Crohn's Disease Flashcards
What is Crohn’s characterised by?
Transmural inflammation affecting any part of the gut, from mouth to anus. There are skip lesions and a cobblestone appearance
What is are risk factors for Crohn’s?
Smoking, FH, genetics
What can cause exacerbations?
NSAIDs, chronic stress + depression
What small bowel symptoms might be present?
Abdominal pain, weight loss, right iliac fossa pain
What colon symptoms might be present?
Bloody diarrhoea and urgency, pain on defecation
What blood results would you expect?
Raised WCC, platelets, CRP, ESR
What tests would you do the same as UC?
LFT, stool sample, faecal calprotectin
What is the gold standard test?
A colonoscopy and biopsy showing transmural inflammation
What are some differential diagnoses?
Ulcerative colitis, IBS, Coeliacs
How would you manage mild/moderate Crohn’s?
Prednisolone, smoking cessation, correct any iron/folate/B12 defieciencies,
How would you manage severe Crohn’s?
IV hydrocortisone
How many patients will get perianal disease?
About 50%
How would you look for perianal disease?
MRI
How would you treat perianal disease?
Oral antibiotics, immunosuppressants
What are the aims of surgery?
Resection of affected areas, control of perianal/fistulising disease, defunction distal disease
What are some potential complications of Crohn’s?
Malabsorption, small bowel obstruction, toxic dilation, bowel perforation, abscess formation, fistula formation, sclerosing cholangitis, colorectal cancer
What would you see under a microscope?
Transmural inflammation, granulomas
What GI signs might be present?
Bowel ulceration, abdominal tenderness, abdominal mass, perianal disease
What extraintestinal signs might be present?
Clubbing, oral aphthous ulcers, skin/joint/eye problems
What would you give if the patient isn’t responding to steroids?
Anti-TNF alpha antibodies like infliximab or adalimumab
What drugs would you give to maintain remission in order?
Azathioprine, methotrexate, anti-TNF alpha antibodies
What surgery is available?
Resection of worst affected areas
What are indications for surgery?
Failure of medical therapy, obstruction from strictures, fistulae/abscesses/perianal disease, toxic dilatation and perforation
