CROHN'S DISEASE

Question 1

Crohn’s Disease

Answer 1

• Chronic, inflammatory bowel disease that affects the whole GI tract.
• Associated with thickened wall, extending through all layers, with deep ulceration

Question 2

How does Crohn’s disease present?

Answer 2

• may present as recurrent attacks, with acute exacerbations
• combined with periods of remission or less active disease.

Question 3

Symptoms

Answer 3

Symptoms depend on the site of disease but may include
abdominal pain
diarrhoea
fever
weight loss
rectal bleeding

Question 4

May lead to complications such as:

Answer 4

Intestinal strictures or fistulae
Anaemia and malnutrition
Colorectal and small bowel cancers
Growth failure and delayed puberty in children.
Extra-intestinal manifestation: arthritis or joints, eyes, liver and skin abnormalities

Question 5

Acute treatment: first flare up in 12 month period

Answer 5

• Monotherapy with either prednisolone, methylprednisolone or IV hydrocortisone
• If patient has distal ileal, ileocaecal or right sided disease:
  Use budesonide if normal treatment doesn’t work
• Aminosalicylates may be used (sulfasalazine or mesalazine)
  Less side-effects, but less effective

Question 6

If patient has distal ileal, ileocaecal or right sided disease: acute

Answer 6

Use budesonide if normal treatment doesn’t work

Question 7

Acute treatment: 2 + flare up in 12 month period

Answer 7

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

Question 8

Treatment - maintenance

Answer 8

• Encourage the person to stop smoking
• Monotherapy of either azathioprine or mercaptopurine
• Alternative = methotrexate

Question 9

Treatment - after surgery

Answer 9

After surgery:
Azathioprine + Metronidazole
Azathioprine alone if metronidazole is not tolerated

Question 10

Diarrhoea in Crohn’s

Answer 10

Loperamide
Codeine
Colestyramine

Question 11

Diarrhoea in Crohn’s vs UC

Answer 11

In Crohn’s we can use loperamide and codeine
But in UC we can’t

Question 12

Fistulating CD

Answer 12

When a fistula develops between intestine and perianal skin, bladder, and vagina

Question 13

What do you do if fistulating CD is asymptomatic?

Answer 13

Can be left alone if asymptomatic

Question 14

What do you do if fistulating CD is symptomatic?

Answer 14

To improve symptoms (not fully heal):
Metronidazole +/ - Ciprofloxacin
Metronidazole given usually for 1 month (no longer than 3 months due to peripheral neuropathy)

Question 15

Maintenance in fistulating CD

Answer 15

Azathioprine or mercaptopurine (infliximab if not responding)
Treatment must last at least one year