2+ Crohn's Disease

Question 1

What are the extra-intestinal features of IBD?

Answer 1

Pyoderma gangrenosum
Erythema nodosum
Arthritis: pauciarticular and asymmetric
Ulcers
PSC (associated with UC)
Clubbing

Question 2

What is Crohn’s disease?

Answer 2

IBD of unknown aetiology characterised by transmural inflammation of the GI tract. It may involve any or all parts of the GI from mouth to perianal area although it is usually seen in the terminal ileal and perianal location

Question 3

What is the epidemiology of Crohn’s disease?

Answer 3

Onset is typically 20-40 or some in 50-60

Question 4

What are the microscopic features of crohn’s disease?

Answer 4

Inflammation in ALL layers from mucosa to serosa –> transmural inflammation

Increased goblet cells
Granulomas

Question 5

What are the macroscopic/endoscopic features of crohn’s disease?

Answer 5

Cobble-stone appearance (discrete deep ulcers transversely and longitudinally)

Skip lesions

Deep ulcers

Question 6

What are the radiological features of Crohn’s disease?

Answer 6

Strictures
Proximal bowel dilation
Rose thorn ulcers
Fistulae

Question 7

What is the clinical presentation of crohn’s disease?

Answer 7

Diarrhoea- usually non-bloddy
Weight loss more prominent
Abdominal pain (esp RLQ)
Perianal disease
Oral ulcers
Extra-intestinal features

Question 8

What are some common complications of Crohn’s?

Answer 8

Intestinal obstruction: small or colon
Anaemia: malabsorption, vitamin deficiencies and blood loss
Short-bowel syndrome: after a bowel resection or high intestinal fistula
Malignancy
Gallstones
Hepatic steatosis
Fistulae or sinuses

Question 9

What Ix do you do for Crohn’s disease?

Answer 9

• FBC: anaemia
• Iron studies; at risk of malabsorption/malnourishment, GI bleeding
• Serum B12; malabsorption
• Serum Folate: malabsorption
• CMP (Albumin, Calcium, Magnesium etc); malabsorption
• CRP: correlate with Crohn’s activity nlike UC
• Stool testing; check for C.diff
• Faecal calprotectin
• Abdominal X-Ray; not diagnostic but can help in assessing severity, checking for bowel loop distension suggestive of obstruction or checking for pneumoperitoneum
• Ileocolonoscopy: macroscopic features, can do a biopsy
• Capsule endoscopy if needed

Question 10

What is the goal of treatment with Crohn’s disease?

Answer 10

• Induce remission in active disease
• Maintain corticosteroid free remission and prevent relapse
• Achieve mucosal healing

Question 11

What is the induction therapy for Crohn’s disease?

Answer 11

Induction Therapy for Mild to Moderate Crohn’s
- PO Corticosteroids for 12 weeks: prednisolone
o If ileocaecal disease use budesonide

Induction Therapy for Severe Crohn’s:
- IV hydrocortisone, methylprednisolone

Question 12

What is the maintenance therapy for Crohn’s disease?

Answer 12

• Thiopurines: azathioprine, mercaptopurine
  o Add allopurinol if shunting is happening
• Methotrexate
• Biologicals: adalimumab, infliximab, ustekinumab

Question 13

What are the surgical options for Crohn’s disease?

Answer 13

Ileocaecal resection