Crohn's Disease

Question 1

What is Crohn’s characterised by?

Answer 1

Transmural inflammation affecting any part of the gut, from mouth to anus. There are skip lesions and a cobblestone appearance

Question 2

What is are risk factors for Crohn’s?

Answer 2

Smoking, FH, genetics

Question 3

What can cause exacerbations?

Answer 3

NSAIDs, chronic stress + depression

Question 4

What small bowel symptoms might be present?

Answer 4

Abdominal pain, weight loss, right iliac fossa pain

Question 5

What colon symptoms might be present?

Answer 5

Bloody diarrhoea and urgency, pain on defecation

Question 6

What blood results would you expect?

Answer 6

Raised WCC, platelets, CRP, ESR

Question 7

What tests would you do the same as UC?

Answer 7

LFT, stool sample, faecal calprotectin

Question 8

What is the gold standard test?

Answer 8

A colonoscopy and biopsy showing transmural inflammation

Question 9

What are some differential diagnoses?

Answer 9

Ulcerative colitis, IBS, Coeliacs

Question 10

How would you manage mild/moderate Crohn’s?

Answer 10

Prednisolone, smoking cessation, correct any iron/folate/B12 defieciencies,

Question 11

How would you manage severe Crohn’s?

Answer 11

IV hydrocortisone

Question 12

How many patients will get perianal disease?

Answer 12

About 50%

Question 13

How would you look for perianal disease?

Answer 13

MRI

Question 14

How would you treat perianal disease?

Answer 14

Oral antibiotics, immunosuppressants

Question 15

What are the aims of surgery?

Answer 15

Resection of affected areas, control of perianal/fistulising disease, defunction distal disease

Question 16

What are some potential complications of Crohn’s?

Answer 16

Malabsorption, small bowel obstruction, toxic dilation, bowel perforation, abscess formation, fistula formation, sclerosing cholangitis, colorectal cancer

Question 17

What would you see under a microscope?

Answer 17

Transmural inflammation, granulomas

Question 18

What GI signs might be present?

Answer 18

Bowel ulceration, abdominal tenderness, abdominal mass, perianal disease

Question 19

What extraintestinal signs might be present?

Answer 19

Clubbing, oral aphthous ulcers, skin/joint/eye problems

Question 20

What would you give if the patient isn’t responding to steroids?

Answer 20

Anti-TNF alpha antibodies like infliximab or adalimumab

Question 21

What drugs would you give to maintain remission in order?

Answer 21

Azathioprine, methotrexate, anti-TNF alpha antibodies

Question 22

What surgery is available?

Answer 22

Resection of worst affected areas

Question 23

What are indications for surgery?

Answer 23

Failure of medical therapy, obstruction from strictures, fistulae/abscesses/perianal disease, toxic dilatation and perforation