Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GASTROENTEROLOGY > Crohn's Disease > Flashcards

Crohn's Disease Flashcards

1
Q

How is it different from UC?

Where is commonly affected?

How does it affect the bowel lining?

A

Forms skip lesions from mouth to anus

Terminal ileum

Transmural (through whole bowel wall) granulomatous inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who is it more common in?

A

Smokers

Younger people more affected compared to UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms:

2 common symptoms

3 more obscure ones

How does it tend to present compared to UC?

A

Diarrhoea - bloody 25% of the time

Lower abdo pain especially RLQ

Weight loss

Fever

Fatigue

More acutely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs:

  • Perianal - 3
  • What might you find in the RIF?
A

Abscess
Fistula
Tags

Mass from inflammation on palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Non-GI signs:

  • Mouth - 1
  • Eyes - 23
  • Nails - 1
  • You also get erythema nodosum and pyoderma
    gangrenosum. Define both of them?

SAME AS UC

A

Aphthous ulcers

Uveitis
Episcleritis
Conjunctivitis

Clubbing

A type of panniculitis, an inflammatory disorder affecting subcutaneous fat. It presents as tender red nodules on the anterior shins. Less commonly, they affect the thighs and forearms

A rare, inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Non-GI signs:

You also get entero-colitis. Define it? - What is it also known as?

You also get sacroiliitis. Define it?

ONLY IN CROHNS

A

Enteropathic arthropathy or enteropathic arthritis refers to acute or subacute arthritis in association with, or as a reaction to, an enteric (usually colonic) inflammatory condition.

Reactive arthritis

Sacroiliitis is a painful condition where either one or both of the sacroiliac joints become inflamed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hepatobiliary signs?

1 - ONLY IN CROHNS

3 other hepatobiliary diseases that may present in conjunction with Crohn’s? - Same as UC

A

Gallstones

Chronic hepatitis
NAFLD
Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors:

Gene mutation

What ethnicity is it more common in?

A

NOD2 mutation

White ethnicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigations - Bloods - Why do you do the following:

  • FBC - 2
  • 2 other things you look for in the blood that could indicate inflammation
  • CRP/ESR
  • U&E, Mg and Ca
  • LFT
  • Antibodies for Crohn’s only
A

FBC - Haemoglobin and haematinics (iron, folate and B12) - patients usually have anaemia

Raised platelets
Low albumin

CRP/ESR - raised in inflammation

Nutritional deficiencies

Hepatobiliary disease

Anti-saccharomyces cerevisiae antibodies (ASCA) - antibodies (70% accurate in Crohn’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Investigations - stool:

What can be done to the stool to rule out infection?

Marker for inflammation and why it is used?

One important bacteria that may cause inflammation or colon and diarrhoea?

A

Culture to rule out infection

Faecal calprotectin

C. diff toxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigations:

What classical signs would you find on endoscopy? - 3

What would biopsy show?

Are crypt changes more common in Crohn’s or UC?

A

Skip lesions
Cobblestone appearance
Aphthous ulcers

Transmural disease with granulomas

It is more common in UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Investigations - imaging

AXR:

  • what might you find on colon? - 2
  • what might you find on the hips? - 1

What is the use of a CT/MRI?

What will a barium enema reveal?

A

Dilation - toxic megacolon, obstruction
Abscesses

Sacroiliitis

Show the disease extent in more detail

Any strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management - Medical - inducing remission in an attack:

What med do you give to induce remission? Route? How long?

What med is given for 2 wks after this? Route?

When is budesonide used?

A

Methylprednisolone IV 3 days

Prednisolone PO

If the disease is isolated to the ileocecal region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management - Medical - inducing remission in an attack:

What should be added if the disease is refractory?

What tends to be done only to kids instead of drugs? Why?

A

Add azathioprine or Mercaptopurine
Add/switch to the biologic

Enteral nutrition therapy for 6-8 wks - either polymeric formula (drinkable) or elemental formula (via NG tube as too gross to drink).

Less effective than steroids in adult but in kids, it’s more effective and doesn’t affect growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management - Medical - maintaining remission:

What one lifestyle change can be done if it is mild?

In what situation would treatment be needed?

What is the first line?

2-second line options?

A

Smoking cessation

Frequent relapses <6 wks
>2 steroids courses per yr
Relapse <6 wks after stopping steroids

5-ASA - Azathioprine or mercaptopurine

Immunosuppressor - Methotrexate
Biologics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Biologics and Janus Kinase Inhibitors:

Why are they used?

Give some examples of Anti-TNFα?

A

For induction and maintenance in refractory moderate-severe disease.

Infliximab
Adalimumab
Golimumab

17
Q

Management - other considerations:

What might provide symptomatic relief?

Rx for upper GI disease?

Meds used for perianal disease? - two ABs and one 5-ASA

Treatment for fistulae

A

Loperamide
Antispasmodic - slows down GI tract

PPI

Metronidazole PO
Ciprofloxacin PO
Topical mesalazine - 5-ASA

Seton insertion - a thin silicone string inserted into the tract - allows drainage and healing

18
Q

Surgical:

% that need surgery for Crohn’s

Indications

What is common after surgery?

A

70%

Medically refractory
Obstruction or perforation from stricture, fistulae and abscesses
Growth failure in kids

Relapse

19
Q

Surgical - Small bowel procedures include resection ad anastomoses.

If an extensive amount of the small bowel is resected, it may cause short gut syndrome. What are some of the symptoms?

What can be done to avoid having to do this for structures?

A

Diarrhoea (due to lack of absorption)

Steatorrhoea (due to lack of absorption)

Electrolyte abnormalities (due to lack of absorption)

Malnutrition - vitamin deficiencies, weight loss and fatigue (due to lack of absorption)

Strictureplasty

20
Q

Surgical - Large bowel procedures:

What is done if in the rectum?

If affecting other parts of the large bowel, what is then done?

A

Panproctocolectomy with ileostomy

Subtotal colectomy with ileorectal anastomosis

21
Q

Surgical:

What can be given post-op to maintain remission?

What deficiency may happen if >20cm is removed?

You can also get some bile salt malabsorption due to the loss of the terminal ileum. What can be given to treat this?

A

Azathioprine plus 3 months of metronidazole

Vitamin B12 deficiency so supplements need to be taken

Cholestyramine - Cholestyramine powder is also used to treat itching caused by a blockage in the bile ducts of the gallbladder.

22
Q

Severe Crohn’s:

4 things to do?

A

IV hydration and electrolytes
IV steroids
Thromboembolism prophylaxis
MC&S/CDT to exclude infection

23
Q

Complications

A

Small bowel obstruction due to bowel thickening and fibrosis leading to stricture
Abscess
Fistula
Cancer though less than in UC

24
Q

Azathioprine

MOA

How long does it take to work?

Side effects

What about 5-ASA?

A

Affects lymphocytes

6-10 wks

Abdominal pain
Nausea
Pancreatitis
Abnormal LFT’s so need monitoring

Has no effect in Crohn’s

GASTROENTEROLOGY (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions