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Gastroenterology > Chrons Disease > Flashcards

Chrons Disease Flashcards

1
Q

What is the cause of chron’s disease?

A

Immune dysregulation and dysbiosis (loss of beneficial microbial input or signal and an expansion of pathogenic microbes) which promotes chronic inflammation

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2
Q

What are the risk factors for chrons disease?

A

Familiar aggregation
Genetic predisposition (mutation of NOD2 gene, HLA-B27 association)
Tobacco smoke

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3
Q

What is the pathophysiology behind chrons disease?

A

Immune dysregulation

Dysregulation of IL23TH27 signalling -> unrestrained Th17 cell function -> inflammation -> local tissue damage (oedema, erosions/ulcers, necrosis) -> obstruction, fibrotic scarring, stricture, and strangulation of the bowel.
Mutations of the NOD2 gene protein are likely involved in development of CD

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4
Q

What are the symptoms like in CD?

A

Intermittent course and episodic acute flared and periods of remission. Clinical creatures differ depending on severity of CD

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5
Q

What are the constitutional symptoms of CD?

A

Low grade fever
Weight loss
Fatigue

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6
Q

What are the GI symptoms of CD?

A

Chronic diarrhoea
Lower GI bleeding (uncommon)
Abdominal pain, typically in the RLQ
Palpable abdominal mass in RLQ
Features of CD complications - malabsorption and enterocutaneous or perianal fistulas with abscess formation

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7
Q

Which part of the intestine does CD normally affect?

A

Terminal ileum and colon

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8
Q

What are extra intestinal symptoms of CD?

A

Joints
Eyes
Liver/bile ducts
Urogenital system
Oral mucosa
Skin

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9
Q

What disease is involved in the joint for CD?

A

Enteropathic arthritis (type of arthritis that occurs in IBD)

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10
Q

What diseases are involved in the eyes for CD?

A

Uveitis
Iritis
Episcleritis

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11
Q

What disease is involved in the liver/bile ducts for CD?

A

Cholelithiasis

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12
Q

What disease is involved in the urogential system for CD?

A

Urolithiasis

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13
Q

What disease is involved in the oral mucosa for CD?

A

Oral aphthae

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14
Q

What diseases are involved in the skin for CD?

A

Erythema nodosum
Pyoderma gangrenosum

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15
Q

What is the diagnosis for chrons disease?

A

Endoscopy, cross sectional imaging and lab studies are required for initial evaluation of suspected CD

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16
Q

What is the purpose of cross sectional imaging for CD?

A

Establish locations and severity of disease
Identify complications eg abscess

17
Q

What is the purpose of lab studies for CD?

A

Rule out differential diagnosis of CD eg infectious gastroenteritis
Assess and monitor disease activity

18
Q

what are the supportive findings of an ileocolonoscopy?

A

Skin lesions
Cobblestone sign (inflamed edematous sections interspersed with deep ulcerations that resemble cobblestones)

19
Q

What are the supportive findings worth a cross sectional enterography?

A

Edematous thickening of intestinal wall
Creeping fat - excessive mesenteric fat around the affected segments of bowel

20
Q

Which other diagnostic studies can be performed for CD?

A

Ultrasound of the abdomen

21
Q

Which lab studies can be done to rule out differential diagnosis of CD?

A

Stool analysis to identify Ova, cysts
Serology - increased ACSA in CD

22
Q

Which lab studies ca be performed to monitor disease activity?

A

Fecal calprotectin are non invasive markers of intestinal inflammation
Inflammatory markers CRP, ESR, platelets. Increased thrombocytes is an indicator of active disease

23
Q

Which lab tests can be done to identify complications?

A

Complete metabolic panel - identify malnutrition, end organ damage
CBC - iron studies, B12, folate to evaluate for anaemia and micronutrient deficiency

24
Q

What is the pathology of CD?

A

Transmural inflammation
Non caseating granulomas
Giant cells
Distinct lymphoid aggregates of the lamina propria
Creeping fat
Hypertrophic lymph nodes

25
Q

What is the general treatment for CD?

A

Surgery may be required
Lifestyle modifications
Regular monitoring of disease activity

26
Q

What is the purpose for pharmacotherapy in CD?

A

Induction phase - used to manage acute flares (rapid onset drugs used eg corticosteroids)
Maintenance phase - used to maintain remission, typically in patients with moderate or severe CD. (Biologics and immunodilators are the principle agents of maintenance therapy)

27
Q

What is the main use of corticosteroids for CD?

A

Primarily used to induce remission eg oral prednisone

28
Q

What is the purpose for biologics in CD?

A

Increasingly used to induce remission

29
Q

what is the purpose of immunodilators?

A

Primarily users to maintain remission and also can be used as a steroid sparing regimen to induce remission

30
Q

What is the purpose of 5 amino-salicylic- acid derivative in CD?

A

May be considered to induce remission of mild to moderate colonic or ileocolonic CD
Not effective in isolated bowel disease

31
Q

What are the clinical features of mild to moderate CD?

A

Ambulatory patient
Normal dietary intake
Weight loss <10%
No major complications

32
Q

What are the clinical features of moderate to severe CD?

A

Fever
Significant weight loss
Abdominal pain
Intermittent nausea

33
Q

What are the clinical features of severe to fulminant CD?

A

Severe fever
Signs of intestinal obstruction
Persistent vomiting
Peritoneal signs
Abscess formation

34
Q

What is the treatment for mild attack of CD?

A

Prednisalone 30mg/day for a week then 20mg/day for a month. If symptoms resolve decrease prednisalone by 5mg every 2-4 weeks until parameters are normal

35
Q

What is the treatment for a severe attack of CD?

A

Admit for IV steroids and IV hydration saline and dextrose-saline 2L/24 hours
Then hydrocortisone 100mg/6hours IV
Treat rectal disease with steroids eg hydrocortisone 100mg in 100ml saline solution .9%
Metronidazole 400mg/8hours or 500mg/8hours IV
Monitor temperature, blood pressure and record stool frequency
Physical examination daily
If after 5 days there is improvement, switch to oral prednisone 40mg/day.
If no response during IV treatment then consider ct abdomen to exclude collections

36
Q

What subjects should be looked at for the d/d of chrons disease and ulcerative colitis?

A

Pathophysiology
Frequency/ type of desecration
Nutritional status
Physical examination
Extraintestinal manifestations
Fistulas
Other complications
Cancer risk
Antibodies
(Look at amboss’ list on chrons disease to learn the in-depth version its very good but long)

37
Q

What are the complications of CD?

A

Fistulising CD
Colorectal cancer
Short bowel syndrome
Stenosis/strictures
Intestinal perforation
Primary sclerosing cholangitis
Abscess formation/phlegmons

38
Q

What are the systemic complications of CD?

A

Signs of malabsorption syndrome - weight loss, failure to thrive and growth failure in children, anaemia, osteoporosis, amyloidosis

Gastroenterology (28 decks)

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