Crohn's

Question 1

What is the definition of Crohn’s?

Answer 1

The chronic granulomatous inflammatory disease that can affect any part of the gastrointestinal tract. It is grouped with UC to form the diseases known as inflammatory bowel diseases.

Question 2

What are the risk factors for Crohn’s?

Answer 2

There is both a genetic and environmental component.

This is Th1 mediated and so TNF-a which can lead to inflammation from mouth to anus leading to the cobblestone appearance.

Question 3

What is the epidemiology?

Answer 3

Can affect all ages but tends to present in teens around 20-40 years

Question 4

What are the presenting symptoms?

Answer 4

Weight loss, fever, maliase

Crampy abdominal pain due to the inflammation

Right iliac fossa pain

Uveitis (eye infection), seronegative arthritis (joint infection), erythema nodosum(skin infection) and anaemia

Diarrhoea (blood or steatorrhea)

Question 5

What are the presenting signs?

Answer 5

Weight loss

Clubbing

Anaemia

Peripheral skin tags, fistulae and abscesses

Signs of complications: Uveitis, erythema nodosum, pyoderma gangrenosum

Aphthous ulcers in mouth.

Question 6

What are the appropriate investigations?

Answer 6

FBC - WCC up, high platelets and low Hb
Us and Es
CRP - elevated or normal
ESR - elevated due to the prolonged inflammation 
LFT - low albumin
Stool microscopy and culture
AXR 
CXR
MRI on younger patients
Small bowel barium 
Endoscopy (very good for differentiation and progression of the disease)
Radionucide-labelled neutrophil scan

Question 7

What is the management plan?

Answer 7

Acute:

• Aminosalisyclates analogues
• Iv/oral corticosteroids
• Fluid resuscitation (replacement), may also be on oral iron
• analgesia
• paraentral feeding as necessary
• monitor markers of disease

Long term:
Steroids (budenoside and prednisolone) 
5-ASA analogues 
Immunosuppression (Azathioprine (Anti-TNF-a)
Stop smoking + healthy diet

Question 8

When is surgery indicated in Crohn’s?

Answer 8

When medical treatment has no effect

Failure to thrive in children

involves resection of affected bowel or stoma formation.

Question 9

What are the possible complications?

Answer 9

GI: 
Haemorrhage 
Strictures (apple core)
Perforation 
Fistulae (between bowel, bladder, vagina) 
Perianal fistulae and abscesses 
GI cancer 
Malabsorption

Extraintestinal Features:
Uveitis 
Episcleritis
Gallstones 
Kidney stones 
Arthropathy
Sacroiliitis 
Ankylosing spondylitis
Erythema nodosum 
Pyoderma gangrenosum
Amyloidosis

Question 10

What is the prognosis for Crohn’s?

Answer 10

This is a chronic relapsing condition.

2/3rds of patients will need surgery and 2/3rds of this will need more than one operation.