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5_Paeds > Crohn's Disease > Flashcards

Crohn's Disease Flashcards

1
Q

What is the definition of Crohn’s disease?

A

A transmural, focal, subacute/chronic inflammatory disease that can affect any part of the GI tract

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2
Q

What has happened to the incidence of Crohn’s disease over the last 20 years?

A

Increased incidence

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3
Q

What % of patients present with Crohn’s disease in adolescence?

A

25%

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4
Q

How common is Crohn’s disease in children compared to ulcerative colitis?

A

More common

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5
Q

Where does Crohn’s disease most commonly affect?

A

Distal ileum and proximal colon

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6
Q

What is the pathophysiology of Crohn’s disease?

A

Acutely inflamed thickened bowel –> strictures of bowel and fistulae between adjacent loops of bowel or bowel and skin/vagina/bladder

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7
Q

What is the aetiology of Crohn’s disease?

A

Combination of genetics + gut microbiome + mucosal immunity

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8
Q

What is the classical presentation of Crohn’s disease?

A

Abdo pain
Diarrhoea
Weight loss

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9
Q

What other features may be present in Crohn’s disease?

A

General ill health (fever, lethargy etc.)
Growth failure/delayed puberty
Extraintestinal manifestations

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10
Q

What are the extraintestinal manifestations of Crohn’s disease?

A

Oral lesions
Uveitis
Arthralgia
Erythema nodosum

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11
Q

What are the investigation categories for Crohn’s disease?

A

Bloods
Imaging - upper GI endoscopy, ileocolonoscopy, and histology
Small bowel imaging

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12
Q

What findings may be found from blood tests in Crohn’s disease?

A

Increased platelet count
Raised ESR and CRP
Iron deficiency anaemia
Decreased serum albumin

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13
Q

What findings from imaging would suggest Crohn’s disease?

A

Non-caseating epithelioid cell granulomata

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14
Q

What findings from small bowel imaging would suggest Crohn’s disease?

A

Narrowing, fissuring, mucosal irregularities

Bowel wall thickening

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15
Q

What is involved in the management of Crohn’s disease?

A 
Nutritional therapy
Systemic steroids
Immunosuppressant
Biologic agents
Surgery
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16
Q

What treatment is used to induce remission at first presentation of Crohn’s disease?

A

Nutritional therapy

Systemic steroids

17
Q

What is used to treat relapses of Crohn’s disease?

A

Immunosuppressive therapy

18
Q

What is involved in nutritional therapy for Crohn’s disease?

A

When the normal diet is replaced with whole protein modular feeds (polymeric diet) for 6-8 weeks

19
Q

In what % of cases of Crohn’s disease is nutritional therapy effective?

A

75%

20
Q

What systemic glucocorticosteroids are given for Crohn’s disease?

A

Prednisolone
Methylprednisolone
Hydrocortisone

21
Q

What are the immunosuppressant therapy options for Crohn’s disease?

A

Azathioprine
Mercaptopurine
Methotrexate

22
Q

What is the caution that needs to be taken when prescribing immunosuppressant therapy for Crohn’s disease and why?

A

Assess TPMT activity, because it is the enzyme that breaks these drugs down and if there is decreased activity, it is a contraindication

23
Q

What is the advantage of using methotrexate for Crohn’s disease?

A

Is an alternative if TPMT activity is reduced

24
Q

What is the role of biologic agents in the management of Crohn’s disease?

A

Used if conventional treatments have failed

25
Q

What biologic agents can be used in the management of Crohn’s disease?

A

Anti-TNF alpha agents - infliximab

Adalimumab

26
Q

What is the role of surgery in the management of Crohn’s disease?

A

To treat the complications of Crohn’s disease

27
Q

What complications of Crohn’s disease can surgery treat?

A

Obstruction
Fistulae
Abscess formation
Severe localised disease unresponsive to treatment

28
Q

What drugs are used to maintain remission of Crohn’s disease?

A

Azathioprine/mercaptopurine (if not used to induce remission)
Methotrexate (if the above has already been used)

29
Q

What is the management of oral manifestations of Crohn’s disease?

A

Topical steroids (although evidence is uncertain)

30
Q

What is the management of arthralgia in Crohn’s disease?

A

Sulfasalazine
Analgesics
Local steroid injections

31
Q

What is the management of erythema nodosum in Crohn’s disease?

A

Corticosteroids

32
Q

What is the management of pyoderma gangrenosum in Crohn’s disease?

A

Topical/systemic steroids

33
Q

What is the management of uveitis in Crohn’s disease?

A

Topical and/or systemic steroids

34
Q

What is the prognosis of Crohn’s disease?

A

Good if treatment is started in childhood

35
Q

What % of children with Crohn’s disease will not need immunosuppression or surgery?

A

30%

5_Paeds (18 decks)

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