2.8// Crohn's Complications Flashcards
What is Crohn’s disease?
Crohn’s disease is a long-term condition that causes inflammation of the lining of the digestive system.
Inflammation can affect any part of the digestive system, from the mouth to the back passage. But it mostly occurs in the last section of the small intestine (ileum) or the large intestine (colon).
Crohn’s disease can affect people of all ages, but it’s usually diagnosed between the age of 15 and 40.
What are the symptoms of Crohn’s disease?
The symptoms of Crohn’s disease vary. They depend on which part of the digestive system is inflamed.
Common symptoms include:
Recurring diarrhoea
Abdominal pain and cramping, which is usually worse after eating
Extreme tiredness (fatigue)
unintended weight loss
Blood and mucus in your poo
You may have long periods without symptoms, or very mild symptoms. This is known as remission. This may be followed by periods where the symptoms are particularly troublesome. These are known as flare-ups or relapses.
Less common symptoms include:
a high temperature of 38°C or above
feeling sick (nausea)
being sick (vomiting)
joint pain and swelling (arthritis)
inflammation and irritation of the eyes (uveitis)
areas of painful, red and swollen skin – most often the legs
Mouth ulcers
Anal pain and discharge due to perianal Crohn’s
Children with Crohn’s disease may grow at a slower rate than expected
When should you speak to your GP practice?
Diarrhoea for more than 7 days
Persistent abdominal pain
Unexplained weight loss
Blood in your poo
Concern about your child’s development
What are causes of Crohn’s?
The exact cause of Crohn’s disease is unknown.
A combination of factors may be responsible, including:
genetics – genes you inherit from your parents
a problem with the immune system (the body’s defence against infection and illness) – where it attacks healthy bacteria in the gut and causes inflammation
environmental factors – like air pollution, medication or previous infections
smoking – smokers are twice as likely to develop Crohn’s disease, and usually have more severe symptoms than non-smokers
What will your GP ask you if you are suspected of Crohn’s?
your pattern of symptoms
your diet
any recent travel – for example, you may have developed travellers’ diarrhoea
whether you’re taking any medication, including any over-the-counter medicines
whether anyone else in your family has any bowel conditions
What tests will the GP do to check your general health?
check your pulse
check your blood pressure
measure your height and weight
measure your temperature
examine your abdomen (tummy)
Your GP may also:
- Arrange blood tests to check for inflammation, infection and anaemia
- Ask for a stool (poo) sample to use a qFIT test to check for blood and mucus, infection or inflammation via a faecal calprotectin test
Who may you be referred to?
gastroenterologist
What tests may the gastroenterologist recommend?
gastroscopy – a thin flexible tube with a camera is put into your mouth to look at your food pipe and stomach
colonoscopy – a thin, flexible tube with a camera is put into your bottom to look at the whole of your large bowel
sigmoidoscopy – a thin, flexible tube with a camera is put into your bottom to look at the end of your large bowel
a colon capsule endoscopy (pill camera)
X-ray or barium enema
MRI scan or CT scan
What is the treatment for Crohn’s?
There’s currently no cure for Crohn’s disease, but treatment can improve the symptoms and keep the inflammation under control.
Your treatment will usually be provided by a range of healthcare professionals.
Once your symptoms are under control, you are likely to be offered treatment to help keep them under control. If your Crohn’s stays under control for a long time, you may choose to stop treatment. You may need to start again if your symptoms come back.
What is the first treatment offered for Crohn’s?
The first treatment offered is usually steroids, such as prednisolone or budesonide (corticosteroids) to reduce inflammation quickly.
Steroids are often effective in reducing your symptoms. But they can have significant side effects. So they’re not suitable for long-term use and your dose will slowly be reduced when your symptoms start to improve
What medication may be given alongside steroids?
Medicines to suppress your immune system (immunosuppressants) may be given alongside steroids if your symptoms flare up twice or more during 12 months, or return when your steroid dose is reduced.
Common types include azathioprine, mercaptopurine and methotrexate.
What may be used if steroids and immunosuppressants aren’t working?
If steroids and immunosuppressants don’t help or aren’t right for you, biological therapies may be used.
Biological therapies block particular chemicals involved in the immune response, which helps reduce inflammation. They’re made using living cells in a lab. They can be given as a drip or an injection. Treatment usually lasts at least 12 months. Your inflammatory bowel disease (IBD) team will be able to discuss these with you.
Common types are adalimumab, infliximab, ustekinumab or vedolizumab.
What is the risk of biological therapies? (5)
There’s a risk that these medicines may cause side effects, which can cause symptoms such as:
itchy skin
a high temperature
joint and muscle pain
swelling of the hands or lips
problems swallowing
You should seek immediate medical help if you experience these symptoms. Reactions can occur immediately after treatment or months later, even after treatment stops.
What’s another option rather than medication to treat Crohn’s, and why may you consider it?
Surgery to treat Crohn’s disease may be an option if:
you choose to have surgery instead of taking medications that may cause side effects
medications don’t control your symptoms
your quality of life is severely affected by your condition
you have serious complications of Crohn’s disease
What will the surgery do?
Surgery might involve widening narrow parts of your bowel, or removing parts of it (resection).
Resection involves removing the inflamed area of the intestine.
If you have a resection, you might have the healthy sections of bowel joined back together. Or you might have the end of your small bowel joined to the skin of your tummy (an ileostomy or stoma). In this case, poo comes out of the opening on your tummy and is collected in special bags that you wear. An ileostomy might be temporary, to give your bowel time to heal, or it might be permanent.
your IBD team will tell you what surgery they recommend and let you know what to expect.
What are the recommendations when it comes to diet and Crohn’s?
There is no evidence that a particular diet causes or triggers flare-ups of Crohn’s disease. But alongside medications, some changes to your diet may help control symptoms for some people.
Do
- eat 5 to 6 small meals rather than 3 main meals
- try to eat a healthy, varied diet that includes a wide variety of fruit, vegetables, nuts, seeds, proteins and wholegrains
- drink plenty of water
What do your IBD team recommend when it comes to diet?
Do not make major changes to your diet without talking to your IBD team and make sure you are still getting all the nutrients you need. You can speak to your IBD team about:
keeping a food diary to find out if any particular foods affect your symptoms
removing trigger foods from your diet
taking a food supplement if you are struggling to get enough nutrients from your diet
being referred to a dietitian
What should you do about smoking when it comes to Crohn’s?
If you smoke, it is advised that you make every effort to stop smoking, especially if you need to have surgery.
If you smoke, smoking can make Crohn’s worse and is it important that you make every effort to stop smoking.
Does Crohn’s affect fertility?
A woman’s chance of becoming pregnant isn’t usually affected by Crohn’s disease.
However, surgery for Crohn’s disease might affect your fertility.
Most women with Crohn’s disease will have a normal pregnancy and a healthy baby. But if you’re pregnant or planning a pregnancy you should discuss it with your IBD team. This is because they may need to change your medication.
If you’re having a flare-up of Crohn’s disease you may also be advised to avoid getting pregnant until it’s under control.
What are some long-term complications of Crohn’s?
Over time, inflammation can damage sections of the digestive system. This can result in complications such as:
narrowing of the bowel (stricture)
a channel developing between your bowel and your skin, another section of bowel or a body organ (fistula)
These problems usually need surgical treatment.
What is SOCRATES for appendicitis?
site= migratory; starts umbilical, then RLQ (can vary dependent on the anatomical location)
character= usually consistent with intermittent cramps
symptoms= anorexia (common), nausea and vomiting, failure to pass flatus or stool, Rovsing’s sign
exacerbating= movement and coughing
severity= severe
What is Rovsing’s sign?
A positive Rovsing’s sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen
What is SOCRATES for small bowel obstruction?
site= umbilical
character= colicky and severe
associated symptoms= anorexia, nausea/ vomiting/ unable to pass stool and wind/ abdominal distention/ bloating
exacerbating factors= oral intake
severity= severe
What is SOCRATES for pancreatitis?
site= epigastric/ LUQ pain, radiating to the back
character= constant and severe
associated symptoms= nausea/ vomiting, anorexia, dyspnoea
exacerbating factors= worse on movement
severity= severe
What is Murphy’s sign?
Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area.
Which of these images is large and small bowel obstruction?
a= small
b= large
What may a small bowel obstruction x-ray look like?
Describe this image.
How do blood donations and who can give to who?
What is the positive and negative for blood donations?
Who is it especially important to look out for when it comes to positive and negative?
women who want children
also if given to a negative person, next time be careful
What is the difference between a colostomy and ileostomy?
colostomy is an operation that connects the colon to the abdominal wall, while an ileostomy connects the last part of the small intestine (ileum) to the abdominal wall
How does the renin-angiotensin system work?
