Crohn's Disease Flashcards
Define Crohn’s disease
Chronic granulomatous transmural inflammatory disease that can affect any part of the gastrointestinal tract from the mouth to the anus. The most commonly affected part of the gut in CD is the terminal ileum (70%)
Crohn’s Diseases is characterised by cobbles-tone appearance, skip lesions and transmural inflammation, which is responsible for stricture and fistula formation.
What are the causes/risk factors of Crohn’s?
Unknown aetiology but there seems to be interplay between genetic and environmental factors Genetic factors: • Family history (greater genetic association in CD than UC) • CARD15 (NOD2) • HLA-B27 • Increased serum p-ANCA
Environmental factors: • Smoking (increases risk of CD but reduces risk of UC) • NSAIDs • High sugar and fat intake • Chronic stress and depression • Intestinal dysbiosis
What are the symptoms of Crohn’s?
• Abdominal pain/cramps • Diarrhoea • Fever • Fatigue/malaise • Weight loss • Diarrhoea (may contain blood) • Steatorrhoea • Diarrhoea at night
What are the signs of Crohn’s?
- Weight loss
- Clubbing
- Abdominal tenderness
- Signs of anaemia
- Aphthous ulcers
Perianal lesions • Skin tags • Fistulae • Abscesses • Scarring
Signs of bowel obstruction • Bloating • Abdominal distension • Abdominal pain/cramps • Borborgymus • Vomiting • Constipation
Extragastrointestinal manifestations • Eyes - Uveitis, episcleritis, conjunctivitis • Joints - Arthropathy - Ankylosing spondylitis • Skin - Erythema nodosum - Pyoderma gangrenosum • Hepatobiliary - Primary sclerosing cholangitis - Cirrhosis - Gallstones
What investigations are carried out for Crohn’s?
Bloods • FBC - Low Hb, high WCC, high platelet count • Raised ESR/CRP • Low albumin • Deranged LFTs (associated liver disease) • Iron studies - Iron, ferritin, TIBC, transferrin saturation • B12 and folate
OGD or colonoscopy • Monitor disease severity/progression • Cobblestone mucosa • Fistulae/abscesses • Granulomas
Small bowel barium follow-through • Deep ulceration • Fibrosis/strictures • Cobblestone mucosa CT/MRI
Stool • MC&S – exclude infectious colitis • Faecal calprotectin – indicates migration of neutrophils to intestinal mucosa i.e. inflammation; distinguishes IBD from IBS and assesses disease severity
AXR – dilated bowel loops indicates ileus,
exclude toxic megacolon
What is the management for Crohn’s?
Conservative
• Education and advice
• Smoking cessation
• Refer to dietician
Medical
• 5-ASA analogues e.g. mesalazine, sulfasalazine
• Steroids e.g. prednisolone, budesonide
• Immunosuppressants e.g. azathioprine, cyclosporin, mercaptopurine, methotrexate
• TNF-alpha inhibitors e.g. infliximab, adalimumab
Inducing remission • Prednisolone • Budesonide • 5-ASA • Azathioprine, mercaptopurine • Infliximab, adalimumab
Maintaining remission
• Azathioprine
• Mercaptopurine
• Methotrexate
Indications for surgery
• Failure of medical therapy
• Complications
• Failure to thrive in children
Surgical
• Resection and stoma formation
(disease often recurs)
What are the complications of Crohn’s?
• Haemorrhage • Perforation • Bowel obstruction • Strictures • Fistulae - Enterocystic - Enterovaginal - Enterocolonic - Enteroenteral • Abscess • GI carcinoma • Malabsorption • Anaemia
