Crohn's Disease Flashcards
What is the definition of Crohn’s disease?
A transmural, focal, subacute/chronic inflammatory disease that can affect any part of the GI tract
What has happened to the incidence of Crohn’s disease over the last 20 years?
Increased incidence
What % of patients present with Crohn’s disease in adolescence?
25%
How common is Crohn’s disease in children compared to ulcerative colitis?
More common
Where does Crohn’s disease most commonly affect?
Distal ileum and proximal colon
What is the pathophysiology of Crohn’s disease?
Acutely inflamed thickened bowel –> strictures of bowel and fistulae between adjacent loops of bowel or bowel and skin/vagina/bladder
What is the aetiology of Crohn’s disease?
Combination of genetics + gut microbiome + mucosal immunity
What is the classical presentation of Crohn’s disease?
Abdo pain
Diarrhoea
Weight loss
What other features may be present in Crohn’s disease?
General ill health (fever, lethargy etc.)
Growth failure/delayed puberty
Extraintestinal manifestations
What are the extraintestinal manifestations of Crohn’s disease?
Oral lesions
Uveitis
Arthralgia
Erythema nodosum
What are the investigation categories for Crohn’s disease?
Bloods
Imaging - upper GI endoscopy, ileocolonoscopy, and histology
Small bowel imaging
What findings may be found from blood tests in Crohn’s disease?
Increased platelet count
Raised ESR and CRP
Iron deficiency anaemia
Decreased serum albumin
What findings from imaging would suggest Crohn’s disease?
Non-caseating epithelioid cell granulomata
What findings from small bowel imaging would suggest Crohn’s disease?
Narrowing, fissuring, mucosal irregularities
Bowel wall thickening
What is involved in the management of Crohn’s disease?
Nutritional therapy Systemic steroids Immunosuppressant Biologic agents Surgery
What treatment is used to induce remission at first presentation of Crohn’s disease?
Nutritional therapy
Systemic steroids
What is used to treat relapses of Crohn’s disease?
Immunosuppressive therapy
What is involved in nutritional therapy for Crohn’s disease?
When the normal diet is replaced with whole protein modular feeds (polymeric diet) for 6-8 weeks
In what % of cases of Crohn’s disease is nutritional therapy effective?
75%
What systemic glucocorticosteroids are given for Crohn’s disease?
Prednisolone
Methylprednisolone
Hydrocortisone
What are the immunosuppressant therapy options for Crohn’s disease?
Azathioprine
Mercaptopurine
Methotrexate
What is the caution that needs to be taken when prescribing immunosuppressant therapy for Crohn’s disease and why?
Assess TPMT activity, because it is the enzyme that breaks these drugs down and if there is decreased activity, it is a contraindication
What is the advantage of using methotrexate for Crohn’s disease?
Is an alternative if TPMT activity is reduced
What is the role of biologic agents in the management of Crohn’s disease?
Used if conventional treatments have failed
What biologic agents can be used in the management of Crohn’s disease?
Anti-TNF alpha agents - infliximab
Adalimumab
What is the role of surgery in the management of Crohn’s disease?
To treat the complications of Crohn’s disease
What complications of Crohn’s disease can surgery treat?
Obstruction
Fistulae
Abscess formation
Severe localised disease unresponsive to treatment
What drugs are used to maintain remission of Crohn’s disease?
Azathioprine/mercaptopurine (if not used to induce remission)
Methotrexate (if the above has already been used)
What is the management of oral manifestations of Crohn’s disease?
Topical steroids (although evidence is uncertain)
What is the management of arthralgia in Crohn’s disease?
Sulfasalazine
Analgesics
Local steroid injections
What is the management of erythema nodosum in Crohn’s disease?
Corticosteroids
What is the management of pyoderma gangrenosum in Crohn’s disease?
Topical/systemic steroids
What is the management of uveitis in Crohn’s disease?
Topical and/or systemic steroids
What is the prognosis of Crohn’s disease?
Good if treatment is started in childhood
What % of children with Crohn’s disease will not need immunosuppression or surgery?
30%
