Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YR6: GASTRO > Crohn's Disease > Flashcards

Crohn's Disease Flashcards

1
Q

What is Crohn’s disease?

A

Chronic transmural granulomatous inflammatory disease that can affect any part of the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give 3 epidemiological facts about Crohn’s

A

Affects any age but peaks in 15-30
Prevalence increasing
M:F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the aetiology of Crohn’s

A

UNKNOWN
FH increases risk of IBD
Smoking increases risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which area of the GI tract is most commonly affected in Crohn’s?

A

80% have small bowel involvement (usually in ileum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List 3 symptoms of Crohn’s

A

Diarrhoea: unexplained + persistent. May be bloody or steatorrhoea
Crampy abdominal pain
Non specific Sx: Fatigue, fever, malaise + WL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List 7 signs of Crohn’s on examination

A

Pallor, clubbing, apthous mouth ulcers
Abdominal tenderness/ mass
Perianal skin tags, fistulae + abscesses
Signs of malnutrition: serial WL/ faltering growth
Extra-intestinal manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common presenting complaint in adults and children with Crohn’s?

A

Adults: Diarrhoea
Children: Abdo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where is the most commonly affected area in Crohn’s?

A

Terminal ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List 6 extra intestinal features of Crohn’s

A

Erythema nodosum, pyoderma gangrenosum
Clubbing
Enteropathic arthritis
Uveitis, Episcleritis
Gallstones
Kidney stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe bloods taken/ results for Crohn’s

A

FBC: low Hb, high platelets
U+Es: ?dehydration
LFTs: low albumin
High ESR: chronic inflammation
CRP: correlates with disease activity
Ferritin, B12, Folate + Vit D: ?deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why is a stool sample used in suspected Crohn’s?

A

Microscopy + culture
To exclude infective gastroenteritis/ pseudomembranous colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which investigation differentiates IBD from IBS?

A

Faecal calprotectin
If raised, suggests active inflammation in IBD
(normal in IBS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What imaging can be performed in Crohn’s and why?

A

CT enterography or MR enterography: localises disease, identifies fistulae + abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the investigation of choice in Crohn’s? Name 3 hallmark features

A

Colonoscopy
Skip lesions
Deep mucosal ulcers (rose thorn)
Cobblestone appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What may show on a small bowel enema in Crohn’s?

A

Strictures (string sign of Kantor - part of intestine looks like a piece of string= incomplete filling of intestinal lumen)
Proximal bowel dilation
Fistulae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What may be seen on histology in Crohn’s?

A

Inflammation in all layers from mucosa to serosa
Goblet cells
Non- Caseating Granulomas with epithelioid giant cells
Creeping fat

17
Q

What general advice is given to patients with Crohn’s?

A

Smoking cessation

18
Q

Describe induction of remission in acute Crohn’s

A

Glucocorticoids (first line): Prednisolone PO, IV Methylprednisolone
5-ASA drugs (second line): Mesalazine

19
Q

Which steroid is used preferentially in limited terminal ileal/ ascending colonic CD?

A

Budesonide PO

20
Q

List 3 immunomodulators that can be used as add on therapy to induce remission of Crohn’s

A

Azathioprine
Mercaptourine
Methotrexate

21
Q

When are immunomodulators added to glucocorticoids to induce remission of Crohn’s?

A

If >,2 inflammatory exacerbations in a 12-month period
OR
if steroid dose can’t be tapered as planned

22
Q

Why should immunomodulators not be used as monotherapy to induce remission in Crohn’s?

A

Onset of clinical effect is too slow.

23
Q

What can be used to induce remission of isolated peri-anal crohns?

A

Metronidazole

24
Q

Which drug can be used in refractory/ fistulating Crohn’s ?

A

Infliximab (+ typically continue on Azathioprine or Methotrexate)

25
Q

Describe maintenance therapy for Crohn’s disease

A

Azathioprine or Mercaptopurine
(Methotrexate second line)

26
Q

What must be assessed prior to offering azathioprine or mercaptopurine?

A

Thiopurine methyltransferase (TPMT) activity

27
Q

Describe pharmacological therapy in Crohn’s

A

CS can be used to induce remission but should be discontinued once the acute flare has been managed. Immunomodulators + biologics are the mainstays of maintenance therapy
but can ALSO be used to induce remission

28
Q

What drugs can be used in supportive management of Crohn’s?

A

Anti-motility: Loperamide
Anti-spasmodics: Mebeverine
Bulk-forming laxatives: Ispaghula husk

29
Q

List 3 indications for surgical management of Crohn’s

A

Severe complications (e.g., bowel obstruction, intra-abdominal abscess, perianal abscess)
Unsuccessful medical therapy
Sx control in disease localised to a short segment of bowel

30
Q

List 3 procedures that may be performed in management of Crohn’s

A

Surgical drainage of abscess
Laparoscopic/ open resection of the diseased bowel segment (small bowel resection, segmental colectomy)
Stricturoplasty (bowel-sparing technique)

31
Q

List 6 GI complications of Crohn’s

A

Perianal fistulae + abscesses
Small bowel cancer
Colorectal cancer
Strictures
Perforation + peritotnitis
Short bowel syndrome

32
Q

What is the investigation of choice for perianal fistula?

A

MRI: determines if there is an abscess + if the fistula is simple (low) or complex (high- passes through/ above muscle layers)

33
Q

Describe management of perianal fistulae

A

Metronidazole PO
+/- Infliximab (aids in closure + maintaining closure)
If complex: Draining seton

34
Q

What is a seton?

A

A piece of surgical thread that is run through the fistula to allow continuous drainage while the fistula is healing.

Useful because persisting fistula tracks after premature skin closure predispose to abscess formation

This ensures the fistula doesn’t heal containing pus within, which would result in further abscess formation.

35
Q

What is the prognosis in Crohn’s?

A

Chronic relapsing condition
2/3 require surgery at some stage
2/3 of these patients require > 1 operation

36
Q

What bowel pathogen must be excluded from differentials when suspecting crohns?

A

Yersinia enterocolitica

37
Q

List 4 systemic complications of Crohn’s

A

Failure to thrive in kids
Iron Deficiency Anaemia
Osteoporosis: malabsorption of calcium + vit D
Amyloidosis: chronic inflammation leads to increased production of serum amyloid A

YR6: GASTRO (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions