Crohn's disease

Question 1

Montreal classification

Answer 1

Stricturing
- obstructing / fibrosis

Penetrating
- fistula / free perforation

Nonstricturing non penetrating

Question 2

Continuous versus patch

Answer 2

Crohn can make both

Question 3

Typical of Crohn

Answer 3

Anal disease

Question 4

Lab

Answer 4

ASCA positive p-ANCA negative

Question 5

Indications for surgery

Answer 5

Massive lower GI bleeding
(although primary conservative, endoscopic vs highly selective coiling) - total abdominal colectomy +/- PA +/- ileostomy.

Severe colitis, fulminant colitis, toxic megacolon
If free perforation, shock, etc - total abdominal colectomy with end ileostomy

Stricture

• segment or colectomy depending on extent
• 7% of colonic strictures harbour adenocarcinoma