chrons disease management

Question 1

General points of managmne of chrons disease

Answer 1

stop smoking

(some studies suggest an increased risk of relapse secondary to NSAIDs and the combined oral contraceptive pill)

Question 2

first line to induce remission in chrons?

Answer 2

glucocorticoids (oral, topical or intravenous)
budesonide - in subgroups

with

enteral feeding - with an elemental diet

Question 3

when is enteral feeding with elemental diet particularly useful?

Answer 3

particularly if there is concern regarding the side-effects of steroids (for example in young children)

Question 4

second line to induce remission in chrons?

Answer 4

ADD 5-ASA drugs (e.g. mesalazine)

but are not as effective

Question 5

3rd line drug to induce remission ?

Answer 5

azathioprine or mercaptopurine* may be used as an add-on medication to induce remission

not used as monotherapy!!!

Methotrexate is an alternative to azathioprine

Question 6

chrons refractory to remission drugs and fistulating Crohn’s

Answer 6

infliximab is useful in refractory disease and fistulating Crohn’s

Question 7

what is used for isolated peri anal disease in chrons ?

Answer 7

metronidazole

Question 8

first line to maintain remission ?

Answer 8

azathioprine or mercaptopurine

Question 9

second line to maintain remission ?

Answer 9

methotrexate is used second-line

Question 10

what activity should be measured before offering azathioprine or mercaptopurine

Answer 10

assess thiopurine methyltransferase (TPMT)

Question 11

80% of patients with Crohn’s disease will eventually have surgery what are the typical surgery in chrons ?

Answer 11

stricturing terminal ileal disease → ileocaecal resection
segmental small bowel resections
stricturoplasty

Question 12

Management of simple perianal fistulas ?

Answer 12

ymptomatic perianal fistulae are usually given oral metronidazole

anti-TNF agents such as infliximab may also be effective in closing and maintaining closure of perianal fistulas

Question 13

Management of complex perianal fistulas ?

Answer 13

draining seton is used for complex fistulae

a seton - a piece of surgical thread - left in the fistula for several weeks to keep it open.

This is useful because persisting fistula tracks after premature skin closure predispose to abscess formation

Question 14

management of perianal abcess ?

Answer 14

requires incision and drainage combined with antibiotic therapy

a draining seton may also be placed if a tract is identified