Crohn's Disease Flashcards
Define Crohn’s Disease?
Chronic granulomatous inflammatory disease that can affect any part of the GI tract
Grouped with UC and known together, as inflammatory bowel disease
What is the aetiology of Crohn’s Disease?
Cause unknown but thought to be due to interplay between genetic and environmental factors
Though inflammation can occur anywhere from mouth to anus, 40% involves the terminal ileum
What is the epidemiology of Crohn’s Disease?
UK annual incidence: 5-8/100,000
UK prevalence: 50-80/100,000
Affects any age but peaks in teens, 20s and 40s
What are the presenting symptoms of Crohn’s Disease?
Crampy abdominal pain Diarrhoea (may be bloody or steatorrhoea) Fever, Malaise, weight loss Symptoms of complications Right Iliac Fossa Pain sometimes
Why is there crampy abdominal pain in Crohn’s Disease?
Due to inflammation, fibrosis or bowel obstruction
Why is there sometimes right iliac fossa pain?
Due to inflammation of terminal ileum
What are the signs of Crohn’s Disease on physical examination?
Weight Loss
Clubbing
Signs of Anaemia
Aphthous ulcers in mouth
Perianal skin tags, fistulae and abscesses
Uveitis, erythema nodusum, pyoderma gangrenosum
What bloods do we do for Crohn’s Disease?
FBC U&Es LFTs High ESR CRP may be high or normal
What do we look for specifically in the FBC for Crohn’s Disease?
Low Hb, high platelets, high WCC
What do we look for specifically in the LFTs for Crohn’s Disease?
Low albumin
Why do we do stool microscopy and culture for Crohn’s Disease?
Exclude Infective Colitis
What might we see on an AXR for Crohn’s Disease?
Could show evidence of toxic megacolon
When do we do an Erect CXR for Crohn’s Disease?
If there is a risk of perforation
What might we see on a Small bowel barium follow-through for Crohn’s Disease?
Fibrosis/strictures (string sign of Kantor)
Deep ulceration (rose thorn ulcers)
Cobblestone mucosa
What is the String sign of Kantor?
Part of the intestine looks like a piece of string, showing incomplete filling of the intestinal lumen
What is the use of Endoscopy (OGD, colonoscopy) and biopsy in Crohn’s Disease?
Could help differentiate UC and CD
Useful for monitoring malignancy and disease progression
What might you see on an Endoscopy (OGD, colonoscopy) and biopsy for Crohn’s Disease?
Can show mucosal oedema and ulceration with ‘rose thorn fissures’ (occurs when there is a cobblestone mucosa)
Fistulae and abscesses
Transmural chronic inflammation with infiltration of macrophages, lymphocytes and plasma cells
Granulomas with epithelioid giant cells may be seen in blood vessels
How can we use a Radionucide-labelled neutrophil scan for Crohn’s Disease?
Can localise the inflammation (when other investigations are contraindicated)
What is the management plan for an Acute Exacerbation of Crohn’s Disease?
Fluid Resuscitation
IV/oral corticosteroids
5-ASA analogues (e.g. mesalazine and olsalazine)
Analgesia
Parenteral nutrition may be necessary
Monitor markers of disease activity (e.g. fluid balance, ESR, CRP, platelets, Hb)
What is the long-term management plan for Crohn’s Disease?
Steroids
5-ASA analogues
Immunosuppression
Anti-TNF agents (e.g. infliximab and adalimumab)
Why do we use Steroids for Crohn’s Disease?
For acute exacerbations
How do 5-ASA analogues work for Crohn’s Disease?
Decreases the frequency of relapses (useful for mild to moderate disease)
More commonly used in UC however
What is the immunosuppression drugs used for Crohn’s Disease?
Using steroid-sparing agents (e.g. azathioprine, 6-mercaptopurine, methotrexate) reduces the frequency of relapses
How can we use Anti-TNF agents for Crohn’s Disease?
Very effective at inducing and maintaining remission
Usually reserved for refractory Crohn’s
What is the general advice for patients with Crohn’s Disease?
Stop smoking Dietician referral (low fibre diet necessary if there are stricture present)
When is surgery indicated in Crohn’s Disease?
If:
Medical treatment fails
Failure to thrive in children in the presence of complications
Involves resection of affected bowel and stoma formation (there is a risk of disease recurrence)
What are the possible GI complications of Crohn’s Disease?
Haemorrhage Strictures Perforation Fistulae (between bowel, bladder, vagina) Perianal fistulae and abscesses GI cancer Malabsorption
What are the extraintestinal features of Crohn’s Disease?
Uveitis Episcleritis Gallstones Kidney Stones Arthropathy Sacroilitis Ankylosing Spondylitis Erythema nodosum Pyoderma gangrenosum Amyloidosis
What is the prognosis for patients with Crohn’s Disease?
It is a chronic relapsing condition
2/3 of patients will require surgery at some stage
2/3 of these patients require more than 1 operation
