Case 15 Crohn's complications Flashcards by Chloe Tan

What are the symptoms of Crohn’s disease

fatigue
blood and mucus in stool
abdominal pain
diarrhoea
unintended weight loss

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What are the Causes of Crohn’s disease

genetics
smoking
environment - diseases of the west, children grow up germ free environment
immune system- TNF alpha, attack healthy bacteria
infection

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What questions would you ask in a history for Crohn’s disease

diet
recent travel
family hx
medications

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What blood tests would you need for diagnosis of Crohn’s

inflammation- CRP, ESR
Anaemia- FBC
Infection- WCC count

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What stool sample tests are needed for diagnosis of Crohn’s

Parasite
faecal calprotectin
Infections
Blood and mucus

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what imaging tests are used in the diagnosis of Crohn’s disease

MRI, CT
Barium swallow- small bowel enema
Colonoscopy- biopsy

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What tests are done in the examination in the diagnosis of Crohn’s disease

Pulse
BP
Height
Weight
Temp
Abdomen examination

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What is initial treatment of Crohn’s disease

Corticosteroids
- prednisolone
- hydrocortisone injections

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what is the additional treatment in Crohn’s disease

immunosuppressants
- azathioprine- safe for pregnancy
- methotrexate- not safe for pregnancy
- mercaptopurine

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what is the treatment for severe Crohn’s disease

Biological Therapies
- Infliximab (IV drip)
- Adalimumab (injection)
- both are against TNF alpha

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What are the two surgical options for Crohn’s disease

Resection- remove inflamed section
Ileostomy- Divert digestive waste away from inflamed colon

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What are less common symptoms of Crohn’s

High temp
nausea
Mouth ulcers
Areas of red swollen skin
vomiting
joint pain and swelling

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Where is the site of pain for
- Appendicitis
- small Bowel obstruction
-pancreatitis
- cholecystitis

umbilical, then RLQ

umbilical

LUQ, radiate to back

RUQ

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Where is the character of pain for
- Appendicitis
- small Bowel obstruction
-pancreatitis
- cholecystitis

consistent with intermittent cramps

colicky and severe

constant and severe

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what are the associated symptoms for
- Appendicitis
- small Bowel obstruction

Anorexia
nausea and vomiting
unable to pass flatus or stool

Rovsing sign for appendicitis
distension/bloating for SB obstruction

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what are the associated symptoms for
-pancreatitis
- cholecystitis

Nausea and vomiting

Anorexia and dyspnoea for pancreatitis
Murphys sign for cholecystitis

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What are the Exacerbating factors for
- Appendicitis
- small Bowel obstruction
-pancreatitis
- cholecystitis

Movement and coughing

oral intake

movement

fatty foods

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What is Rovsing’s Sign

Appendicitis
Press hand on LLQ, pain in RLQ
due to inflamed peritoneum

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What are the symptoms of bowel obstruction

Bloating
unable to pass flatus or stool
Colicky abdominal pain
nausea and vomiting
anorexia

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how do symptoms differ depending on where the obstruction is

if proximal, vomiting is more common
If distal, Constipation is more common

How does distention differ depending on where the obstruction is

Small bowel- central
Large bowel- peripheral

What are Causes of Small Bowel Obstruction

Adhesions
- scar from surgery
-Hernias
-Crohn’s

What is a main cause of Large Bowel Obstruction

Colon cancer

what are the risks of bowel Surgery

Infection
Blood clots- travel to leg, need blood thinners
Scar may not heal properly- hernia
damage to surrounding structures- spleen, bladder, ureter
bleeding
pain

What is the difference in a radiograph of small and large bowel obstruction in terms of its positioning?

Small bowel- central distention Large bowel- peripheral distention

What is the difference in a radiograph of small and large bowel obstruction in terms of its appearance

small Bowel -valvulae conniventes -go all the way through bowel -thinner than haustra large Bowel -finger like projections into lumen of LI -thicker than connective tissue in SI -don't go all the way through bowel -can see faeces

what is the 369 rule

to see the calibre of the bowel SI- Less than 3cm LI- less than 6 cm Caecum- less than 9cm

What are the physiological consequences of ileostomy

No water reabsorption in LB - water goes out through stoma Loss of electrolytes

Which part of bowel reabsorbs the most water and how much

small bowel 6L in jejunum 2.5L in ileum

what are three adaptations to change after ileostomy

Mucosal hyperplasia- enhanced absorption hypomobility- increases time for absorption Aldosterone upregulation -increase sodium reabsorption in SI, sodium retention in kidney

What are two ways to fix the bowel after resection

Stoma- bring end of bowel to skin anastomose two loose ends of bowel, but if inflamed this will not work

What are differences in stoma for ileostomy and colostomy for -site -content -appearance

Ileostomy - RLQ (generally) -has more digestive juices, liquid, acidic - therefore spout the stoma, more protruding so it does not irritate the skin Colostomy -LLQ -Faecal matter -closer to the skin

What is a stricture

narrowing of digestive tract due to chronic inflammation

What are the symptoms of a stricture

vomiting abdominal pain -cramping nausea constipation

what are the surgical treatments of a stricture

Strictureplasty -open narrowed section of bowel - most effective in jejunum and ileum, least effective in duodenum -avoids need to remove part of SI small bowel resection

What is a fistula

when ulcers or abcesses formed penetrate through an organ wall, creates a tunnel to drain pus

What are the symptoms for a SI and LI fistula

diarrhoea passage of undigested food

What are the symptoms for Intestinal and bladder fistula

UTI cloudy urine blood burning when peeing

What are the symptoms for Intestinal and skin fistula

bump/ boil that drains fluid and stool

What are the symptoms for Intestinal and vaginal fistula

passage of stool through vagina

what is first line treatment for fistula

Abx and medication

What happens when first line medication for fistula is unsuccessful

surgery - medical plug -medical glue -open up fistula to let it drain -seton- tube to drain infection -Ileostomy

What is the treatment for Anal Fistula

fistulostomy

What is an abcess

Collection of pus

How do you treat an abscess

Antibiotics drainage is sometimes needed to heal it fully

what are symptoms of an abcess

abdominal pain painful bowel movements discharge of pus from anus lump on the edge of the anus that is small red and tender fever

what is the procedure for removing an abcess

insert a tube leave it in for a week usually feel better within a couple of days

what questions are asked to a doctor about a surgery from a patient

Preparation for surgery complications of surgery restrictions post surgery supplies they need post surgery How long the recovery time will be how it affects their diet Why is this surgery recommended