Crohn's disease

Question 1

What is it?

Answer 1

Inflammation of the GI tract from mouth to anus

Question 2

Symptoms

Answer 2

Abdominal pain
Diarrhoea
Weight loss
Low grade fever
Fatigure

Question 3

Complications

Answer 3

• Intestinal strictures, abscesses, fistulae
• Malnutrition, anaemia
• Colorectal cancer/small bowel cancers
• Growth failure + delayed puberty (kids)
• Arthritis
• Osteoporosis
• Abnormalities of joints, liver or skin

Question 4

Lifestyle advice

Answer 4

High fibre diet
Smoking cessation = reduced risk of relapse
Loperamide or codeine to treat diarrhoea

Question 5

1st presentation OR 1 acute flare up in 12 months

Answer 5

1st line = corticosteroid (prednisolone, methylprednisolone, IV hydrocortisone)

Alternative = budesonide or aminosalicylate in patients with distal ileal, ileocaecal or right-sided colonic disease

Question 6

2+ acute flare ups in 12 months OR corticosteroid dose cannot be reduced

Answer 6

1st line = azathioprine or mercaptopurine
Alternative = methotrexate
Last resort = monoclonal antibodies under specialist supervision in acute flare ups

Question 7

Maintenance of remission

Answer 7

Azathioprine or mercaptopurine
Alternative = methotrexate

Question 8

Maintenance of remission after surgery

Answer 8

Azathioprine or mercaptopurine or aminosalicylates