CROHN'S DISEASE

Question 1

WHEN DOES CROHN’S DISEASE PRESENT?

Answer 1

• bimodal presentation

- 15 to 30 years and 60 to 80 years

Question 2

WHAT IS THE PATHOPHYSIOLOGY OF CROHN’S DISEASE?

Answer 2

• inflammation of the large bowel

- affect any part of GI tract (mouth to anus) - commonly distal ileum or proximal colon

Question 3

WHAT ARE THE CHARACTERISTICS OF CROHN’S DISEASE?

Answer 3

• transmural inflammation
• discontinuous inflammation (skip lesion)
• deep ulcers and fissure (cobblestone appearance)
• fistula formation
• non-caseating granulomatous inflammation

Question 4

WHAT ARE THE RISK FACTORS FOR CROHN’S DISEASE?

Answer 4

• FHx
• Smoking
• White European descent
• Appendicectomy

Question 5

WHAT ARE THE CLINICAL FEATURES OF CROHN’S DISEASE

Answer 5

• episodic abdominal pain - colicky and vary in site (usually right lower quadrant)
• diarrhoea - blood or mucus
• systemic features- malaise, anorexia, pyrexia

Question 6

WHAT IS FOUND ON EXAMINATION OF ABDOMEN?

Answer 6

• abdominal tenderness
• mouth or perianal lesions
• signs of malabsorption or dehydration

Question 7

WHAT INVESTIGATIONS ARE AVAILABLE FOR CROHN’S DISEASE?

Answer 7

1) Stool sample - faecal calprotectin, H.pylori (rule out infective cause)
2) Blood tests - FBC (anaemia, inflammation), CRP
3) Colonoscopy with biopsy (gold standard)
4) CT abdominal scan- severe crohn’s for obstruction and perforation

Question 8

WHAT IS THE MANAGEMENT FOR AN ACUTE ATTACK?

Answer 8

1) Aggressive fluid resuscitation
2) Nutritional support
3) Prophylactic heparin
4) Anti-embolic stocking
5) Corticosteroid therapy - IV hydrocortisone or oral prednisolone
6) Immunosuppressive agents - mesalazine or azathioprine

Question 9

HOW DO YOU MAINTAIN REMISSION IN CROHN’S DISEASE?

Answer 9

1) Immunomodulators - azathioprine or methotrexate
2) Smoking cessation
3) Colonoscopic surveillance - risk of colorectal malignancy

Question 10

WHAT IS THE SURGICAL MANAGEMENT FOR CROHN’S DISEASE?

Answer 10

• provided for those who failed medical management, severe complication, growth impairment
  1) Ileocaecal resection (remove terminal ileum and caecum

Question 11

WHAT ARE THE COMPLICATIONS OF CROHN’S DISEASE?

Answer 11

1) GI - fistula, stricture (due to inflammation leading to small bowel obstruction), GI malignancy, toxic megacolon, bowel perforation
2) Extraintestinal - malabsorption (growth delay for children), osteoporosis (steroid use, secondary to malabsorption)

Question 12

WHAT IS TOXIC MEGACOLON?

Answer 12

inflammatory bowel diseases cause the colon to expand, dilate, and distend (>6cm). When this happens, the colon is unable to remove gas or feces from the body. If gas and feces build up in the colon, your large intestine may eventually rupture.