Crohn’s Disease Flashcards
What is the pathophysiology in Crohn’s disease
Transmural process
• Mucosal inflammation
• Ulceration
• Stricturing
• Fistula development
• Abscess formation
• 33% involve the small bowel only
• Terminal ileum (ileitis)
• 50% involve small bowel & colon
• Terminal ileum & proximal ascending colon
(ileocolitis)
• 20% colon alone
• 33% associated w/ perianal disease
• Fistulas, fissures, or abscesses
What is strongly associated with UC development
Cigarette smoking
• Strongly associated w/ development, resistance &
early relapse
Explain the various fistula complications that happen with Crohn’s disease
stulas
• Can be asymptomatic and required no therapy
• Symptomatic fistula requires surgical intervention
• Medical therapy tried first
• Large abscesses associated with fistulas
• Percutaneous or surgical drainage
• Long term antibiotics to follow
• Fistulas between small intestine & colon
• Commonly asymptomatic
• Diarrhea, weight loss, bacteria overgrowth & malnutrition
• Fistulas to bladder
• Colovesical fistula
• Recurrent UTI
• Fistulas to vaginal wall
• Malodorous drainage
• Personal hygiene
• Penetration to bowel
• Intraabdominal/retroperitoneal phlegmon or abscess
• Fever, chills, tender abdominal mass & leukocytosis
• Perianal disease
• Painful skin tags, anal fissures, perianal abscess &
fistulas
Explain carcinoma and malnutrition defects with chron’s disease
Carcinoma
• Recommended annual screening colonoscopy
• Malabsorption
• Occurs after small bowel resection
• Vitamins A, D & B12
• Fat malabsorption
• Low fat diet
What are the clinical manifestations of Crohn’s disease
Physical Examination
• Temperature, weight, nutritional status
• Abdominal tenderness or mass
• Chronic inflammatory disease
• Ileitis or ileocolitis
• Intermittent non-bloody diarrhea
• Colitis involving rectum or left colon
• Bloody diarrhea & fecal urgency
• Referred RLQ or periumbilical pain
• Palpable mass
• Thickened or matted loops of inflamed intestine
• Intestinal Obstruction
• Narrowing of small bowel
• Postprandial bloating & cramping pains
• Can occur in active & chronic disease
• Abscesses
• Abdominal & rectovaginal fistula
• Perianal disease
• Carcinoma
What laboratory findings are there for Crohn’s disease and why
Laboratory
• Anemia
• Chronic inflammation vs mucosal blood loss vs Fe+ or Vitamin B12 deficiency
• Leukocytosis
• Inflammation vs abscess vs steroid therapy
• Hypoalbuminemia
• Intestinal protein loss vs malabsorption vs bacterial overgrowth vs chronic inflammation
• Elevated ESR & CRP
• Fecal calprotectin
• Elevation = active inflammation
• Positive ASCA & negative pANCA
What are endoscopy, pathologic, and imaging findings suggestive of Crohn’s disease
• Endoscopic, pathologic & radiographic
• Colonoscopy
• Evaluate colon & terminal ileum
• Obtain mucosal biopsies
• Endoscopy
• Aphthoid, linear or stellate ulcers
• Strictures & segmental involvement
• Pathology
• Granulomas
• Imaging
• CT or MR enterography
• Ulcerations, strictures & fistula
• Capsule imaging
• Identify small bowel involveme
What are non-medical treatment options for crohn’s
No specific therapy
• Symptomatic improvement
• Control of disease process
• Smoking cessation
• Diet
• Well balanced diet
• Lactose intolerance
• Obstructive symptoms
• Low roughage diet
• Early introduction of biologic therapy
• Risk factors for aggressive disease
• Young age population
What are medical treatment options for crohn’s
• Suppress acute clinical symptoms
• Does not alter underlying disease
• Prednisone 40-60 mg/day
• Severe disease w/ distal colon or proximal small intestine
• Slow taper, 5 mg/week
• Goal 20 mg/day
• Taper 2.5 mg/week
• Immunomodulators & Biologics
• Used in effort to wean off corticosteroids
• Refer to page 672 - 673 of Current Diagnosis
• Entocort
• Ileal-release budesonide preparation
• 9 mg/day x8-16/wks induces remission (50-70% )
• Mesalamine
• Active or maintenance of remission
• Use for colon, not small bowe
What are surgical indications for crohn’s
• Refractory to medical therapy
• Intraabdominal abscess
• Massive bleeding
• Refractory fistulas
• Obstructions
How are abscesses treated in crohn’s
• Tender abdominal mass w/ fever & leukocytosis
• Stat CT of abdomen/pelvis
• Broad spectrum ABX
• Percutaneous drainage vs surgery
How is an SBO managed with crohn’s
• Small bowel obstruction
• NPO
• NGT
• IVF
• Corticosteroids
• Indicated for active inflammation
• Consult surgery
How is perianal disease managed with crohn’s
• Pelvic MRI
• Proper perianal skin care
• PO ABX
• Anorectal abscess
• Severe, constant perianal pain
• Perianal examination
• Pelvic CT scan
• Surgical drainage needs
• Depends on size & location
