Crohn's Disease

Question 1

What is Crohn’s disease?

Answer 1

Crohn’s disease (CD) is a disorder of unknown aetiology characterised by transmural inflammation of the gastrointestinal (GI) tract.

Question 2

What are risk factors for Crohn’s Disease?

Answer 2

white ancestry
age 15-40 or 60-80 years
family history of CD

Question 3

How does Crohn’s come about?

Answer 3

Trigger
Lesion with inflammatory infiltrates around intestinal crypts causing ulceration of superficial mucosa and deepens.

Also involves lymph nodes.
Hyperaemia and oedema of inflamed mucosa.
Leads to bowel obstruction
HISTOPATHOLOGY= cobblestone appearance in gut

Question 4

What is the epidemiology of Crohn’s?

Answer 4

Highest incidence in Northern climates and more developed areas.
Equally prevalent men and women
Higher in white and Ashkenazi Jews
May be higher in smokers

Question 5

What may you find in the history and examination of someone with Crohn’s disease?

Answer 5

abdominal pain
prolonged diarrhoea
perianal lesions
bowel obstruction
blood in stools
fever
fatigue
abdominal tenderness

Question 6

What investigations may you do for Crohns?

Answer 6

Bloods
> FBC (anaemia, leuc)
> Iron studies (def.)
> Serum B12 (N/L)
> Serum folate (N/L)
> Metabolic panel (hypo nutrient)
> CRP/ ESR (elev.)

Stool test (rule out infection)

Yersinia sero (neg.)

Plain abdo film (inflammation, calcifications, abcsesses)

CT Abdo (skip lesions, bowel wall thickening, surrounding inflammation, abscess, fistula)

MRI Abdo/ Pelvis (skip lesions etc. same as CT)

Question 7

How do you manage Crohn’s?

Answer 7

Treating the inflammation:
> Observation then budesonide plus 5ASA (e.g. pentasa, mesalazine)
> Conventional steroids
> Biologic therapy (e.g. Infliximab)
> Azathioprine

Symptoms and risk management:
> LIfestyle and nutritional advice
> PPI
> Antispasmodic and antidiarrhoeal

Question 8

What are the complications of Crohn’s Disease?

Answer 8

> Obstruction
> Sepsis
> Toxic megacolon
> Anaemia
> Malignancy
> Short bowel syndrome
> Absorption and metabolic disorders
> Extraintestinal complications

Question 9

Do Crohn’s die?

Answer 9

Yes, life expectancy is decreased with Crohn’s disease as time spent with the disease goes on.