Crohn's Disease

Question 1

What is Crohn’s disease?

Answer 1

Crohn’s disease is a chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract and a type of inflammatory bowel disease (IBD).

Question 2

What is the typical age range for Crohn’s disease presentation?

Answer 2

Patients typically present between 20-40 years old.

Question 3

What is the incidence of Crohn’s disease?

Answer 3

The incidence is around 10-20 per 100,000 per year.

Question 4

What is the aetiology of Crohn’s disease?

Answer 4

The exact cause is unclear, but it involves an inappropriate immune response to an environmental trigger in genetically susceptible individuals.

Question 5

What percentage of Crohn’s disease patients have a first-degree relative with the disorder?

Answer 5

Approximately 15% of patients have a first-degree relative with the disorder.

Question 6

Which part of the gastrointestinal tract is most commonly affected by Crohn’s disease?

Answer 6

The small bowel, particularly the terminal ileum, is affected in 80% of cases.

Question 7

What are common macroscopic features of Crohn’s disease?

Answer 7

Aphthous ulcers, cobblestone appearance, bowel wall thickening, fistulae, and fissures.

Question 8

What are common microscopic features of Crohn’s disease?

Answer 8

Lymphoid hyperplasia, non-caseating granulomas, and transmural inflammation.

Question 9

What are the risk factors for developing Crohn’s disease?

Answer 9

Family history, smoking, previous infectious gastroenteritis, NSAID usage, and a diet high in refined sugar and low in fibre.

Question 10

What are common symptoms of Crohn’s disease?

Answer 10

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.

Question 11

What are some extra-intestinal manifestations of Crohn’s disease?

Answer 11

Arthritis, episcleritis, uveitis, conjunctivitis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis, fatty liver, gallstones, nephrolithiasis, anaemia, vitamin B12 deficiency, and thromboembolism.

Question 12

What initial laboratory investigations are important in suspected Crohn’s disease?

Answer 12

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.

Question 13

What imaging studies are useful in the assessment of Crohn’s disease?

Answer 13

Abdominal X-ray, ultrasound, CT scan, and MRI.

Question 14

What endoscopic procedures are essential for diagnosing Crohn’s disease?

Answer 14

Colonoscopy with biopsy and upper gastrointestinal endoscopy.

Question 15

What is the first-line treatment for inducing remission in Crohn’s disease?

Answer 15

Corticosteroids such as prednisolone or methylprednisolone.

Question 16

What medications can be used as add-on treatment in Crohn’s disease?

Answer 16

Thiopurines (e.g., azathioprine, mercaptopurine) and methotrexate.

Question 17

What biologic therapies are available for Crohn’s disease?

Answer 17

Anti-TNF agents (e.g., infliximab, adalimumab) and integrin receptor antagonists (e.g., vedolizumab).

Question 18

When is surgical intervention indicated in Crohn’s disease?

Answer 18

In cases of strictures, fistulae, abscesses, or when medical therapy fails to control symptoms.

Question 19

What are potential complications of Crohn’s disease?

Answer 19

Bowel obstruction, fistulae, abscess formation, malnutrition, colorectal cancer, and growth failure in children.

Question 20

How does smoking affect Crohn’s disease?

Answer 20

Smoking increases the risk of developing Crohn’s disease and can lead to more severe disease progression.

Question 21

What is the role of faecal calprotectin in Crohn’s disease?

Answer 21

Faecal calprotectin is a marker of intestinal inflammation and can help differentiate between inflammatory bowel disease and irritable bowel syndrome.

Question 22

What dietary modifications are recommended for Crohn’s disease patients?

Answer 22

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.

Question 23

What is the significance of non-caseating granulomas in Crohn’s disease?

Answer 23

Non-caseating granulomas are a histological feature that can help differentiate Crohn’s disease from other forms of inflammatory bowel disease.

Question 24

How does Crohn’s disease differ from ulcerative colitis?

Answer 24

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.

Question 25

What is the importance of vitamin B12 monitoring in Crohn’s disease?

Answer 25

Vitamin B12 deficiency can occur, especially if the terminal ileum is affected, leading to anaemia and neurological symptoms.