Crohn's

Question 1

How common is Crohn’s?

Answer 1

-1-2 in 1000
-Typically presents either in children / adolescents or >60s
-3x increased risk in smokers

Question 2

What causes Crohn’s?

Answer 2

-Chronic inflammation caused by transmural granulomatous inflammation
-Affects any part of the GI tract from mouth to anus

Question 3

How does Crohn’s present?

Answer 3

-Diarrhoea +/- blood
-Abdo pain - particularly RIF
-Weight loss / fatigue
-Fever, anorexia, malaise

Question 4

What signs might you find on examining a patient with Crohn’s?

Answer 4

-Abdo tenderness
-Perianal fistulae / skin tags
-Clubbing
-Episcleritis, psoriasis
-Aphthous ulcers

Question 5

How would you investigate someone with Crohn’s?

Answer 5

-FBC, CRP, U+E, LFTs, ferritin, B12, folate
-Stool MC+S and faecal calprotectin
-Colonoscopy and biopsy - skip lesions, cobblestone appearance
-pANCA negative

Question 6

What treatment would you consider for someone with Crohn’s?

Answer 6

LIFESTYLE eg quit smoking
INDUCING REMISSION
-Prednisolone
-Mesalazine
-Azathioprine / mercaptopurine / infliximab
MAINTENANCE
-Azathioprine or mercaptopurine
-Mesalazine = 2nd line
-80% will have surgical resections