Crohn's Disease Flashcards
What is Crohn’s disease?
Crohn’s disease is a chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract and a type of inflammatory bowel disease (IBD).
What is the typical age range for Crohn’s disease presentation?
Patients typically present between 20-40 years old.
What is the incidence of Crohn’s disease?
The incidence is around 10-20 per 100,000 per year.
What is the aetiology of Crohn’s disease?
The exact cause is unclear, but it involves an inappropriate immune response to an environmental trigger in genetically susceptible individuals.
What percentage of Crohn’s disease patients have a first-degree relative with the disorder?
Approximately 15% of patients have a first-degree relative with the disorder.
Which part of the gastrointestinal tract is most commonly affected by Crohn’s disease?
The small bowel, particularly the terminal ileum, is affected in 80% of cases.
What are common macroscopic features of Crohn’s disease?
Aphthous ulcers, cobblestone appearance, bowel wall thickening, fistulae, and fissures.
What are common microscopic features of Crohn’s disease?
Lymphoid hyperplasia, non-caseating granulomas, and transmural inflammation.
What are the risk factors for developing Crohn’s disease?
Family history, smoking, previous infectious gastroenteritis, NSAID usage, and a diet high in refined sugar and low in fibre.
What are common symptoms of Crohn’s disease?
Abdominal pain (often in the right lower quadrant), diarrhoea (which may be bloody or non-bloody), perianal pain or itching, oral ulcers, nausea, vomiting, fever, fatigue, and weight loss.
What are some extra-intestinal manifestations of Crohn’s disease?
Arthritis, episcleritis, uveitis, conjunctivitis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis, fatty liver, gallstones, nephrolithiasis, anaemia, vitamin B12 deficiency, and thromboembolism.
What initial laboratory investigations are important in suspected Crohn’s disease?
Full blood count, liver function tests, bone profile, iron studies, vitamin B12 and folate levels, C-reactive protein, erythrocyte sedimentation rate, faecal calprotectin, and stool microscopy, culture, and sensitivity.
What imaging studies are useful in the assessment of Crohn’s disease?
Abdominal X-ray, ultrasound, CT scan, and MRI.
What endoscopic procedures are essential for diagnosing Crohn’s disease?
Colonoscopy with biopsy and upper gastrointestinal endoscopy.
What is the first-line treatment for inducing remission in Crohn’s disease?
Corticosteroids such as prednisolone or methylprednisolone.
What medications can be used as add-on treatment in Crohn’s disease?
Thiopurines (e.g., azathioprine, mercaptopurine) and methotrexate.
What biologic therapies are available for Crohn’s disease?
Anti-TNF agents (e.g., infliximab, adalimumab) and integrin receptor antagonists (e.g., vedolizumab).
When is surgical intervention indicated in Crohn’s disease?
In cases of strictures, fistulae, abscesses, or when medical therapy fails to control symptoms.
What are potential complications of Crohn’s disease?
Bowel obstruction, fistulae, abscess formation, malnutrition, colorectal cancer, and growth failure in children.
How does smoking affect Crohn’s disease?
Smoking increases the risk of developing Crohn’s disease and can lead to more severe disease progression.
What is the role of faecal calprotectin in Crohn’s disease?
Faecal calprotectin is a marker of intestinal inflammation and can help differentiate between inflammatory bowel disease and irritable bowel syndrome.
What dietary modifications are recommended for Crohn’s disease patients?
A diet low in refined sugars and high in fibre is recommended; however, during flare-ups, a low-residue diet may be advised to reduce bowel volume.
What is the significance of non-caseating granulomas in Crohn’s disease?
Non-caseating granulomas are a histological feature that can help differentiate Crohn’s disease from other forms of inflammatory bowel disease.
How does Crohn’s disease differ from ulcerative colitis?
Crohn’s disease can affect any part of the gastrointestinal tract and involves transmural inflammation, whereas ulcerative colitis is limited to the colon and rectum and involves only the mucosal layer.
What is the importance of vitamin B12 monitoring in Crohn’s disease?
Vitamin B12 deficiency can occur, especially if the terminal ileum is affected, leading to anaemia and neurological symptoms.
