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3. Inflammation > Crohn's Disease > Flashcards

Crohn's Disease Flashcards

1
Q

How does Crohn’s disease differ from UC?

A

UC: continuous and uniform inflammation of large bowel
CD: patchy inflammation anywhere in GI (skip lesions)

UC: stool urgency, fatigue, increased bowel movements, mucus in stool
CD: abdominal pain, diarrhoea, weight loss

UC: submucosal and mucosal diarrhoea
CD: transmural

UC: depleted goblet cells, lot of crypt abscesses, potential pseudopolyps
CD: granulomas, goblet cells

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2
Q

What is Crohn’s disease?

A

Crohn’s disease is a type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.

Inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people. This inflammation often spreads into the deeper layers of the bowel.

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3
Q

What is the age of onset for Crohns?

A

15-30

60-70

in UC first peak is most likely

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4
Q

What is the gender gap in Crohn’s disease?

A

Females > males

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5
Q

How does smoking relate to Crohn’s disease?

A

Aggravates

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6
Q

What factors influence the development of Crohns?

A
  1. Genetic suscepitbility
  2. Environment (increased animal protein detrimental)
  3. Intestinal microbiota
  4. Host immune response
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7
Q

What part of the GI does Crohns Disease most like affect?

A

Crohn’s disease mainly effects the ileum and caecum (40%)

  • Small intestine (30-40%) has skip lesions (inflammation pattern)
  • Skip lesions can occur in large intestine (20%)
  • 10% have perianal lesions
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8
Q

What microscopic changes occur in Crohn’s disease?

A
  1. Transmural inflammation of the intestinal wall
  2. Skip lesions due to abrupt transition between healthy gut tissue and ulcerations
  3. Infiltration with neutrophils
  4. Granulomas
  5. Presence of goblet cells
  6. More crypt abscesses
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9
Q

What macroscopic changes occur in Crohn’s disease?

A
  1. Cobblestone appearance due to bowel that is thickened and the ulcers and fissures
  2. Aphthoid ulcerations in the very early stages of the disease
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10
Q

What are the major symptoms for Crohn’s disease?

A
  1. Diarrhoea
  2. Abdominal pain
  3. Weight loss
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11
Q

What are complications related to Crohnn’s disease?

A
  1. Cancer
    • Colon cancer, small intestinal cancer
  2. Bowel obstruction
  3. Free perforation
  4. Haemorrhage
  5. Malnutrition
  6. Small intestinal bacterial overgrowth
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12
Q

How is Crohns Disease diagnosed?

A

Is mainly based on endoscopic findings and imaging studies with compatible clinical history

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13
Q

What would radiological imaging of the small bowel show in Crohn’s disease?

A

The findings include an asymmetrical alteration in the mucosal pattern with deep ulceration, and areas of narrowing or stricturing

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14
Q

What are the treatment aims of Crohns Disease?

A

The aim of management is to induce and then maintain clinical remission and achieve mucosal healing to prevent complications

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15
Q

How is remission induced pharmacologically in crohn’s disease?

A
  1. Glucocorticoids
    • Oral prednisolone
    • Induce remission in moderate and severe attacks of CD
    • Overall remission varies from 60-90%
  2. Antibiotics → used for secondary complications
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16
Q

How is remission maintained pharmacologically in crohn’s disease?

A

Patients with good prognosis disease (older age at diagnosis, no perianal disease, limited ulceration at index investigations, non-smoker) may not require maintenance therapy

Other maintenance therapy includes:

  1. Immunosuppressant medication
  2. Anti-TNF agents
17
Q

What role does surgery play in Crohn’s disease?

A

Approximately 80% of patients will require an operation at some time during the course of their disease.

Indications for surgery:

  1. Failure of medical therapy, with acute or chronic symptoms producing ill-health
  2. Complications (e.g. toxic dilatation, obstruction, perforation, abscesses, enterocutaneous fistula)
  3. Failure to grow in children despite medical treatment.
  4. Presence of perianal sepsis: an examination under anaesthetic is performed, the sepsis is drained and a seton is inserted to ensure ongoing drainage
18
Q

What anti-TNF agents are used in Crohns disease?

A

infliximab, adalimumab

19
Q

What is the prognosis for Crohn’s disease?

A

With treatment, most people achieve a healthy weight, and the mortality rate for the disease is relatively low

Up to 80% of people with Crohn’s disease are hospitalised at some point during the course of their disease

3. Inflammation (21 decks)

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