Chron's Disease* Flashcards
What is Crohn’s
Chronic Inflammatory bowel disease characterised by Transmural granulomatous inflammation in the GI tract (Rectum spared)
What is the most common age of onset for Crohn’s
15 to 40 year old
What group of people are more prone to Crohn’s
Caucasian and Jews
What is the chance of familial Crohn’s
10-25% chance Crohn’s is passed on
What are the symptoms of Crohn’s
Abdominal cramp
Weight loss
fever
RUQ pain
What are the signs of Crohn’s
Anaemia - clubbing and pale
Apthous ulcers
Tender right Iliac fossa
Do PR exam - fistulae and perianal abscess
What are the DERM manifestations of Crohn’s
Erethyma nodosum
Pyoderma gangrenosum
What are the eye manifestations of Crohn’s
Anterior uveitis
Episcleritis
What are the MSK manifestations of Crohn’s
Arthritis
Sacro-ilitis (like Ankylosing)
What type of stones can Crohn’s cause
Gall stones (common>UC)
What are the investigations of Crohn’s
pANCA Negative
Raised Faecal Calcoprotein (IBD)
Endoscopy = Skip lesion, Cobblestone and string sign
Biopsy = Transmural inflammation w/ non caseasting granuloma
What is the string sign of Kantour (GI series)
String like terminal ileum found in Crohn’s
What will Bloods show in Crohn’s
Raised WCC Raised ESR/CRP Raised Platelets (Thrombocytosis) Anaemia (Chronic) Low albumin (malabsorption)
What is faecal calcoprotein
An antigen of neutrophils and is raised with inflammation
What is the gold standard investigation for CROHN’S
Colonoscopy
- Rose thorn ulcer(transmural granulomatous inflammation)
- Skip lesions (Intermittent inflammation)
- Cobblestone mucosa (erythema nodosum)
- Non caseating granuloma
How would you medically treat Crohn’s flare
Sulasalazine and Prednisolone
What should be given to patients with severe Crohn’s and don’t respond to remission
Biological agents (Anti TNF antibodies)
- Infliximab
- Adalimumab
How would you maintain remission of Crohn’s
Ist = Azathioprine 2nd = Methotrexate
How would you manage a peri-anal fistula
High fistula = Drainage Seton
Low fistula = Fistulotomy
Sphincter saving = fibrin glue and plug
How would you manage a peri anal abscess
IV antibiotics
Incision and Drainage
What is Pellagra( DDD)
A patient with Chron’s can present with DDD due to malnutrution
- DEMENTIA
- DERMATITIS
- DIARRHOEA
After a bowel resection, What is a possible diagnosis causing steatorrhea
short bowel syndrome
What is a complication of TPN (Total parenteral nutrition)
Hypophospahatemia/magnesia
- SOB
- Seizure
How would you differentiate the inflammation between Chrons and UC
Crohn's = Transmural UC = Mucosa confined
