Crohn's Disease Flashcards
What layer of the GI wall is affected in Crohn’s?
Trans-mural (whole wall) inflammation
What is the peak onset age of Crohn’s?
20-30
What are the symptoms of Crohn’s?
- Diarrhoea ± blood
- Rectal bleeding
- Right ileac fossa pain (cramping)
- Weight loss and anorexia
- Perianal abscesses/anal fissure
- Frequency and urgency
- Malaise
- Malnutrition
- Oral ulceration
- Fistula formation (can destroy sphincter muscles)
- Systemic symptoms (10-15%)
What is Crohn’s often misdiagnosed as?
Anorexia or IBS
How many patients need surgery in their lifetime?
70-80% (50% in first 10 years)
What does the Montreal classification do?
Classify Crohn’s by age at diagnosis, location and behaviour
What cell drives the Crohn’s inflammatory response?
T cells
What genetic defect is associated with Crohn’s?
NOD2 (receptor on Paneth cells) defect - recognise good and bad bacteria, good bacteria get through lining and set up immune reactive response
What are the 5 types of disease distribution?
1) Ileo-colonic
2) Ileal (most have some form of ileal disease)
3) Colonic
4) Perianal
5) Upper GI
What are signs of Crohn’s?
- Cachexia
- Abdominal mass
- Scars from previous operations
- Stomas (often 2-3)
- Parenteral nutrition
What investigations are done to diagnose Crohn’s?
1) Blood tests
2) Faecal calprotectin
3) Endoscopy
4) Histology
5) Imaging
What blood test results would you see in Crohn’s?
Anaemia and low B12, folate, ferritin and albumin
What would you see in endoscopy for Crohn’s?
Discrete ulcers
What would you see in histology and what does it help distinguish between?
- Granulomas and white cells
- Distinguishes between UC and Crohn’s
What imaging would you do in Crohn’s?
- MRI small bowel (would see inflammatory strictures)
- MRI pelvis
- Small bowel ultrasound
How do you treat Crohn’s short term?
1) Steroids
2) Antibiotics - ciprofloxacin, metronidazole
How do you treat Crohn’s long term?
1) Immunosuppressants
2) Biologics
3) Enteral modulen (nutrition)
4) Surgery
Describe enteral modulen (nutrition)
- Anti-inflammatory properties
- Especially useful in paediatrics and pre-surgery
- If live on this for a few months, can cure Crohn’s, get nutrition but give bowel a rest
- Can give in combination with diet, dietician advice
Describe surgery for Crohn’s
- Can’t cure like UC
- If remove bowel it will come back and there is a limited amount of bowel can remove (short bowel syndrome)
- Lifetime risk 80%
- Examination under anaesthetic (EUA) - perianal abscess/fistula
- Stricturoplasty - removal of small bowel structure
- Colectomy
- Diverting colostomy/ileostomy (stomas) - temporary or permanent
What are most of the surgeries for Crohn’s?
Operations for fistulas and abscesses
What is a common way to do surgery for Crohn’s?
- Not removing bowel, just opening up areas so that food can get through
- Cut and stitch the other way
What kind of surgery might be done for someone with ileo-colonic Crohn’s and a fibrotic stricture?
Right hemicolecotmy
Why is it difficult to keep patients taking the medication?
Bc patients don’t feel any different on them, and worsens immune system
How might someone with acute Crohn’s present?
- 2 weeks of worsening abdominal pain
- Feverish
- Tender in RIF
- Cachectic
- Weight loss 50kg to 43kg
- CRP 150
