Crohn's disease Flashcards
Define Crohn’s disease
Chronic granulomatous inflammatory disease that can affect any part of GI tract
Grouped w/ ulcerative colitis & known together as inflammatory bowel disease (IBD)
Aetiology of Crohn’s disease
3
UNKNOWN
Thought to be genetic & environmental factors
Inflammation can occur anywhere from mouth to anus, but 40% involves terminal ileum
Epidemiology of Crohn’s disease
prevalence, age
UK prevalence 50-80/100,000
Affects any age but peaks in teens, 20s & 40s
Presenting symptoms of Crohn’s disease
5+
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
Signs of Crohn’s disease on physical examination
6
Weight loss Clubbing Signs of anaemia Aphthous ulcers in mouth Perianal skin tags, fistulae & abscesses Uveitis, erythema nodosum, pyoderma gangrenosum
Investigations for Crohn’s disease
7
Bloods Stool microscopy & culture AXR Erect CXR Small bowel barium follow through Endoscopy (OGD, colonoscopy) & biopsy Radionucide-labelled neutrophil scan
Investigations for Crohn’s disease - bloods
5
FBC - low Hb, high platelets, high WCC U&Es LFTs - low albumin High ESR (suggests chronic inflammation) CRP high or normal
Investigations for Crohn’s disease - stool microscopy & culture
Exclude infective colitis
Investigations for Crohn’s disease - AXR
Could show toxic megacolon
Investigations for Crohn’s disease - erect CXR
If risk of perforation
Investigations for Crohn’s disease - small bowel barium follow through
(3)
Can show:
Fibrosis/strictures (string sign of Kantor - incomplete filling of lumen)
Deep ulceration (rose thorn ulcers)
Cobblestone mucosa
Investigations for Crohn’s disease - endoscopy
6
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
Investigations for Crohn’s disease - radionucide labelled neutrophil scan
Can localise inflammation when other investigations contraindicated
Management of Crohn’s disease
4 groups
Acute exacerbation
Long term
General advice
Surgery
Management of Crohn’s disease - acute exacerbation
6
Fluid resuscitation IV/oral corticosteroids 5-ASA analogues Analgesia Parenteral nutrition may be necessary Monitor markers of disease activity
Management of Crohn’s disease - long term
4
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
Management of Crohn’s disease - general advice
2
Stop smoking Dietician referral (low fibre diet necessary if strictures present)
Management of Crohn’s disease - surgery
3 indications
INDICATIONS -
Medical treatment fails
Failure to thrive in children in presence of complications
Involves resection of affected bowel & stoma formation (risk of disease recurrence)
Complications of Crohn’s disease
2 groups
GI
Extra GI
Complications of Crohn’s disease - GI
7
Haemorrhage Strictures Perforation Fistulae (between bowel, bladder, vagina) Perianal fistulae & abscesses GI cancer Malabsorption
Complications of Crohn’s disease - extra GI
10
Uveitis Episcleritis Gallstones Kidney stones Arthropathy Sacroiliitis Ankylosing spondylitis Erythema nodosum Pyoderma gangrenosum Amyloidosis
Prognosis of Crohn’s disease
3
Chronic relapsing condition
2/3 patients need surgery at some point
2/3 of these need >1 operation
