Crohn's disease Flashcards
What type of disease is Crohn’s?
-2
IBD
autoimmune
describe/define Crohn’s succinctly?
Chronic disconnected transmural inflammation of the bowel anywhere from mouth to anus.
disconnected nature of inflammation leads to what feature.
skip lesions
transmural nature of inflammation leads to what feature.
fistulas
what is a granuloma
pocket of macrophages
which ethnicities are at risk?
-2
Caucasian
Ashkenazic Jew
which gene is implicated?
HLA-B27
which lifestyle factor increases risk?
-1
smoking
Is FHx a risk factor?
yes
is family history required for you to have crohn’s?
no
where is inflammation worst?
as a result what vitamin is deficient?
terminal ileum
B12
why is there anaemia?
-3 reasons
low B12, low folate, low iron
which phenomena in adolescent is delayed?
puberty
what blood tests increase in flare ups?
-4
FCP
CRP
ESR
leukocytes
why is there diarrhoea?
inflamed intestines can not absorb water & nutrients
why is there fatigue?
anaemia
malabsorption
what happens to weight and why?
weight loss
not absorbing nutrients
which inflammatory marker allows you to differentiate IBD from IBS?
FCP
what does FCP stand for?
faecal calprotectin
what does ESR stand for?
erythrocyte sedimentation rate
high ESR indicates what?
inflammation
most common symptom in adults?
diarrhoea
most common symptom in children?
abdo pain
where is abdo pain particularly bad?
-which quadrant
LRQ
3 layers of the gut?
mucosa
sub mucosa
muscularis
define transmural?
going through wall
crohns pt has blood in stool and pain on defecation.
what might be cause in respect to crohn’s?
anal fissure
what is an anal fissure?
tear in anal lining
hallmark feature of toxic megacolon on AXR?
big colon
treatment for toxic megacolon
resect colon
bowel perforation on AXR, what is hallmark feature?
sub-diaphragmatic air
which complications of crohn’s can cause distended abdomen?
-2
toxic megacolon
strictures/obstruction
why might crohn’s pt be at increased risk of skin cancer?
SE of thiopurines
Complications of IBD that requires regular screening?
bowel cancer
where do apthous ulcers most commonly arise?
mouth
symptoms of crohn’s?
-4
diarrhoea
abdominal pain
bloody stools
fatigue/lethargy
potential features on rectal exam?
-6
blood, skin tags, erythema, fissures, fistulas, ulceration
cutaneous extra-intestinal manifestations?
-2
describe what each of these things are?
Erythema nodosum - fat under skin gets inflamed, causing tender red nodule to form on skin, mainly on shins
Pyoderma gangrenosum - pustule or nodule becomes ulcer and keep growing
MSK extra-intestinal manifestations?
-3
arthritis
Osteoporosis
clubbing
low oestrogen and crohn’s is a risk factor for what MSK condition, particularly for women?
osteoporosis
most common extra-intestinal manifestation in both Crohn’s & UC ?
arthritis
hepatobiliary extra-intestinal manifestation that is way more common in UC?
Primary sclerosing cholangitis
most common place to see erythema nodosum on body?
legs
extra-intestinal manifestation in eyes?
-2
episcleritis
uveitis
give all potential blood results for crohn’s?
-10
↓B9, ↓B12, ↓D, ↓Fe, ↑FCP, ↑CRP, ↑ESR, ↑WBC
LFTs – low albumin
U&Es - ↑urea, high urea:creatinine ratio, from dehydration
what do you want to exclude on stool culture?
-2
gastroenteritis & pseudomembranous colitis
in the context of crohn’s,
low albumin shows what?
what blood test is done to check albumin?
malabsorption
LFT
features seen on colonoscopy?
- 3
deep ulcers
skip lesions
cobblestone appearance
features seen on histology?
-3
transmural inflammation
granulomas
goblet cells
gold standard Ix?
Colonoscopy + biopsy
which serum antibody marker is high in crohn’s?
ASCA
features seen on barium fluoroscopy?
-3
o Kantor’s string sign = strictures
o “rose thorn” ulcers
o Fistulae
what do you call a fistula between bowel and bowel?
enteroenteric fistula
what do you call a fistula between bowel and skin?
enterocutaneous
what do you call a fistula between bowel and bladder?
enterovesical
what do you call a fistula between bowel and vagina?
enterovaginal
give all potential blood results for crohn’s?
↓B12, ↓D, ↓Fe, ↑FCP, ↑CRP, ↑WBC
LFTs – low albumin
U&Es - ↑urea, high urea:creatinine ratio, from dehydration
what is seen on colonoscopy?
-3
o Deep ulcers, skip lesions, cobblestone mucosa
what is seen on histology?
transmural inflammation, granulomas, goblet cells
antibody marker for crohn’s?
ASCA
antibody marker for UC?
pANCA
a stricture is seen on barium fluoroscopy.
What name is given to this type of stricture?
Kantor’s string sign
group of drugs used to induce remission?
give two named examples in this group?
Glucocorticoids
prednisolone or hydrocortisone
name two 1st line drugs used to maintain remission?
what group are these two drugs?
what class?
Azathioprine or Mercaptopurine
immunomodulators
purine synthesis inhibitors
2nd line drug to maintain remission?
methotrexate
last resort drug for refractory crohn’s?
group of drug?
moa of this drug (class)?
Adalimumab
monoclonal antibody
TNF alpha blocker
Adalimumab & methotrexate belongs to what group of drugs?
immunosuppressant
what class is ciprofloxacin?
flucloxacillin
what class is metronidazole?
what type/group of drugs does it belong to?
nitroimidazole
antibiotics
azathioprine causes risk of what cancer?
skin cancer
definitive treatment for abscess?
incise+drain
definitive treatment for fistulae?
resect affected part of bowel
definitive treatment for highly damaged/inflamed ileum?
ileocecal resection
panproctocolectomy is done.
what type of stoma is needed?
ileostomy
peri-anal disease from Crohn’s.
which two drugs can be given?
what group to these two drugs belong to?
ciprofloxacin or metronidazole
antibiotics
