Crohn's Disease Flashcards
What is Crohn’s disease?
it’s a transmural (from mucosa to serosa) irritable bowel disease that affects the whole digestive tract from oral cavity to anus
Who is most likely to be affected with Crohn’s? (epi)
Caucasians
those with a FM of crohn’s
equal female:males
at what age does crohn’s usually present?
bimodial pattern of incidence
more often the peak is 15-30yrs
can have a second peak at 50-80yrs
what causes crohn’s?
not fully elucidated
a combination of genetics, environment, and inappropriate immune response
there are >100 genes associated with Crohn’s
some known triggers are bacteria like Mycobacterium paratuberculosis
What part of the GI tract is more often affected in crohn’s?
terminal ileum and right colon (right lower quadrant)
what is the pathophys to crohn’s disease?
- genetically predisposed individual
- trigger event
- dysfunctional immune response ➔ pro-inflammatory mediators
- ulceration ➔ transmural inflammation
- forms non-caseating granulomas transmurally ➔ doesn’t always form granulomas
- creates the classic cobblestone mucosal appearance with skip lesions
- during remission, scarring replaces the inflamed areas of the intestines
What are the common inital s/s for presenting crohn’s
- non-bloody chronic diarrhea
- RLQ pain and abdo tenderness/fullness
- anorexia and wt loss
what GI related physical exam findings would you find in a crohn’s pt?
- perianal skin tags
- ulcers
- fistulas
- scarring
- abscesses
- perforation
what are some extraintestinal manifestations of crohn’s disease?
mainly in CD
- stomatitis/aphthous ulcers ➔ mouth redness/sores
- B12/iron deficiency anemia ➔ malabsorption
Also seen in ulcerative colitis
skin
1. erythema nodosum – tender, red bumps usually on skins
2. pyoderma gangrenosum – large painful sores on skin, mostly on the legs
eyes ➔ uveitis or episcleritis
bones ➔ arthritis
biliary/liver ➔ gallstones, liver steatosis, cholangitis
what are the main cx we’re worried about in crohn’s disease?
- perianal disease ➔ fistulas, strictures, abscesses
- toxic colitis ➔ ileus + colonic dilation
- colon cancer
- VTE
What ix is required for a definitive diagnosis of crohns?
endoscopy or colonoscopy w/biopsy
+ stool culture to r/o infectious causes of chronic diarrhea
what would you expect to see on an endoscopy/colonoscopy for a potential dx of crohn’s?
transmural ulcers in a classic cobblestone pattern with skip lesions anywhere in the GI tract from mouth to anus
what ix are available to distinguish crohn’s vs ulcerative colitis?
- the endoscopic/colonoscopy biopsy ➔ UC would have uniform inflammation from rectum/colon upwards
- barium studies ➔ CD has string sign vs UC has stove-pipe sign (loss of haustral markings)
- special serology
- anti-neutrophil cytoplasmic antibodies (ANCA) ➔ more +Ve in UC bc more of an autoimmune process
- anti-saccharomyces cerevisiae antibodies (ASCA) ➔ more +Ve in CD bc CD is triggered
besides the diagnostic ix for crohn’s, what other ix would you consider and your reasoning?
- fecal calprotectin ➔ would help rule in an IBD as it’s a marker for intestinal inflammation
- stool tests ➔ O&P (looks for parasites and their eggs) ➔ to r/o infectious causes for diarrhea
- CBC ➔ tell us if it’s infectious however the wbc/plts may be elevated because of the inflammation
- liver tests ➔ ALT/AST/ALP/GGT ➔ to rule out or investigate potential underlying liver disease
- electrolytes ➔ look for electrolyte imbalances that may be causing abdo issues
imaging
1. consider a CT to potentially view any potential cx of the Crohn’s that can’t be visualized on endoscopy
How would you manage crohn’s disease?
maintenance therapy: 5-ASA, biologics, or immunomodulators
therapeutic during a flare: corticosteroids
- potentially add an immunomodulator in a flare if corticosteroid is not enough
- could try adding a biologic if above not sufficient
