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Year Two - Gastroenterology System > Crohn's Disease > Flashcards

Crohn's Disease Flashcards

1
Q

What is inflammatory bowel disease (IBD)?

A

It is defined as chronic, relapsing-remitting conditions in which there is inflammation of the gastrointestinal tract

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2
Q

What are the two inflammatory bowel disease disorders?

A

Ulcerative colitis (UC)

Crohn’s disease

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3
Q

What is Crohn’s disease?

A

It is an intermittent inflammatory bowel disease that most commonly affects the terminal ileum and colon; however, it can affect the entire gastrointestinal tract

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4
Q

What is the aetiology of Crohn’s disease?

A

The underlying aetiology remains unclear

However, there is evidence that the combination of an altered intestinal microbiota and compromised colonic epithelial integrity, results in the inappropriate exposure of non-sterile intestinal contents to the underlying immunological tissue – resulting in inflammation

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5
Q

What are the six risk factors of Crohn’s disease?

A

Young Age < 30 Years Old

Ashkenazi Jewish Descent

IBD Family History

HLA-B27 Positive

Gastrointestinal Infection

Smoking

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6
Q

What gene is associated with Crohn’s disease?

A

NOD-2

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7
Q

What are the five clinical features of Crohn’s disease?

A

Non-Bloody Diarrhoea

Right Iliac Fossa Pain/Mass

Perianal Disease

Mouth Ulcerations

Weight Loss

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8
Q

What is the most common clinical feature of Crohn’s disease in children?

A

Abdominal pain

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9
Q

What are the nine extra-intestinal manifestation of Crohn’s disease?

A

Gallstones

Oxalate Renal Calculi

Colorectal Cancer

Arthritis

Osteoporosis

Erythema Nodosum

Pyoderma Gangrenosum

Uveitis

Episcleritis

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10
Q

What pneumonic is used to remember the extra-intestinal manifestations of Crohn’s disease?

A

A PIE SAC

Aphthous Ulcers

Pyoderma Gangrenosum

Iritis

Erythema Nodosum

Sclerosing Cholangitis

Arthritis

Clubbing

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11
Q

What are the three most common extra-intestinal manifestations of Crohn’s disease?

A

Gallstones

Oxalate Renal Calculi

Episcleritis

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12
Q

What four investigations are used to diagnose Crohn’s disease?

A

Blood Tests

Stool Tests

Endoscopy + Biopsy

Abdominal X-Ray (AXR)

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13
Q

What are the five blood test results that indicate Crohn’s disease?

A

Decreased RBC Levels

Increased WCC Levels

Increased CRP Levels

Decreased Albumin Levels

Decreased Vitamin B12 Levels

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14
Q

What are the two stool tests used to diagnose Crohn’s disease?

A

Faecal Calprotectin

Stool Culture

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15
Q

What is faecal calprotectin?

A

It is an inflammatory marker, which is released during colitis

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16
Q

What faecal calprotectin result indicates Crohn’s disease?

A

There are elevated levels of this inflammatory marker present in stool cultures – usually > 200ug/g

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17
Q

How is faecal calprotectin used to investigate Crohn’s disease?

A

This stool test is useful for distinguishing between inflammatory bowel syndrome and inflammatory bowel disease

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18
Q

How are stool cultures used to investigate Crohn’s disease?

A

They are used to exclude gastrointestinal infections

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19
Q

What three gastrointestinal infections present similarly to Crohn’s disease, and are therefore important to exclude?

A

Salmonella

E.coli

Campylobacter

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20
Q

What is the gold standard investigation used to diagnose Crohn’s disease?

A

Endoscopy with biopsy

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21
Q

What are the four macroscopic features of Crohn’s disease on endoscopy?

A

Skip Lesions of Inflamed Mucosa

Cobble-Stone Appearance

Erythematous Mucosa

Transmural Inflammation

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22
Q

What is transmural inflammation?

A

It is defined as the infiltration of inflammatory cells to all layers - from mucosa to serosa

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23
Q

What are the two microscopic features of Crohn’s disease on endoscopy?

A

Increased Goblet Cell Abundance

Granuloma Formation

24
Q

What are the four features of Crohn’s disease on abdominal x-ray?

A

Proximal Bowel Dilation

Kantor’s String Sign

Rose Thorn Ulcers

Fistulae

25
What is Kantor's string sign?
It is a severe narrowing of bowel loop
26
What is rose thorn ulcers?
They are sections of stenosed terminal ileum, which are filled with barium enema
27
How do we conservatively manage Crohn's disease?
We advise patients about smoking cessation
28
What is the first line management option for the induction of remission in Crohn's disease?
Corticosteroids
29
Name two corticosteroids are used to manage Crohn's disease
Oral prednisolone IV hydrocortisone
30
What is the second line management option for the induction of remission in Crohn's disease?
Aminosalicylates (5-ASA)
31
Name an aminosalicylate (5-ASA) used to manage Crohn's disease
Mesalazine
32
What is the third line management option for the induction of remission in Crohn's disease?
Thiopurines
33
Name two thiopurines used to manage Crohn's disease
Azathioprine Mercaptopurine
34
What are the two fourth line management options for the induction of remission in Crohn's disease?
Biologics Immunosuppressants
35
What are the four side effects of azathioprine?
Bone marrow depression Nausea & vomiting Pancreatitis Increased non-melanoma skin cancer
36
What blood test should be conducted prior to administration of azathioprine? Why?
Thiopurine Methyltransferase (TPMT) Activity When very low/absent, azathipurine should not be administered. When decreased, hower not deficient, it should be commenced at a lower dose
37
What blood test should be conducted to monitor complication development of azathioprine? Why?
Full blood count This is to monitor development of bone marrow depression
38
Name two biologics used to manage Crohn's disease
Infliximab Adalimumab
39
What is the mechanism of action of infliximab?
Anti-TNFa
40
What is the mechanism of action of adalimumab?
Anti-TNFa
41
Name an immunosuppressant used to manage Crohn's disease
Methotrexate
42
What should patients be aware of when taking methotrexate?
They require effective contraception during and for at least 6 months after treatment This applies to both men and women
43
What is the first line management option for remission maintenance in Crohn's disease?
Thiopurines
44
What is the second line management option for remission maintenance in Crohn's disease?
Immunosuppressants
45
What is the third line management option for remission maintenance in Crohn's disease?
Biologics
46
What is a surgical management option of Crohn's disease?
Proctectomy
47
When is proctectomy used to manage Crohn's disease?
It is used to manage severe rectal Crohn's disease, in which rectal complications such as haemorrhae and fistulae have developed
48
What are the eight complications of Crohn's disease?
Anal fissure Perianal Fistulae Perianal Abscess Bowel Obstruction Gallstones Malnutrition Vitamin B12 deficiency anaemia Small Bowel Cancer Colorectal Cancer
49
In Chron's disease, what is th most likely cause of bleeding post-defecation?
Anal fissure
50
What is the management option used to manage perianal abscesses in Crohn's disease?
Incision and drainage
51
What is the gold standard investigation used to investigate perianal fistulae in Chron's disease?
MRI Pelvis
52
What is the management option for simple perinal fistulae in Crohn’s disease?
Oral Metronidazole
53
What is the management option for complex perinal fistulae in Crohn's disease?
Draining Seton
54
What is a seton?
It is a piece of surgical thread that is run through the fistula to allow continuous drainage while the fistula is healing This ensures that the fistula doesn't heal containing pus within, which would result in further abscess formation
55
What pneumonic is used to remember the key features of Crohn's disease?
crowns NESTS No blood or mucus Entire GI tract Skip lesions Terminal ileum/Transmural inflammation Smoking risk factor
56
How do we remember that smoking is a risk factor of Crohn's disease?
Smoking sets a NEST on fire
57
What pharmacological management option is only used to treat Crohn's disease and not ulcerative colitis?
Methotrexate

Year Two - Gastroenterology System (33 decks)

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