Crohn's Disease Flashcards

1
Q

what is crohn’s disease?

A

chronic relapsing inflammatory bowel disease (IBD)

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2
Q

what is crohn’s disease characterised by?

A

transmural granulomatous inflammation which can affect any part of the GI tract, most commonly the ileum, colon or both

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3
Q

what ages do patients commonly present with crohns disease?

A

40-50 and 60-80 years

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4
Q

what are the symptoms of crohn’s disease?

A
  • crampy abdominal pain
  • diarrhoea
  • systemic symptoms - weight loss and fever
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5
Q

what are some of the non-GI manifestations of crohn’s disease?

A
  • erythema nodosum
  • pyoderma gangrenosum
  • anterior uveitis
  • episcleritis
  • arthritis
  • sacro-ilitis
  • gallstones
  • AA amyloidosis
  • renal stones
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6
Q

what are the colonscopy findings in crohn’s disease?

A
  • intermitten inflammation (‘skip lesions’)
  • cobblestone mucosa
  • rose-thorn ulcers +/- fistulae or abscesses
  • non-caseating granulomas
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7
Q

where does crohn’s most commonly affect the bowel?

A

terminal ileum

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8
Q

what is the typical findings on endoscopic biopsy?

A

non-caseating granulomas

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9
Q

what radiological investigations should be carried out in suspected crohn’s disease?

A
  • endoscopy
  • MRI - suspected small bowel disease
  • upper GI series may should ‘string sign of kantour’
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10
Q

what is ‘string sign of kantour’?

A

string-like appearance of contrast-filled narrow terminal ileum

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11
Q

what is the medical management to induce remission?

A
  1. glucocorticoids (prednisolone or IV hydrocortisone)
    budesonide is an alternative
  2. 5-ASA drugs (e.g. mesalazine)
  • enteral nutrition
    • azathropurine or mercaptopurine if >2 exacerbations in 12 month period
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12
Q

when is inflximab used in the management of crohns disease?

A
  • refractory disease
  • fistulating crohns
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13
Q

when is metronidazole used in the management of crohns?

A

isolated peri-anal disease

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14
Q

what should be assessed before commencing azathioprine or mercaptopurine?

A

thiopurine methyltransferase (TPMT)

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15
Q

what is the medical management to maintain remission?

A
  • azathiopurine or mercaptopurine
  • methotrexate if above not tolerated
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16
Q

what is a peri-anal fistula?

A

abnormal tract between the anal canal and surface of the skin

17
Q

how can you assess peri-anal fistula?

A

MRI of the pelvis or examination under anaesthesia

18
Q

what is the management of peri-anal fistula?

A
  • drainage seton = high (trans-sphincteric) fistulae
  • fistulotomy = low (submucosal) fistulae
  • long-term antibiotics (e.g. metronidazole or ciproflaxazin)
19
Q

what non-radiological investigations should be carried out in suspected crohn’s disease?

A
  • blood tests - FBC, ESR/CRP, clotting, albumin, LFTs
  • stool culture
  • faecal calprotectin - to distinguish between IBD and IBS