Crohn's Disease Flashcards
What is Crohn’s disease?
Chronic transmural granulomatous inflammatory disease that can affect any part of the GI tract
Give 3 epidemiological facts about Crohn’s
Affects any age but peaks in 15-30
Prevalence increasing
M:F
Describe the aetiology of Crohn’s
UNKNOWN
FH increases risk of IBD
Smoking increases risk
List 4 symptoms of Crohn’s
Crampy abdominal pain (due to inflammation, fibrosis or bowel obstruction)
Diarrhoea (may be bloody or steatorrhoea)
Fever + malaise
Symptoms of complications
List 7 signs of Crohn’s on examination
Weight loss
Fluid depletion
Abdominal tenderness, distension + masses
Signs of anaemia
Perianal skin tags, fistulae + abscesses
Aphthous ulcers in mouth
Hypotension, Tachycardia + pyrexia in acute exacerbation
Where is the most commonly affected area in Crohn’s?
Terminal ileum
List 5 extra intestinal features of Crohn’s
Clubbing, erythema nodosum, pyoderma gangrenosum
Uveitis, Episcleritis
Arthropathy: Arthritis, Sacroiliitis, Ankylosing spondylitis
Gallstones
Kidney stones
Describe bloods taken/ results for Crohn’s
FBC: low Hb, high platelets, high WCC U+Es LFTs: low albumin High ESR (chronic inflammation) CRP: high or normal
Why is a stool sample used in suspected Crohn’s?
To exclude infective colitis
What imaging is performed in Crohn’s and why?
AXR: identify toxic megacolon
CT abdo: localises disease, identifies fistulae + abscesses
What may show on a small bowel barium follow through?
Fibrosis/strictures (string sign of Kantor - part of intestine looks like a piece of string= incomplete filling of intestinal lumen) Deep ulceration (rose thorn ulcers) Cobblestone mucosa
Why perform an endoscopy and biopsy in Crohn’s?
Helps differentiate UC + CD
Monitoring malignancy + disease progression
What may be seen on colonoscopy and biopsy in Crohn’s?
Mucosal oedema + ulceration with ‘rose thorn fissures’
cobblestone mucosa
Fistulae + abscesses
Transmural chronic inflammation
Skip lesions
Non- Caseating Granulomas with epithelioid giant cells
What does the medical management of Crohn’s involve?
Glucocorticoids: to induce remission/ in exacerbations
5-ASA analogues: decreases frequency of relapses (mild to moderate disease)
Immunosuppression: using steroid-sparing agents (e.g. azathioprine, methotrexate) reduces frequency of relapses
Anti-TNF agents: (e.g. infliximab + adalimumab): very effective at inducing + maintaining remission (reserved for refractory Crohn’s)
What general advice is given to patients with Crohn’s?
Stop smoking
Dietician- low fibre diet if there are stricture present
In which situations is surgery indicated in management of Crohn’s?
Medical treatment fails
Failure to thrive in children in the presence of complications
List 5 GI complications of Crohn’s
Colorectal cancer Strictures Perforation + peritotnitis Perianal fistulae + abscesses Toxic megacolon
What is the prognosis in Crohn’s?
Chronic relapsing condition
2/3 require surgery at some stage
2/3 of these patients require > 1 operation
Describe the surgery performed in management of Crohn’s
Resection of affected bowel + stoma formation
Not curative- risk of disease recurrence
What bowel pathogen must be excluded from differentials when suspecting crohns?
Yersinia enterocolitica
List 4 systemic complications of Crohn’s
Failure to thrive in kids
Anaemia
Osteoporosis
Amyloidosis
Give an example of each type of drug used in Crohn’s
Glucocorticoids: Methylprednisolone, Prednisolone, IV hydrocortisone
5-ASA analogues: Azathioprine, Methotrexate
Anti-TNF agents: Infliximab
