Crohn's Disease

Question 1

What is Crohn’s disease?

Answer 1

Chronic transmural granulomatous inflammatory disease that can affect any part of the GI tract

Question 2

Give 3 epidemiological facts about Crohn’s

Answer 2

Affects any age but peaks in 15-30
Prevalence increasing
M:F

Question 3

Describe the aetiology of Crohn’s

Answer 3

UNKNOWN
FH increases risk of IBD
Smoking increases risk

Question 4

List 4 symptoms of Crohn’s

Answer 4

Crampy abdominal pain (due to inflammation, fibrosis or bowel obstruction)
Diarrhoea (may be bloody or steatorrhoea)
Fever + malaise
Symptoms of complications

Question 5

List 7 signs of Crohn’s on examination

Answer 5

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

Question 6

Where is the most commonly affected area in Crohn’s?

Answer 6

Terminal ileum

Question 7

List 5 extra intestinal features of Crohn’s

Answer 7

Clubbing, erythema nodosum, pyoderma gangrenosum
Uveitis, Episcleritis
Arthropathy: Arthritis, Sacroiliitis, Ankylosing spondylitis
Gallstones
Kidney stones

Question 8

Describe bloods taken/ results for Crohn’s

Answer 8

FBC: low Hb, high platelets, high WCC 
U+Es 
LFTs: low albumin 
High ESR (chronic inflammation) 
CRP: high or normal

Question 9

Why is a stool sample used in suspected Crohn’s?

Answer 9

To exclude infective colitis

Question 10

What imaging is performed in Crohn’s and why?

Answer 10

AXR: identify toxic megacolon

CT abdo: localises disease, identifies fistulae + abscesses

Question 11

What may show on a small bowel barium follow through?

Answer 11

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

Question 12

Why perform an endoscopy and biopsy in Crohn’s?

Answer 12

Helps differentiate UC + CD

Monitoring malignancy + disease progression

Question 13

What may be seen on colonoscopy and biopsy in Crohn’s?

Answer 13

Mucosal oedema + ulceration with ‘rose thorn fissures’
cobblestone mucosa
Fistulae + abscesses
Transmural chronic inflammation
Skip lesions
Non- Caseating Granulomas with epithelioid giant cells

Question 14

What does the medical management of Crohn’s involve?

Answer 14

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)

Question 15

What general advice is given to patients with Crohn’s?

Answer 15

Stop smoking

Dietician- low fibre diet if there are stricture present

Question 16

In which situations is surgery indicated in management of Crohn’s?

Answer 16

Medical treatment fails

Failure to thrive in children in the presence of complications

Question 17

List 5 GI complications of Crohn’s

Answer 17

Colorectal cancer 
Strictures  
Perforation + peritotnitis
Perianal fistulae + abscesses  
Toxic megacolon

Question 18

What is the prognosis in Crohn’s?

Answer 18

Chronic relapsing condition
2/3 require surgery at some stage
2/3 of these patients require > 1 operation

Question 19

Describe the surgery performed in management of Crohn’s

Answer 19

Resection of affected bowel + stoma formation

Not curative- risk of disease recurrence

Question 20

What bowel pathogen must be excluded from differentials when suspecting crohns?

Answer 20

Yersinia enterocolitica

Question 21

List 4 systemic complications of Crohn’s

Answer 21

Failure to thrive in kids
Anaemia
Osteoporosis
Amyloidosis

Question 22

Give an example of each type of drug used in Crohn’s

Answer 22

Glucocorticoids: Methylprednisolone, Prednisolone, IV hydrocortisone
5-ASA analogues: Azathioprine, Methotrexate
Anti-TNF agents: Infliximab