Crohn's Disease Flashcards
What is Crohn’s Disease?
A chronic, inflammatory bowel disease that affects the gastro-intestinal tract.
Areas of the gastro-intestinal wall becomes thickened with inflammation, which extends to all layers; and could also have granulomas present.
What are the symptoms of Crohn’s disease?
May include:
- abdominal pain
- diarrhoea
- fever
- anal fissure
- weight loss
- rectal bleeding.
What are some complications of Cronh’s disease?
- Stricture (narrowing of G.I tract) - causes passing food difficult, leading to vomiting and sickness
- Perforation (holes in G.I tract) - contents of G.I tract leak out and cause infection or abscess in abdomen
- Cancer (bowel cancer & colorectal) - higher risk of developing colon cancer
- Fistula
- Malnutrition
- Anaemia
- Osteoporosis
- Arthritis
- Growth failure and delayed puberty in children
What is fistulating Crohn’s disease?
A complication that involves the formation of fistula between the intestine and adjacent structures such as the bladder, vagina etc.
What is a fistula?
A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure.
Aim of treatment for Crohn’s disease?
Reducing symptoms, maintaining or improving quality of life whilst minimising toxicity of the drugs.
Aim of treatment for fistulating crohn’s disease.
Surgery and medical treatment to close and maintain closure of the fistula
What are the non-drug treatment for crohn’s disease?
Smoking cessation, stress management and diet change
Drug treatment for acute crohn’s disease?
A corticosteroid like prednisolone or methylprednisolone. or intravenous hydrocortisone, to induce remission.
If a simple corticosteroid is unsuitable or contra-indicated with patients with distal ileal, ileocaecal or right-sided colonic disease, use budesonide.
An alternative option is aminosalicylates like sulfasalazine and mesalazine.
What is the most effective treatment?
A corticosteroid like prednisolone.
Budesonide is less affective than a corticosteroid but has fewer side effects.
Aminosalicylates are less effective than both but have fewer side effects
When is an add-on treatment given in Crohn’s disease?
When there are two or more inflammatory exacerbations in a 12 month period, or the corticosteroid dose cannot be reduced
What are the add-on drug treatments for Crohn’s disease?
Azathioprine or mercaptopurine can be added to a corticosteroid or budesonide to induce remission.
If these are not tolerated, methotrexate can be added to a corticosteroid
Treatment for severe, active Crohn’s disease?
Adalimumab and infliximab, following inadequate response to other treatment.
These can be used as mono therapy or combined with immunosuppressant but there’s uncertainty about its effectiveness.
Vedolizumab and Ustekinumab is recommended for moderate to severely active Crohn’s disease, when adalimumab or infliximab is unsuccessful, not tolerated and contra-indicated.
What symptoms may suggest relapse in Crohn’s disease?
Unintended weight loss, abdominal pain, diarrhoea and general ill-health.
What should be done for those who reject maintenance treatment during remission?
A suitable follow up plan should be agreed, symptoms that could suggest relapse should be spoken about and information provided on how to access healthcare if a relapse occurs.
