Crohn's disease

Question 1

Define Crohn’s disease

Answer 1

Chronic granulomatous inflammatory disease that can affect any part of GI tract

Grouped w/ ulcerative colitis & known together as inflammatory bowel disease (IBD)

Question 2

Aetiology of Crohn’s disease

3

Answer 2

UNKNOWN
Thought to be genetic & environmental factors
Inflammation can occur anywhere from mouth to anus, but 40% involves terminal ileum

Question 3

Epidemiology of Crohn’s disease

prevalence, age

Answer 3

UK prevalence 50-80/100,000

Affects any age but peaks in teens, 20s & 40s

Question 4

Presenting symptoms of Crohn’s disease

5+

Answer 4

Crampy abdo pain
Diarrhoea (may be bloody or steatorrhoea)
Fever, malaise, weight loss
Symptoms of complications
Sometimes RIF pain due to inflammation of terminal ileum

Question 5

Signs of Crohn’s disease on physical examination

6

Answer 5

Weight loss
Clubbing
Signs of anaemia
Aphthous ulcers in mouth
Perianal skin tags, fistulae & abscesses
Uveitis, erythema nodosum, pyoderma gangrenosum

Question 6

Investigations for Crohn’s disease

7

Answer 6

Bloods
Stool microscopy & culture
AXR
Erect CXR
Small bowel barium follow through 
Endoscopy (OGD, colonoscopy) & biopsy
Radionucide-labelled neutrophil scan

Question 7

Investigations for Crohn’s disease - bloods

5

Answer 7

FBC - low Hb, high platelets, high WCC
U&Es
LFTs - low albumin
High ESR (suggests chronic inflammation)
CRP high or normal

Question 8

Investigations for Crohn’s disease - stool microscopy & culture

Answer 8

Exclude infective colitis

Question 9

Investigations for Crohn’s disease - AXR

Answer 9

Could show toxic megacolon

Question 10

Investigations for Crohn’s disease - erect CXR

Answer 10

If risk of perforation

Question 11

Investigations for Crohn’s disease - small bowel barium follow through
(3)

Answer 11

Can show:
Fibrosis/strictures (string sign of Kantor - incomplete filling of lumen)
Deep ulceration (rose thorn ulcers)
Cobblestone mucosa

Question 12

Investigations for Crohn’s disease - endoscopy

6

Answer 12

Can help differentiate UC & CD
Monitoring malignancy & disease progression
Can show mucosal oedema & ulceration w/ “rose thorn fissure” (when there’s cobblestone mucosa)
Fistulae & abscesses
Transmural chronic inflammation w/ infiltration of macrophages, lymphocytes & plasma cells
Granulomas w/ epitheloid giant cells may be seen in blood vessels & lymphatics

Question 13

Investigations for Crohn’s disease - radionucide labelled neutrophil scan

Answer 13

Can localise inflammation when other investigations contraindicated

Question 14

Management of Crohn’s disease

4 groups

Answer 14

Acute exacerbation
Long term
General advice
Surgery

Question 15

Management of Crohn’s disease - acute exacerbation

6

Answer 15

Fluid resuscitation 
IV/oral corticosteroids
5-ASA analogues
Analgesia
Parenteral nutrition may be necessary 
Monitor markers of disease activity

Question 16

Management of Crohn’s disease - long term

4

Answer 16

Steroids - for acute exacerbations
5-ASA analogues - decreases frequency of relapses
Immunosuppression - reduces frequency of relapses
Anti-TNF agents - v effective to induce & maintain remission

Question 17

Management of Crohn’s disease - general advice

2

Answer 17

Stop smoking
Dietician referral (low fibre diet necessary if strictures present)

Question 18

Management of Crohn’s disease - surgery

3 indications

Answer 18

INDICATIONS -
Medical treatment fails
Failure to thrive in children in presence of complications
Involves resection of affected bowel & stoma formation (risk of disease recurrence)

Question 19

Complications of Crohn’s disease

2 groups

Answer 19

GI

Extra GI

Question 20

Complications of Crohn’s disease - GI

7

Answer 20

Haemorrhage 
Strictures
Perforation
Fistulae (between bowel, bladder, vagina)
Perianal fistulae & abscesses
GI cancer
Malabsorption

Question 21

Complications of Crohn’s disease - extra GI

10

Answer 21

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

Question 22

Prognosis of Crohn’s disease

3

Answer 22

Chronic relapsing condition
2/3 patients need surgery at some point
2/3 of these need >1 operation