chrons Flashcards
what are the two age peaks for chrons disease?
what is the incidence ratio for men and women?
- 15-30
- 50-70
- 1:1
what are the risk factors?
- family history
- smoking (3/4 fold increase, worse outcomes)
- intercurrent infections
- NSAIDs exacerbating factor
how might they present?
- diarrhoea (bloody and chronic)
- abdo pain, weight loss
- systemic symptoms (malaise, anorexia)
- bone demineralisation
what are the extra-intestinal manifestations?
- A PIE SAC:
- Apthous ulcers/ Anal fissures
- Pyoderma gangrenosum/ Perianal Abscess
- Iritis (conjunctivitis and episcleritis)
- Erythema nodosum
- Sclerosing Cholangitis
- Arthritis
- Clubbing of fingertips
what investigations would you do? (Bloods and other investigations)
what is the importance of CRP?
- FBC, CRP, U+Es, LFTs
- stool culture + microscopy
- faecal calprotectin ( differentiates chrons from IBS)
- indicates likelihood of relapse, may indicate bacterial infection
how is chrons diagnosed?
why might you do a CT or barium swallow?
- ilecolonoscopy and biopsy from the terminal ileum
- assess the extent of disease, and both mural and extramural manifestations of Chrons not seen on endoscopy
what sort of perianal disease is associated with chrons?
how should these be assessed?
- skin tags
- fistulae
- abscess
- anal fissure
- stricture
- haemorrhoids
- Pelvic MRI
- examination under anaesthetic
what staging systems are commonly used in chrons?
when should a patient be referred to hospital without a diagnosis of chrons?
when should a patient be referred who has a preexisting diagnosis of chrons?
- chrons disease activity index (CDAI)
- abdo pain and diarrhoea associated with weight loss, iron deficiency or raised inflammatory markers
- severe abdo pain
- severe diarrhoea >8x per day
- bowel obstruction
- systemically unwell
how should you induce remission in chrons disease?
when should you consider add on therapies and what add on therapy should you consider?
- steroid monotherapy ( prednisolone/ IV hydrocortisone)
- budesonide if not tolerated
- two inflammatory exacerbations within 12 months
- unable to taper steroid use
- Azathioprine or mercaptopurine
what needs to be measured before starting AZT or mercaptopurine? when shouldnt you offer them?
what medications should be added if you can not induce remission with AZT and steroids? how long for?
- TPMT activity
- if TPMT is low or absent
- infliximab or adalimumab
- 12 months
how should you maintain remission in chrons disease?
when should you consider surgery?
- strongly encourage smoking cessation
- azathioprine or mercaptopurine monotherapy
- methotrexate if they do not respond to monotherapy
- managing strictures (balloon dilatation/ abdo surgery)
- children who have growth impairment
what should be monitored in Chrons patients?
how should fistulating disease be treated?
- bone mineral density (especially those with low BMI, fracture risk or steroid use)
- antibiotic therapy
- surgical exploration or drainage
why shouldnt you give antidiarrhoeals?
what might ileocaecal disease predispose you to?
- risk of causing toxic megacolon
- right ureteric obstruction
