Crohn's disease (CD)

Question 1

CD is an inflammatory disease characterised by what?

Answer 1

Transmural granulomatous inflammation affecting any part of the gut from mouth to anus

Question 2

Name 3 other features of CD

Answer 2

• Inflammation occurs through all layers of the intestinal wall
• Unaffected areas of bowel between areas of disease (not continuous inflammation - skip lesions)
• Diarrhoea is usually non-bloody
• Associated with strictures and fistulas
• Associated with gallstones
• Cobblestone mucosa

Question 3

What causes UC?

Answer 3

Abnormal immune response to gut flora in genetically susceptible people

Question 4

Where does CD most commonly occur?

Answer 4

Terminal ileum

Question 5

Name 3 presenting features/symptoms

Answer 5

• Diarrhea
• Fatigue
• Abdominal pain/tenderness
• Weight loss
• Mouth ulcers
• Systemic symptoms i.e. fever, malaise, anorexia, arthritis, osteoporosis

Question 6

How is CD diagnosed?

Answer 6

Endoscopy and biopsy

Question 7

Name a complication of CD

Answer 7

• Small bowel obstruction
• Abscess formation
• Perforation
• Perianal fistulae
• Malnutrition

Question 8

1) What is first line for inducing remission in CD?
2) If the 1st line treatment doesn’t work, name 2 immunosuppressants that may be used?

Answer 8

1) Corticosteroids i.e. IV hydrocortisone
2) Azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab

Question 9

1) What 2 drugs are first line for maintaining remission in CD?
2) Name an alternative drug that may be used

Answer 9

1) Azathioprine, mercaptopurine
2) Methotrexate, infliximab, adalimumab

Question 10

When is it possible to surgically operate in CD?

Answer 10

When the disease only affects the terminal ileum

Question 11

1) What kind of drugs are infliximab and adalimumab?
2) What kind of drug is ustekinumab?

Answer 11

1) Anti TNF alpha monoclonal antibodies
2) Anti IL12/23 monoclonal antibodies

Question 12

1) What kind of drug is azathioprine, methotrexate and mercaptopurine?
2) Which of these is a dihydrofolate reductase inhibitor?

Answer 12

1) Immunosuppressant
2) Methotrexate

Question 13

What type of feeding is preferred in CD?

Answer 13

Enteral feeding

Question 14

Perianal fistulae
1) What is the 1st line investigation?
2) What is normally given 1st line for symptomatic perianal fistulae, and what drug may be given if this doesn’t work?
3) What is used for the management of a complex fistula?

Answer 14

1) Pelvic MRI
2) Oral metronidazole, anti-TNF i.e. infliximab
3) Draining seton

Question 15

Before starting azathioprine or methotrexate, a testing the activity of what should be done?

Answer 15

Thiopurine methyltransferase (TPMT) activity