Crohn's

Question 1

What is Crohn’s?

Answer 1

Non specific transmural inflammatory disease that can affect any part of the GI tract

Question 2

Where do lesions most often occur in Crohn’s?

Answer 2

Ileocaecum

Question 3

What is the histology of Crohn’s disease?

Answer 3

Patchy disease- skip lesions, cobblestone appearance
Strictures
Non caseating granulomas
Crypt abscesses, fistulas

Question 4

Who gets Crohn’s?

Answer 4

14-24 yo

Question 5

What is the presentation of Crohn’s?

Answer 5

Diarrhoea- non bloody
Prominent weight loss
Abdo pain- esp in children
Mouth and/or perianal disease
Malabsorption
Lethargy, malaise
Arthritis, clubbing

Question 6

What investigations are done for Crohn’s?

Answer 6

Bloods- anaemia, low B12, raised CRP
Increased faecal calprotectin
MR enterography- gold standard
Endoscopy, colonoscopy and biopsy- diagnostic

Question 7

What investigations are used in Crohn’s in emergencies?

Answer 7

CT
Daily bloods
AXR and erect CXR

Question 8

What is the acute management of Crohn’s?

Answer 8

1. steroids (+ azathioprine if necessary)
2. 5ASA if steroids contraindicated
3. Infliximab f severe disease not responding to conventional

Question 9

What are the indications for surgery in Crohn’s?

Answer 9

Failure of medical management
Symptom relief
Fistulae
Abscess
Stricture
Obstruction

Question 10

What are the options for surgery in Crohn’s?

Answer 10

Abscess drainage
Excision surgery
Stricturoplasty
Bypass surgery in duodenal disease

Question 11

What are the complications of Crohn’s?

Answer 11

Bowel obstruction
Strictures
Fistulae
Adhesions
Surgery --> short bowel disease

Question 12

What can be offered to maintain remission Crohn’s?

Answer 12

1. Azathioprine
2. Methotrexate, infliximab
   5ASAs sometimes used, if previous surgery