Crohn's disease - Full summary Flashcards
What is Crohn’s disease?
This is a chronic inflammatory and ulcerating condition of the entire GI tract
Where can be affected in Crohn’s disease?
Anywhere in the GI tract from mouth to anus
Where is the most commony affected area in Crohn’s disease?
Terminal ileum and colon
What does NESTS stand for in remembering Crohn’s characteristics?
Think Crows nest:
N - No bleeding or mucus PR
E - Entire GI tract can be affected
S - Skip lesions
T - Transmural or Terminal ileum most common
S - Smoking exacerbates (Don’t set nest on fire)
What factors predispose someone to Crohn’s disease?
This is a combination of environmental and genetic factors
Mutations affecting bacterial recognition and immune responses can predispose
Westernised diet, high in refined sugars and dats and low in fruit, vegetables and fibres can also predispose
Describe the key pathophysiological pathway in Crohn’s disease
Bacterial lipopolysaccharides trigger persistent activation of T cells and macrophages, which, in IBD, does not stop
This causes pro-inflammatory cytokine production and neutrophil activation, which causes tissue damage and thus ulceration
Describe the histology of Crohn’s disease
Increased inflammatory cells in lamina propria
Non-caseating granulomas in 50% of cases
Cryptitis and crypt abscess formation
Knife like fissure formation in tissue
Describe the pathology of Crohn’s disease
Inflammation of the bowel wall causes thickening and possible stricture formation, with cobblestone mucosa and fat wrapping
Describe the pattern of symptoms in Crohn’s disease
This is a chronic condition but patient will experience phases of exacerbation and remission, with an unpredictable response to therapy
What are some symptoms of Crohn’s disease?
Abdominal pain
Small bowel obstruction
Diarrhoea
Bleeding PR (rare)
Anaemia
Weight loss
Peri-anal abscesses
How might children with Crohn’s present?
Poor growth
Delayed puberty
Malnutrition
Bone demineralisation
What are some possible oral manifestations of Crohn’s disease?
Swollen lips
Angular cheilitis
Oral ulceration
Mucosal tags
Cobblestone mucosa
Stag horning of sublingual folds
Signs of anaemia or malabsorption
What name is given to Crohn’s disease that only affects the mouth?
Oral Crohn’s disease
What are some clinical signs associated with Crohn’s disease?
Weight loss
Right iliac fossa mass (+pain)
Fever
Peri-anal abscesses, fistulas, skin tags, sphincter damage, fissures and skip lesions
What are some common nutritional deficiencies in Crohn’s disease?
Weight loss - 65-75%
Iron deficiency - 27%
Vitamin B12 deficiency - 48%
Folic acid deficiency - 54%
Vitamin D deficiency - 75%
