Crohn's Disease

Question 1

At what age does it most commonly present?

Answer 1

20-40

Question 2

What is Chron’s associated with?

Answer 2

Smoking (3 times the risk), altered immunity, NSAIDs exacerbate the disease

Question 3

Symptoms include?

Answer 3

Diarrhoea, urgency, abdo pain, weight loss, failure to thrive, fever, malaise, anorexia, very smelly stools

Question 4

Signs include?

Answer 4

Aphthous ulcers, abdo tenderness, abdo mass, perianal abscess/fistula do/skin tags

Extra abdominal signs: clubbing, skin, joint and eye problems
Erythema nodosum and pyroderma gangranosum

Question 5

Complications of Chron’s disease include? Name 5…

Answer 5

Small bowel obstruction, toxic dilatation (colon >6cm diameter), abscess formation, fistulae, perforation, rectal haemorrhage, colon cancer, fatty liver, PBC, osteomalacia, renal stones, malnutrition

Question 6

What tests would you do?

Answer 6

Bloods, stool, colonoscopy with rectal biopsy, barium enema

Question 7

What might you see on colonoscopy?

Answer 7

Skip lesions, fissures, fistulae, cobblestone appearance and deep ulcers

Question 8

Conservative treatment?

Answer 8

Deal with psychological issues, smoking cessation, stop NSAIDs and optimise nutrition

Question 9

What treatment would you give for mild attacks? (Symptomatic but systemically well)

Answer 9

Prendisalone 30mg/d 1 week and then 20mg/d for a further 4 weeks. If symptoms resolve then titration downwards and stop steroids as long as parameters normal

Question 10

What is the management for severe attacks?

Answer 10

Give IV hydrocortisone and dextrose saline, metronidazole, monitor and examine daily

If they improve move onto oral Prendisalone, if not give infliximab to reduce inflammation

Question 11

If abdo pain occurs what must you rule out?

Answer 11

Sepsis

Question 12

When is prognosis poorer?

Answer 12

Patients under 30, needing steroids at first presentation, perianal disease, diffuse small bowel disease

Question 13

Which areas of the GI are most commonly affectedin?

Answer 13

Terminal ileum (70%) and proximal colon

Question 14

Crohn’s vs UC

Answer 14

Can be anywhere along GI, skip lesions, transmural ulceration/inflammation, cobblestone appearance, smoking increases risk, thickened bowel wall, pseudopolyps

Question 15

What is Chron’s disease?

Answer 15

A chronic inflammatory GI disease characterised by transmittal granulomatous inflammation affecting any part from the mouth to the anus