Chapter 50: IBD- Crohn's Disease

Question 1

Crohn’s disease:

Incidence

Answer 1

3–6/100,000

Question 2

At-risk population

Answer 2

• High in the Jewish population
• low in the African black population
• similarrates between African American and U.S. white populations

Question 3

Sex?

Answer 3

Female > male

Question 4

Distribution?

Answer 4

Bimodal distribution (i.e., two peaks in incidence):

• peak incidence at 25 to 40 years of age
• second bimodal distribution peak at 50 to 65 years of age

Question 5

Crohn’s disease initial symptoms

Answer 5

• Abdominal pain
• diarrhea
• fever
• weight loss
• anal disease

Question 6

Crohn’s disease anatomic distribution

Answer 6

Classic phrasing “mouth to anus”

• Small bowel only (20%)
• Small bowel and colon (40%)
• Colon only (30%)

Question 7

Crohn’s disease route of spread

Answer 7

Small bowel, colon, or both with “skip areas” of normal bowel; hence, the name “regional enteritis”

Question 8

Bowel wall involvement

Answer 8

Full thickness (transmural involvement)

Question 9

Anal involvemement

Answer 9

Common:

• fistulae
• abscesses
• fissures
• ulcers

Question 10

Rectal involvement

Answer 10

Rare

Question 11

Mucosal findings

Answer 11

• Aphthoid ulcers
• Granulomas
• Linear ulcers
• Transverse fissures
• Swollen mucosa
• Full-thickness wall involvement

Question 12

Diagnostic tests

Answer 12

• Colonoscopy with biopsy
• barium enema
• UGI with small bowel follow through
• stool cultures

Question 13

Complications

Answer 13

• Anal fistula/abscess
• fistula
• stricture
• perforation
• abscesses
• toxic megacolon
• colovesical fistula
• enterovaginal fistula
• hemorrhage
• obstruction
• cancer

Question 14

Cancer risk

Answer 14

Overall increased risk, but about half that of ulcerative colitis

Question 15

Incidence of toxic megacolon

Answer 15

≈5%

Question 16

Indications of Surgery

Answer 16

• Obstruction
• massive bleeding
• fistula
• perforation
• suspicion of cancer
• abscess(refractory to medical treatment)
• toxic megacolon (refractory to medical treatment)
• strictures
• dysplasia

Question 17

What are the medication options for treating IBD?

Answer 17

Sulfasalazine, mesalamine (5-aminosalicylic acid)

Steroids, metronidazole (Flagyl®), azathioprine, 6-mercaptopurine (6-mp),infliximab

Question 18

Which medications are used for Crohn’s Disease but not ulcerative colitis?

Answer 18

• Methotrexate
• Antibiotics (e.g., Flagyl®/Cipro®)

Question 19

What are infliximab, adalimumab, certolizumab, natalizumab?

Answer 19

Monoclonal antibodies versus TNF-α (tumor necrosis factor-alpha)