Crohn's Flashcards
What is Crohn’s Disease?
- It is one of the main types of IBD along with UC
What is the Prevalence of the condition?
- It has a bimodal peak age of presentation between 15-30years and 60-80 years
- It is a remitting and relapsing course
What are the features in the bowel of Crohn’s Disease?
- It has transmural inflammation in the bowel producing deep ulcers and fissures
- Due to the transmural affect fistula’s can form, commonly a perianal fistula
- Inflammation is not continuous and causes skip lesions
- The microscopic appearance of Crohn’s Disease is non-caseating granulomatous inflammation
What are the Risk Factors of Crohn’s Disease?
- environmental factors
- genetic factors
- family history
- smoking
What are the symptoms of Crohn’s?
- episodic abdominal pain which may be colicky
- Diarrhoea with blood/ mucus
- Systemic Symptoms: Malaise, Anorexia and Low-grade fever
- Malabsorption and malnourishment
What are the Extra-intestinal features of Crohn’s?
- eyes: anterior uvetitis, Iritis and Episcleritis
- skin: erythema nodosum, pyoderma gangrenosum
-renal: renal stones - hepatobiliary: Primary Sclerosing Cholangitis, Cholangiocarcinoma
- msk: enteropathic arthritis, nail clubbing and metabolic bone disease
What investigations would you do for Crohn’s?
Colonoscopy = GOLD STANDARD
- Routine bloods - examine anaemia, low albumin and evidence of inflammation (CRP and WCC)
- Stool sample: faecal calprotectin
- CT abdo/pelvis: bowel obstruction and bowel perforation
- MRI imaging - look for enteric fistulae + peri-anal disease
What is used to treat peri-anal fistulae ?
- Examination under anaesthesia with Proctosigmoidoscopy to examine and treat
What managment would you do for Inducing Remission for Crohn’s?
Inducing remission:
- Admit to emergency department
- Fluid Resuscitation
- Nutritional Support
- Prophylactic Heparin + anti-embolic stockings
- Corticosteriod therapy
- Immunosuppressive agents (Mesalazine or Azathioprine)
- Biological Therapy (infliximab)
What managment would you do for maintaining remission?
- Azathioprine
- Smoking cessation
- Colonoscopic surveillance is offered to people
- Referred to IBD-nurse specialists
- Enteral Nutritional Support should be considered
What is the Surgical Managment for Crohn’s?
- Surgical intervention is considered in those with failed medical managment or severe complications
- A bowel-sparing approach is to be considered to prevent short gut syndrome
- Operations: Ileocaecal Resection, Small bowel resection, peri-anal disease surgery, stricturoplasty
- As patients are high risk ensure pre-operative optimisation ( treating acute attacks and managing nutrition)
What are the Complications of Crohn’s Disease?
- Gastrointestinal: Fistula, Stricture formation, Recurrent Perianal Fistulae, GI malignancy
- Extra-intestinal: Malabsorption, osteoporosis, gallstones (reduced reabsorption of bile salts), renal stones (reduced absorption of fats in the small bowel, leaving calcium in the lumen)
