Crohn's Disease

Question 1

Crohn’s disease is an

Answer 1

inflammatory bowel disease that can involve any segment of the GI tract (from mouth to anus)

Question 2

Crohn’s disease commonly affects

Answer 2

the distal ileum and proximal large colon

Question 3

Injury to the GI wall due to inflammation is caused by

Answer 3

activation of T-helper type 1 cells, leukoctyes, and cytokines

Question 4

The disease progression of Crohn’s disease leads to

Answer 4

abscess formation and crypt destruction

Question 5

Most common symptoms of Crohn’s disease include

Answer 5

abdominal pain and diarrhea (>5 bowel movements per day containing blood and mucus)
right lower quadrant pain
anemia

Question 6

Additional symptoms of Crohn’s disease includes

Answer 6

lack of magnesium, phosphorous, potassium, and zinc
Nutrient deficiencies
fistulas
renal calculi and cholelithiasis

Question 7

Medications used to treat Crohn’s disease include

Answer 7

5-aminosalicylate acids
antibiotics- metronidazole & ciprofloxacin
glucocorticoids
immune modulators
biologic response modifiers

Question 8

The goal of surgery for Crohn’s disease is to

Answer 8

limit the operation to fixing the current complications
helps relieve complications but does not change disease progression
repeat surgery is common

Question 9

Surgical treatment for Crohn’s disease often includes

Answer 9

short bowel syndrome with resection of small intestine

Question 10

Describe the patient optimization for those with Crohn’s disease.

Answer 10

correct anemia, fluid depletion, electrolyte, and acid-base imbalances
assessment of nutritional status

Question 11

Possible comorbidities of those with Crohn’s disease include

Answer 11

sepsis, liver disease, coagulopathy, anemia, arthritis, & hypoalbuminemia

Question 12

For patients with Crohn’s disease it is important to avoid

Answer 12

nitrous oxide

Question 13

______ anesthesia is beneficial for adequate analgesia.

Answer 13

combined anesthesia with epidural and general anesthesia

Question 14

Preoperative anesthesia considerations for Crohn’s disease include combination of _______ to treat fistulas

Answer 14

antibiotics, immunomodulators, biologic agents

Question 15

Malnutrition may be severe enough

Answer 15

requiring TPN

Question 16

Preoperative anesthetic considerations for the Crohn’s disease patient include

Answer 16

evaluate fluid & electrolyte status
may have ankylosing spondylitis
may be anemic due to chronic inflammation and hemorrhage
low albumin from loss of albumin through the diseased mucosa

Question 17

Postoperative pain for patients with Crohn’s disease

Answer 17

hard to control due to patients having chronic abdominal pain
multimodal pain approach is advised

Question 18

________ should be avoided postoperatively for Crohn’s patients

Answer 18

nausea, vomiting, coughing and straining

Question 19

Patients with Crohn’s disease have a postoperative risk of

Answer 19

anastomotic leak and bleeding

Question 20

Intraoperative anesthetic management plans for patients with Crohn’s disease include

Answer 20

neuraxial anesthesia is a good choice- peds patients typically need to be unconscious

• general with TIVA - may use LMA
• May need endotracheal intubation for positioning in lithotomy and steep Trendelenburg

Question 21

_____ should be avoided for patients with concomitant liver disease

Answer 21

Tylenol

Question 22

______ should be given if the patient has had it within the past six months

Answer 22

stress dose of steroids

Question 23

If a patient takes infliximab they have an increased risk of

Answer 23

acute coronary syndrome, & postoperative muscle weakness

Question 24

______ should be avoided for Crohn’s disease patients

Answer 24

nitrous oxide

Question 25

Avoid______ if stimulation of the sphincter muscle is planned

Answer 25

paralytics