Crohn's Disease Flashcards
what is crohn’s disease?
chronic relapsing inflammatory bowel disease (IBD)
what is crohn’s disease characterised by?
transmural granulomatous inflammation which can affect any part of the GI tract, most commonly the ileum, colon or both
what ages do patients commonly present with crohns disease?
40-50 and 60-80 years
what are the symptoms of crohn’s disease?
- crampy abdominal pain
- diarrhoea
- systemic symptoms - weight loss and fever
what are some of the non-GI manifestations of crohn’s disease?
- erythema nodosum
- pyoderma gangrenosum
- anterior uveitis
- episcleritis
- arthritis
- sacro-ilitis
- gallstones
- AA amyloidosis
- renal stones
what are the colonscopy findings in crohn’s disease?
- intermitten inflammation (‘skip lesions’)
- cobblestone mucosa
- rose-thorn ulcers +/- fistulae or abscesses
- non-caseating granulomas
where does crohn’s most commonly affect the bowel?
terminal ileum
what is the typical findings on endoscopic biopsy?
non-caseating granulomas
what radiological investigations should be carried out in suspected crohn’s disease?
- endoscopy
- MRI - suspected small bowel disease
- upper GI series may should ‘string sign of kantour’
what is ‘string sign of kantour’?
string-like appearance of contrast-filled narrow terminal ileum
what is the medical management to induce remission?
-
glucocorticoids (prednisolone or IV hydrocortisone)
budesonide is an alternative - 5-ASA drugs (e.g. mesalazine)
- enteral nutrition
- azathropurine or mercaptopurine if >2 exacerbations in 12 month period
when is inflximab used in the management of crohns disease?
- refractory disease
- fistulating crohns
when is metronidazole used in the management of crohns?
isolated peri-anal disease
what should be assessed before commencing azathioprine or mercaptopurine?
thiopurine methyltransferase (TPMT)
what is the medical management to maintain remission?
- azathiopurine or mercaptopurine
- methotrexate if above not tolerated
what is a peri-anal fistula?
abnormal tract between the anal canal and surface of the skin
how can you assess peri-anal fistula?
MRI of the pelvis or examination under anaesthesia
what is the management of peri-anal fistula?
- drainage seton = high (trans-sphincteric) fistulae
- fistulotomy = low (submucosal) fistulae
- long-term antibiotics (e.g. metronidazole or ciproflaxazin)
what non-radiological investigations should be carried out in suspected crohn’s disease?
- blood tests - FBC, ESR/CRP, clotting, albumin, LFTs
- stool culture
- faecal calprotectin - to distinguish between IBD and IBS
