Crohn's Disease Flashcards
1
Q
What is Crohn’s Disease?
A
- chronic inflammatory disease characterised by transmural granulomatous inflammation
- affects any part of gut
2
Q
What is the major RF for Crohns?
A
Smoking
3
Q
What are the features of Crohns that is different from UC?
*think NESTS
A
- No blood/mucus
- Entire GI tract
- Skip lesions
- Transmural inflammation
- Smoking - RF
4
Q
Which part of the GI is mostly affected by Crohns?
A
- Terminal ileum
5
Q
What are the Sx of Crohns?
A
Sx
- Nausea & vomiting
- Fatigue
- Low-grade fever
- Weight loss
- Abdominal pain
- Diarrhoea (+/- blood)
- Rectal bleeding
- Perianal disease
Signs
- Pyrexia
- Dehydration
- Angular stomatitis
- Aphthous ulcers
- Pallor
- Tachycardia
- Hypotension
- Abdominal pain, mass and distension
6
Q
What are the extraintestinal manifestations of Crohns?
A
- clubbing
- erythema nodosum
- arthritis
- uveitis
- episcleritis
- primary sclerosing cholangitis (more common in UC)
- venous thromboembolism
7
Q
What Ix would you order for Crohns?
A
Bedside
- Obs
- ECG
- Urine analysis
- Stool culture
- Faecal calprotectin
Bloods
- Routine
- CRP
- Haematinics
- Mg
- clotting
- bone profile
Imaging
- AXR
- CT - demonstrates bowel wall thickening, bowel obstruction, abscesses, or fistulae.
- MRI
- Barium follow through
Special test
- colonoscopy
- upper GI endo
- examination under anasthesia
8
Q
What are the Cx of Crohns?
A
- SBO
- Toxic dilatation >6cm
- Abcess formation
- Fistula
- perforation
- colon cancer
- malnutrition
9
Q
What fistulas may form in Crohns?
A
- entero-enteric
- colovesical
- colovaginal
10
Q
What are the tx options for inducing remission in Crohns?
A
- First line
- Steroids
- Exclusive Enteral Nutrition (EEN) - if steroids is to avoid
- Second line (add either one)
- Azathioprine
- Mercaptopurine
- Methotrexate
- Infliximab
- Adalimumab
11
Q
What are the tx options for maintaining remission in Crohns?
A
- First line
- Azathioprine
- Mercaptopurine
- *check TPMT enzyme for both
- Alternatives
- Methotrexate (DHFR inh)
- Infliximab
- Adalimumab
12
Q
What are the surgical options for Crohns?
A
- strictureplasty
- fistulaplasty
13
Q
What are the macroscopic features of Crohns?
A
- Tickening and narrowing
- Cobblestone appearance
- Skip lesions
14
Q
What are the microscopic appearance of Crohns?
A
- Lymphoid hyperplasia
- Granulomatous formation
- Transmural inflammation
- Goblet cell hyperplasia
15
Q
What does the CROHNS mnemonic stand for?
A
- Cobblestone appearance
- Rosethorn ulcers
- Obstruction
- Hyperplasia (lymph node)
- Narrowing lumen
- Skip lesions
