Crohn's Disease Flashcards
What is Crohn’s Disease?
A chronic inflammatory disease characterized by transmural granulomatous inflammation affecting any part of the gut from mouth to anus (esp. terminal ileum in ~70%).
What are the features of Crohn’s?
F>M
Smoking increases risk, NSAIDs may exacerbate disease
Location - mainly distal ileum and caecum
Histology - transmural involvement
Pathology - mouth to anus. Unlike UC, there is unaffected bowel between areas of active disease (skip lesions).
Crohn’s colitis - rectal sparring and peri-anal disease
What are the symptoms of Crohn’s?
Diarrhoea, abdominal pain, weight loss/failure to thrive.
Systemic symptoms: fatigue, fever, malaise, anorexia.
What the signs of Crohn’s?
Bowel ulceration, abdominal tenderness/mass; perianal disease - abscess/ fistulae/skin tags; anal strictures.
What the complications of Crohn’s?
Small bowel obstruction; Toxic dilatation (colonic diameter >6cm, toxic dilatation is rarer than in UC);
Abscess formation (abdominal, pelvic, or peri- anal); fistulae (present in ~10%)
Perforation
Colon cancer
malnutrition
What are the tests and investigations for Crohn’s?
Blood: FBC, ESR, CRP, U&E, LFT, INR, ferritin, TIBC, B12, folate
Stool: MC&S and CDT, faecal calprotectin
Colonoscopy + Biopsy
Small Bowel - MR enteroclysis, double balloon enterscopy, pillcam, enema
What is used to manage Crohn’s?
Smoking cessation
Mild to moderate - Symptomatic but systemically well. Prednisolone 40mg/d PO for 1wk, then taper by 5mg every wk for next 7wk - induce remission
Teaching - topical budenoside
How is severe disease managed?
Admit for IV hydration/electrolyte replacement; IV steroids, eg hydrocortisone 100mg/6h, thromboembolism prophylaxis; ensure multiple stool MC&S/CDT to exclude infection
How is perianal disease managed?
Oral antibiotics, immunosuppressant therapy ± anti-TNFalpha, and local surgery ± seton insertion
What are alternative therapies in Crohn’s?
Azathioprine - if refractory to steroids
Anti-TNFalpha e.g. infliximab, adalimumab
Surgery - aims: resect affected area, control perianal or fistulising disease, defunction distal disease
When is surgery required?
Drug failure (most common); GI obstruction from stricture; perforation; fistulae; abscess formation.
What histological changes are seen in cronh’s?
Granuloma, goblet cells, inflammation in all layers from mucosa to serosa
What is the sign of small bowel stricture?
Kantor’s string sign
What are the extra-intestinal features?
Uveitis, arthritis, erythema nodosum, Pyoderma gangrenosum, Primary sclerosing cholangitis
What is used to maintain remission?
azathioprine or mercaptopurine
