Crohn Disease

Question 1

Crohn disease involves which part of GIT …….!

Answer 1

Ievolves any region of the alimentary tract from the mouth to the anus.

Question 2

Characteristics features of Crohn disease ……?

Answer 2

The inflammatory process tends to be eccentric and segmental, often with skip areas (normal regions of bowel between inflamed areas)

Question 3

Major key difference between CD and UC…?

Answer 3

Although inflammation in ulcerative colitis is limited to the mucosa (except in toxic megacolon), GI involvement in Crohn disease is often transmural

Question 4

Crohn disease tends to have a bimodal age distribution…..?

Answer 4

Crohn disease tends to have a bimodal age distribution, with the first peak beginning in the teenage years.

Question 5

Crohn disease can be characterized as……..?

Answer 5

As inflammatory, stricturing, or penetrating

Question 6

Patients with small bowel disease(CD) are more likely…

Answer 6

An obstructive pattern (most commonly with right lower quadrant pain) characterized by fibrostenosis

Question 7

Patients with colonic disease(CD) are more likely…

Answer 7

To have symptoms resulting from inflammation (diarrhea, bleeding, cramping).

Question 8

Systemic signs and symptoms are more common in which IBD.

Answer 8

Crohn disease than in ulcerative colitis

Question 9

Causes of growth failure in Crohn disease……?

Answer 9

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.

Question 10

Extraintestinal manifestations occur more commonly with Crohn disease than with ulcerative colitis;

Answer 10

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.

Question 11

Which parameters being used as more sensitive and specific markers of bowel inflammation

Answer 11

Fecal calprotectin and lactoferrin

Question 12

Findings on colonoscopy can include in CD……

Answer 12

patchy, nonspecific inflammatory changes (erythema, friability, loss of vascular pattern), aphthous ulcers, linear ulcers, nodularity, and strictures

Question 13

Findings on biopsy in CD……..

Answer 13

Findings on biopsy may be only nonspecific chronic inflammatory changes. Noncaseating granulomas, similar to those of sarcoidosis, are the most characteristic histologic findings,

Question 14

Characteristics findings in biopsy in a case of CD…….?

Answer 14

Transmural inflammation is also characteristic but can be identified only in surgical specimens.

Question 15

Aim of the treatment in Crohn disease,…….?

Answer 15

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.

Question 16

What is A top-down approach in Crohn disease?…….

Answer 16

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

Question 17

Treatment for mild terminal ileal disease or mild Crohn disease of the colon……..?

Answer 17

Initial trial of mesalamine (50-100 mg/kg/day, maximum 3-4 g) may be attempted

Rectal preparations are used for distal colonic inflammation.

Question 18

Which drugs are used for infectious complications and are first-line therapy for perianal disease …….

Answer 18

Antibiotics such as metronidazole (10-22.5 mg/kg/day)

Question 19

Role of probiotics in Crohn disease…..?

Answer 19

probiotics have not been shown to be effective in induction or maintenance of remission for pediatric Crohn disease.

Question 20

Usage of corticosteroids in Crohn disease rationale…..?..

Answer 20

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)

Question 21

Role of immunomodulaters in Crohn disease …..?

Answer 21

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

Question 22

Toxicities of thiopurine……..?

Answer 22

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

Question 23

Role of methotrexate in Crohn disease…..?

Answer 23

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.

Question 24

How to minimise the toxicity of methotrexate….?

Answer 24

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

Question 25

Biologic Therapy in Crohn disease….

Answer 25

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

Question 26

Other biological agents ueses in Crohn disease….

Answer 26

Adalimumab. : fully humanized monoclonal antibody against TNF-α

Vedolizumab : a humanized monoclonal antibody that inhibits adhesion and migration of leukocytes into the GI tract

Question 27

Surgery is the treatment of choice in Crohn disease ….indication…..?

Answer 27

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.

Question 28

Some of the extraintestinal manifestations can, in themselves, be major causes of morbidity, including

Answer 28

sclerosing cholangitis, chronic active hepatitis, pyoderma gangrenosum, and ankylosing spondylitis