Crohn's disease

Question 1

Sx of Crohn’s disease

Answer 1

• intermittent frequent diarrhoea/ urgency
• diffuse abdominal pain
• weight loss, malaise, fever, anorexia
• N/V
• affect whole GIT from mouth to anus
• skip lesion (unaffected area between area of active disease)
• smoking increase risk (opposite to UC)
• bimodal onset age: 20-30 and 60-70

Question 2

Signs of Crohn’s disease

Answer 2

• aphthous ulceration (mouth)
• abdominal tenderness and mass
• perianal abscess, skin tag, fistula, anal stricture
• erythema nodosum
• arthritis
• conjunctivitis, iritis, episcleritis
• clubbing

Question 3

Complications of Crohn’s disease

Answer 3

1. megacolon -> perforation
2. SBO
3. abscess formation
   - high swinging fever
   - localised tenderness
   - palpable mass
4. oseteomalacia, osteoporosis
5. malabsorption
6. increased risk of gallstone, renal stone
7. renal disease
8. risk of GI cancer

Question 4

Investigation for Crohn’s diseaes

Answer 4

Blood - FBE, CRP, ESR, U&E, LFT, INR, ferritin, B12, folate

Stool MC&S - exclude infection

Colonoscopy + rectal biopsy - assess diseaes extent

Small bowel enema - detect ileal disease

Question 5

Management of Crohn’s disease

Answer 5

Multidisciplinary

• steroid - prednisolone po and wean off when get better
• quit smoking
• mental health; brutal disease
• optimize nutrition

if severe,

• admit for NBM, IV rehydration
• prednisolone IV & hydrocortisone IV
• metronidazole for perianal disease (superimposed infection)
• monitor T, P, BP, stool
• consider need for blood transfusion (anaemia)
• if medical intervention fails, consider immunomodulation
• consult surg if abdominal sepsis