Crohn Disease Flashcards
Crohn disease involves which part of GIT …….!
Ievolves any region of the alimentary tract from the mouth to the anus.
Characteristics features of Crohn disease ……?
The inflammatory process tends to be eccentric and segmental, often with skip areas (normal regions of bowel between inflamed areas)
Major key difference between CD and UC…?
Although inflammation in ulcerative colitis is limited to the mucosa (except in toxic megacolon), GI involvement in Crohn disease is often transmural
Crohn disease tends to have a bimodal age distribution…..?
Crohn disease tends to have a bimodal age distribution, with the first peak beginning in the teenage years.
Crohn disease can be characterized as……..?
As inflammatory, stricturing, or penetrating
Patients with small bowel disease(CD) are more likely…
An obstructive pattern (most commonly with right lower quadrant pain) characterized by fibrostenosis
Patients with colonic disease(CD) are more likely…
To have symptoms resulting from inflammation (diarrhea, bleeding, cramping).
Systemic signs and symptoms are more common in which IBD.
Crohn disease than in ulcerative colitis
Causes of growth failure in Crohn disease……?
inadequate caloric intake,
suboptimal absorption or excessive loss of nutrients,
the effects of chronic inflammation on bone metabolism and appetite, and
the use of corticosteroids during treatment.
Extraintestinal manifestations occur more commonly with Crohn disease than with ulcerative colitis;
those that are especially associated with Crohn disease include oral aphthous ulcers, peripheral arthritis, erythema nodosum, digital clubbing, episcleritis, renal stones (uric acid, oxalate), and gallstones.
Which parameters being used as more sensitive and specific markers of bowel inflammation
Fecal calprotectin and lactoferrin
Findings on colonoscopy can include in CD……
patchy, nonspecific inflammatory changes (erythema, friability, loss of vascular pattern), aphthous ulcers, linear ulcers, nodularity, and strictures
Findings on biopsy in CD……..
Findings on biopsy may be only nonspecific chronic inflammatory changes. Noncaseating granulomas, similar to those of sarcoidosis, are the most characteristic histologic findings,
Characteristics findings in biopsy in a case of CD…….?
Transmural inflammation is also characteristic but can be identified only in surgical specimens.
Aim of the treatment in Crohn disease,…….?
The aim of treatment is to relieve symptoms and prevent complications of chronic inflammation (anemia, growth failure), prevent relapse, minimize corticosteroid exposure, and, if possible, effect mucosal healing.
What is A top-down approach in Crohn disease?…….
patients with moderate to severe Crohn disease are treated initially with stronger, disease-modifying agents, with the goal of achieving mucosal healing, or deep remission, early in the disease course
Treatment for mild terminal ileal disease or mild Crohn disease of the colon……..?
Initial trial of mesalamine (50-100 mg/kg/day, maximum 3-4 g) may be attempted
Rectal preparations are used for distal colonic inflammation.
Which drugs are used for infectious complications and are first-line therapy for perianal disease …….
Antibiotics such as metronidazole (10-22.5 mg/kg/day)
Role of probiotics in Crohn disease…..?
probiotics have not been shown to be effective in induction or maintenance of remission for pediatric Crohn disease.
Usage of corticosteroids in Crohn disease rationale…..?..
Corticosteroids are used for acute exacerbations of pediatric Crohn disease because they effectively suppress acute inflammation, rapidly relieving symptoms (prednisone, 1-2 mg/kg/day, maximum 40-60 mg)
Role of immunomodulaters in Crohn disease …..?
Approximately 70% of patients require escalation of medical therapy within the 1st yr of pediatric Crohn disease diagnosis
Azathioprine (2.0-2.5 mg/kg/day) or 6-mercaptopurine (1.0-1.5 mg/kg/day) may be effective in some children who have a poor response to prednisone or who are steroid dependent
Toxicities of thiopurine……..?
Lymphoproliferative disorders have developed from thiopurine use in patients with IBD.
Other common toxicities include hepatitis, pancreatitis, increased risk of skin cancer, increased risk of infection, and slightly increased risk of lymphoma
Role of methotrexate in Crohn disease…..?
The effective in the treatment of active Crohn disease and has been shown to improve height velocity in the 1st yr of administration.
The advantages of this medication include once-weekly dosing by either subcutaneous or oral route (15 mg/m2, adult dose 25 mg weekly) and a more-rapid onset of action (6-8 wk) than azathioprine or 6-mercaptopurine.
How to minimise the toxicity of methotrexate….?
Folic acid is usually administered concomitantly to decrease medication side effects.
Administration of ondansetron prior to methotrexate has been shown to diminish the risk of the most common side effect of nausea.
The most common toxicity is hepatitis
Biologic Therapy in Crohn disease….
Infliximab, a chimeric monoclonal antibody to TNF-α,
is effective for the induction and maintenance of remission and mucosal healing in chronically active moderate to severe Crohn disease, healing of perianal fistulas, steroid sparing, and preventing postoperative recurrence
Other biological agents ueses in Crohn disease….
Adalimumab. : fully humanized monoclonal antibody against TNF-α
Vedolizumab : a humanized monoclonal antibody that inhibits adhesion and migration of leukocytes into the GI tract
Surgery is the treatment of choice in Crohn disease ….indication…..?
localized disease of small bowel or colon that is unresponsive to medical treatment, bowel perforation, fibrosed stricture with symptomatic partial small bowel obstruction, and intractable bleeding.
Some of the extraintestinal manifestations can, in themselves, be major causes of morbidity, including
sclerosing cholangitis, chronic active hepatitis, pyoderma gangrenosum, and ankylosing spondylitis
