Crohn's Disease Flashcards
def
chronic granulomatous inflammatory disease which can affect any part of the GI tract
what conditions make up IBD
UC
CD
aetiology
genetic & environmental factors
inflammation can occur anywhere along the GI tract (40% in terminal ileum)
what is the inflammation like along the bowel in crohn’s disease
‘skip’ lesions
inflamed segments of bowel interspersed with normal segments
epi
incidence 5-8/100,00PA in the UK
affects any age but peak incidence is in teens & twenties
examination
weight loss clubbing signs of anaemia mouth ulcers perianal skin tags, fistulae, abscesses
investigations
1 bloods -FBC (low Hb, high platelets, high WCC) -UEs -LFTs (low albumin) -ESR/CRP 2 stool microscopy & culture -to exclude infective colitis 3 AXR -to exclude toxic megacolon 4 small bowel barium follow-through -fibrosis (string sign of Kantor) -deep ulceration (rose thorn) -cobblestone mucosa 5 endoscopy, colonoscopy & biopsy -to differentate between UC & CD
management of acute exacerbation
fluid resuscitation
corticosteroids
5-ASA analogues (mesalazine, sulfasalazine) may induce remission
analgesia
management of long term CD
1 steroids for acute exacerbations
2 5-ASA analogues (sulfasalazine, mesalazine) reduces relapses
3 immunosuppresion with steroid sparing-agents (azathioprine, 6-mercaptopurine, methotrexate) to reduce relapses
4 anti-TNF agents (infliximab) are very good at acheiving remission
management advice
stop smoking
management surgery
if failure of medical treatment, or failure to thrive in children, or presence of complications
resection of affected bowel & stoma formation
history
crampy abdominal pain
diarrhoea (bloody)
fever, malaise, weight loss
complications
GI -haemorrhage -bowel strictures -perforation -fistulae (between bowel, bladder, vagina) -GI carcinoma extraintestinal features -uveitis -gallstones -kidney stones -ankylosing spondylitis
prognosis
chronic relapsing condition
2/3 will require surgery
