratory distress, mucosa was pink with good peripheral pulses and perfu- sion. Palpation of the precordium reveals normal location and intensity of the left ventricle and right ventricle impulses.

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3 purchase propranolol 40mg on line. Heat labile antibody to wheat starch in sera of wheat sensitive patients buy propranolol without prescription. The role of particulate insoluble substances in food allergy purchase propranolol 80mg line. (Abstract) National Institutes of Health Consensus Development Conference on Celiac Disease Program & Abstracts generic 80mg propranolol visa, pp. 91-95. Immunoanalytical detection of allergenic proteins in food. Grains in relation to celiac disease. Grains in Relation to Celiac (Coeliac) Disease. Toxic cereal grains in coeliac disease IN: Gastrointestinal immunology and gluten-sensitive disease. Overview and pathogenesis of celiac disease. Anaphylaxis in a milk-allergic child after ingestion of milk-contaminated kosher-pareve-labeled "dairy-free" dessert. An evaluation of the sensitivity of subjects with peanut allergy to very low doses of peanut protein: A randomized, double-blind, placebo-controlled food challenge study. A double-blind placebo-controlled study in milk allergic children. A sandwich enzyme-linked immunosorbent assay for the detection of almonds in foods. Double-blind placebo-controlled food challenge studies of fish allergic adults. Rising prevalence of allergy to peanut in children: data from 2 sequential cohorts. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States. Celiac disease-how to handle a clinical chameleon. The hazards of kissing when you are food allergic. Hypersensitivity reactions to Crustacea and mollusks. Use of the indirect competitive ELISA for the detection of Brazil nut in food products. Evaluation of a gliadin-containing gluten-free product in coeliac patients. Celiac disease as a cause of growth retardation in childhood. Risk of non-Hodgkin lymphoma in celiac disease. Catassi C., Bearzi, I., Holmes, G. (2005a) Association of celiac disease and intestinal lymphomas and other cancers. Relationship between oral challenges with previously uningested egg and egg-specific IgE antibodies and skin prick tests in infants with food allergy. Scientific criteria and the selection of allergenic foods for product labeling. Antigenicity of the proteins in soy lecithin and soy oil in soybean allergy. Inter-laboratory evaluation studies for development of notified ELISA methods for allergic substances (wheat). Also, the law does not define the term "gluten-free. These limitations would lead to a very high level of uncertainty associated with models designed to predict the health effects of gluten in the diet. However, it is likely that a threshold based on wheat gluten would be protective for individuals susceptible to oat gluten. An overall uncertainty factor should be estimated from the data and applied to the LOAEL to establish a threshold for gluten. Nevertheless, it is unlikely that theses individuals are substantially more sensitive to oat gluten than they are to wheat gluten. Conversely, there appears to be only a small degree of uncertainty as to whether the most sensitive celiac disease populations were included in the available clinical trials since most of the participants had evidence of disease. The uncertainty associated with gluten thresholds arises primarily from the limited amount of clinical data. We have identified several data gaps for gluten that contribute to current uncertainty about setting gluten thresholds. At the time of this report, the lower limits of detection for the commercially available gluten test kits are in the range of 10 µg gluten/g of food, and the ability to robustly quantify samples is in the range of 20 µg gluten/g of food. Preliminary results indicate that daily consumption of both 10 mg and 50 mg of dietary gluten were well tolerated after three months of continuous consumption, but that minimal histological changes were seen in patients consuming 50 mg of gluten daily. As with food allergens, it is likely there will be significant scientific advances in the near future that will address a number of the limitations identified in this report. The feasibility of using each of the four methods to establish a threshold for gluten was evaluated in light of the available data. The storage proteins in cereal grains (generally referred to as gluten) include both prolamin proteins (gliadins) and glutelin proteins (glutenins). 3. Are extraction methods available for both raw and baked foods? The limit of detection and the limit of quantitation should be below the levels that appear to cause biological responses in most patients with celiac disease. Intestinal mucosal inflammation may occur long before the development of clinical signs or a rise in antibody titers following a gluten challenge. Rather, evidence of intestinal mucosal inflammation is the gold standard biomarker for diagnosis of celiac disease and for assessment of disease severity. Both acute and chronic morbidity have been well documented for individuals with symptomatic celiac disease. However, carrying these alleles does not necessarily lead to celiac disease. Susceptibility to celiac disease is genetically determined and is linked to the presence of the DQ2 or DQ8 HLA alleles. A threshold, if established, could be the basis for decisions on whether to use the term "gluten-free" on product labels. This section provides an evaluation of the available data to support various approaches for establishing a threshold for gluten. The law neither describes how gluten-free should be defined nor states whether there is a safe level of gluten. Based on the data that are currently available and estimates of the amount of oil consumed as a food or food ingredient, it is likely that a threshold based on this approach would be unnecessarily protective of public health. Because not all the eight major food allergens are used to produce highly refined oil, the use of a statutorily-derived threshold for all food allergens would be based primarily on the protein levels in highly refined soy or peanut oil. The combined mean protein concentration for the two most widely used oils derived from food allergens, soy and peanut, is 0.74 µg/ml with a standard deviation (std) of 1.3 µg/ml. There are surprisingly few data available in the published scientific literature reporting on the levels of proteins in highly refined oils. As discussed above, an allergen threshold could be extrapolated from a statutory exemption established by Congress for another purpose, such as the FALCPA exemption for "highly refined oils." Thus, a threshold could be established for all food allergen proteins based on the level of protein in highly refined oils. Finding 4. Of the four approaches described, the quantitative risk assessment-based approach provides the strongest, most transparent scientific analyses to establish thresholds for the major food allergens. No consensus has been reached regarding the most appropriate mathematical model to use for analyzing allergen reaction data. If it is not feasible to establish individual thresholds, a single threshold based on the most potent food allergens should be established. If this approach is employed, the LOAEL or NOAEL determinations used should be based on evidence of the "initial objective sign." Individual thresholds should be established for each of the major food allergens. In Table IV-6, we use peanuts, widely considered to be among the most potent food allergens, to illustrate how specific uncertainty factors may be developed for use in a safety assessment-based approach to set a threshold if that approach is adopted. For peanuts, one of the few food allergens for which NOAEL values are available, the LOAELs for objective signs are approximately 2 to 3 fold greater than the NOAELs.

The condition is usually seasonal and is associated with hay fever order propranolol 80mg fast delivery. If your teddy bear youngster begins to behave more like a grizzly order generic propranolol online, it could be a reaction to antihistamine medications propranolol 80mg mastercard. The tips below may help to reduce your exposure to pollen cheap generic propranolol uk. In most cases, the negative impact can be reduced with treatment. In some cases, you may be referred for allergy testing. Bacterial pink eye: Symptoms include a thick, often yellow-green discharge that lasts all day (usually not with a cold or flu). Know the symptoms of different kinds of pink eye. You might need antibiotic eye drops and ointments for bacterial pink eye if: This kind of pink eye gets better when you avoid the things that are causing the allergy. Pink eye can be caused by a virus, an allergy, or bacteria. Doctors often prescribe antibiotic eye drops or ointments for pink eye. They may be itchy and teary, with a watery discharge, and swollen, crusty eyelids. The eyes are pink because they are infected or irritated. Pink eye is a common condition, especially in children. Many other others, including over-the-counter medicines (those you can buy without a prescription), also can cause allergic reactions. Insect allergy For most kids, being stung by an insect means swelling, redness, and itching at the site of the bite. The tendency to develop allergies is often hereditary, which means it can be passed down through genes from parents to their kids. Surgery - If your watery eyes are significantly impacting your life, we may recommend surgery to clear/create drainage ducts. Eyes that water can make it difficult to see. Lubricating eye drops - If the sensation is caused by dry eye, you may find lubricating eye drops provide relief (albeit temporarily). This sensation may abate somewhat with your eyes closed, though it usually persists regardless. We all know the uncomfortable stinging or burning sensation that comes with irritated eyes. You can minimize the impact of your seasonal allergies by: For a severe allergic reaction (anaphylaxis), call 911 or your local emergency number or seek emergency medical help. Some types of allergies, including allergies to foods and insect stings, can trigger a severe reaction known as anaphylaxis. In some severe cases, allergies can trigger a life-threatening reaction known as anaphylaxis. Allergic reactions can range from mild to severe. In some cases, these symptoms might be accompanied by a runny nose, congestion, or sneezing. This would appear to indicate that there is a need for increased awareness among asthmatic subjects of the potential for these drinks to trigger asthma. PubMed Google Scholar See all References few studies have specifically addressed the role of alcoholic drinks in these responses. It is nevertheless possible that a common pathway exists between aspirin sensitivity and wine sensitivity. However, the relatively short duration of asthmatic responses among the majority of wine-sensitive asthmatic subjects argues against a major role for these chemicals, with asthmatic responses to salicylate-containing medicines generally being longer in duration. The sulfite additives that have been associated with the triggering of asthmatic responses in susceptible individuals 14 x14Simon, R. Sulfite sensitivity. A recent study addressing the use of alternative practitioners in Australia found that individuals using these services were more likely to have a higher alcohol intake. Whether subjects with wine-induced asthma are more likely to visit alternative health practitioners or whether individuals visiting these practitioners are more likely to report wine-induced asthmatic responses is not known. Similarly, the significance of the association between wine-induced asthma and prior consultation with alternative health practitioners for asthma management is not clear but certainly raises other possible interpretations of the self-reported nature of the data. There was, however, a preponderance of women (72.7%) in our study compared with a preponderance of men (63.1%) in the Ayres and Clark 3 x3Ayres, JG and Clark, TJH. Google Scholar See all References and the prevalence of nasal polyps (16.1%), 13 x13Larsen, K. The clinical relationship of nasal polyps to asthma. PubMed Google Scholar See all References , 10 x10Klatsky, AL, Armstrong, MA, and Friedman, GD. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Although the effect of alcoholic drinks on a number of health outcomes is well documented, 9 x9Klatsky, AL. The cardiovascular effects of alcohol. Table VVariables significantly and independently associated with wine-induced asthma (stepwise logistic regression analysis) Response rate and allergic and asthmatic characteristics of subjects. Logistic regression analysis was used to analyze the association between wine-induced asthma and variables relating to both demographics and asthma disease staThis. Chi-squared tests were used to investigate associations between binary variables in this study. Self-assessment of asthma severity was scored as follows: mild, 1; moderate, 2; severe, 3; and very severe, 4. The 3 individual severity scores were averaged for each patient. The first of these addressed the number of asthma attacks experienced, the second addressed the number of times a general practitioner or specialist had been seen for asthma symptoms, and the third involved a self-assessment of asthma severity. This assessment of sulfite sensitivity was based on the determination of reactivity of asthmatic subjects to a panel of dried fruits and preserved vegetables, which were shown to possess consistently high levels of this additive. This new questionnaire also detailed the asthma characteristics of respondents and investigated the presence of other food and chemical sensitivities. In addition, there is little information regarding the characteristics of asthmatic responses to these drinks or the nature of sensitive individuals. Abstract Full Text PDF PubMed Scopus (5) Google Scholar See all References The specific components of alcoholic drinks to which individuals are sensitive, however, remain unknown. Abstract Full Text PDF PubMed Scopus (27) Google Scholar See all References Although alcohol itself seems to be associated with asthmatic responses in some individuals, 4 x4Shimoda, T, Kohn, S, Takao, A et al. Investigation of the mechanism of alcohol-induced bronchial asthma. Crossref PubMed Scopus (43) Google Scholar See all References However, the role of these drinks in triggering asthmatic responses has not been well described. Sensitivities of individuals to salicylates present in wines may also play a role. Wines were the most frequent triggers, with responses being rapid in onset (<1 hour) and of mild to moderate severity. The Department of Medicine, University of Western Australia and the Asthma and Allergy Research Institute, Western Australia Nedlands, Australia. Find out more about how SO2GO, wine preservative remover has helped our wine allergy sufferers, and can help you, on our Testimonials page See how you can enjoy a glass of preservative free wine, without the unpleasant side effects. By neutralising/lowering preservatives, we may prevent the nasty symptoms caused by wine sensitivities. As sensitivity varies from individual to individual the extent of the reaction will vary, but even our most sensitive customers confirm that SO2GO wine preservative remover , makes their morning after more manageable.

Women may experience some prolapse due to abdominal pressure purchase discount propranolol, but no increased risk to the pregnancy is encountered buy generic propranolol line. For those women who have had ileoanal pull-through procedures purchase propranolol 40 mg line, an increase in the number of bowel movements during pregnancy has been reported order cheap propranolol line, but no increased risk for pouchitis or delivery complications [53]. Several studies have found that there is an increased rate of Cesarean section after restorative procto- colectomy despite the fact that there have been no significant differences in pouch function following vaginal delivery [54, 55]. The mode of delivery should be determined by obstetrical considerations and not solely by the presence of an ileoanal pouch. This variation may be due to the heterogeneous nature of surgeries or underreporting of symptoms to physicians After ileoanal pull-through, one report found 15% incidence of dyspareunia, and an increase in menstrual problems [4]. In contrast, other studies have shown a decrease in dyspareunia and an increased frequency of intercourse, secondary to improve- ments in overall health [58]. Menopause Menopause, whether natural or surgical, leads to many physiologic changes in a woman’s body. The prevelance and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Influence of sex and disease on illness-related concerns in inflammatory bowel disease. The menstrual cycle and its effect on inflammatory bowel disease and irritable bowel syndrome: a prevalence study. Pattern of gastrointestinal and psychosomatic symptoms across the menstrual cycle in women with inflammatory bowel disease. A study of the menopause, smoking, and contraception in women with Crohn’s disease. Higher incidence of abnormal pap smears in women with inflam- matory bowel disease. European survey of fertility and pregnancy in women with Crohn’s disease: a case control study by European collaborative group. Pregnancy outcome for women with Crohn’s disease: a follow-up study based on linkage between national registries. Threefold increased risk of infertility: a meta- analysis of infertility after ileal pouch anal anastomosis in ulcerative colitis. Colectomy with ileorectal anastomosis presevers female fertility in ulcerative colitis. Risk of ulcerative colitis and Crohn’s disease among offspring of patients with chronic inflammatory bowel disease. Familial empirical risks for inflammatory bowel disease: differences between Jews and non-Jews. Increased risk of inflammatory bowel disease associated with oral contraceptive use. Lack of association between oral contraceptive use and Crohn’s disease: a community-based matched case-control study. Meta-analysis of the role of oral contraceptive agents in inflammatory bowel disease. Oral contraceptive use and the clinical course of Crohn’s disease: a prospective cohort study [see comments]. Oral contraceptive use and smoking are risk factors for relapse in Crohn’s disease. Disease activity in pregnant women with Crohn’s disease and birth outcomes: a regional Danish cohort study. The effects of inflammatory bowel disease on pregnancy: a case- con- trolled retrospective analysis. A study at 10 medical centers of the safety and efficacy of 48 flexible sigmoidoscopies and 8 colonoscopies during pregnancy with follow-up of fetal outcome and with comparison to control groups. Surgical resections in parous patients with distal ileal and colonic Crohn’s disease. Exposure to mesalamine during pregnancy increased preterm deliveries (but not birth defects) and decreased birth weight. The safety of mesalamine in human pregnancy: a prospective controlled cohort study. Foetal outcome in women with inflammatory bowel disease treated during pregnancy with oral mesalazine microgranules. The safety of 6-mer- captopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Azathioprine use during pregnancy: unexpected intrauterine exposure to metabolites. Therapeutic drug use in women with Crohn’s disease and birth outcomes: a Danish nationwide cohort study. Intentional infliximab use during pregnancy for induction or maintenance of remission in Crohn’s disease. Case report: evidence for transplacental transfer of maternally administered infliximab to the newborn. The effect of restorative proctocolec- tomy on sexual function, urinary function, fertility, pregnancy, and delivery: a systematic review. Female fertility and childbirth after ileal pouch- anal anastomosis for ulcerative colitis. Hormone replacement therapy after menopause is protective of disease activ- ity in women with inflammatory bowel disease. Mortele Introduction Evaluating the small bowel in patients with inflammatory bowel disease has been a significant challenge in the past. Its poor access via endoscopy has led to a signifi- cant reliance on radiology to diagnose and monitor disease progression. Traditionally, the radiological investigation of inflammatory bowel disease has been limited to gastrointestinal fluoroscopic contrast studies such as small bowel follow through and enteroclysis. The traditional planar views obtained by these luminal radio- graphic techniques are limited in the useful mural and extramural information that they provide. In addition, the inherent length of the small bowel with multiple over- lapping loops is a major obstacle for a purely projectional technique. Over the past decade, however, there have been several technical advances in radiology that have revolutionized the evaluation of the small bowel. There has been a shift in the emphasis of investigations to not only those that document anatomical information but also those that provide functional information regarding disease activity and response to therapy. Spatial resolution has been optimized with the continued development of multichannel phased array body coils. Accurate mapping of fistulas is crucial to prevent recurrence and sphincter damage. Radiology is now not only involved in the diagnosis of peria- nal disease but also being used to monitor therapy with new disease-modifying drugs such as infliximab. The use of radiology in inflammatory bowel disease is not restricted only to the bowel. Diagnostic imaging is being increasingly used to evaluate several of the extraintestinal manifestations. Magnetic resonance cholangiography provides a noninvasive evaluation of the biliary system without the inherent risks of endoscopic cholangiography. Investigations such as wireless capsule endoscopy and double balloon enteroscopy are tools that have been recently added to the gastroenterologist’s armamentarium. Although limited data currently exist on its performance, potential for wide spread application exists especially if minimal bowel preparation regimes can be developed. This chapter hopes to familiarize the reader with the current state-of-the-art radiological investigations available for the investigation of inflammatory bowel disease. The techniques, findings, performances, and limitations of the imaging modalities will be reviewed in order to provide a complete understanding. Crohn’s disease, however, is a transmural inflammatory process and requires an imaging modality that can diagnose disease involvement from the mucosa out to the mesentery. A volume of data is acquired, which can be reconstructed and displayed in multiple planes. The second major technological progression has been the develop- ment of neutral contrast agents.