Crohn's Disease

Question 1

Macroscopic Pathology of Crohn’s

Answer 1

Affects any part of the gut

‘Skip lesions’ - discontinuous involvement of gut

‘Cobblestone’ appearance: deep ulceration and fissures

Question 2

Aetiology of Crohn’s

Answer 2

Th1 Dominant - produces pro-inflammatory mediators IL4, IL10 Strong genetic influences

Question 3

What disease is this image characteristic of?

What features do they show?

Answer 3

Crohn’s disease

Shows cobblestone apperance - deep ulceration and fissures

Question 4

Histology - Crohn’s disease

Answer 4

Transmural inflammation

Granulomas may be present

Question 5

Clinical features of Crohn’s disease

Answer 5

Dependent on region involved

Ileocaecal commonest site

Abdominal pain

Weight loss

Recurrent diarrhoea +/- blood & mucus

Tiredness

Anorexia

Question 6

Investigations for Crohn’s

Answer 6

FBC - anaemia of chronic disease (normochromic/normocytic)

Raised platelets, ESR and CRP

Endoscopy & rectal biopsy for histology

MRI/CT - show thickened bowel

X-ray

Question 7

Management of Crohn’s

Answer 7

STOP SMOKING
5-aminosalicyclic acid eg olsalazine, mesalazine, balsalazide to induce remission

Corticosteroid: Prednisiolone 40mg OD for acute attacks

Azothioprine - frequent relapses

SEs - bone marrow suppression, acute pancreatitis, allergies (Weekly FBC then tri-monthly)

Liquid enteral nutrition

Metronidazole - severe peri-anal Crohn’s

Methotrexate - active Crohn’s

Infliximab - steroid resisting Crohn’s, fistulating disease