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GI, liver, kidney > Crohns > Flashcards

Crohns Flashcards

1
Q

Which part of the bowel is effected in crohns?

A

Mouth to anus
Non continious inflammation - healthy gaps in bowel
Transmural

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2
Q

How does Crohns appear on abdo Xray?

A

Cobblestone

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3
Q

IBD bloods

A

FBC, U+Es, LFTs, bone profile, magnesium, CRP, ESR, autoantibodies

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4
Q

Investiagtions for IBD

A

Stool culture - faecal calprotectin, c.diff
Endoscopy
Colonsocopy
Abdo X rays
Bloods - ESR, autoantibodies, immunoglobulins + coeliac antibodies
AXR
CT abdo pelvis

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5
Q

Differentials for IBD

A

Colitis
GE
STIs affecting the rectum
Coeliac disease
Haemorrhoids
IBS
Lymphoma

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6
Q

Initial management for acute presentiation IBD

A

IV fluid
IV steroids
Analgesia

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7
Q

Crohns biopsy results

A

Chronic inflmmation - neutrophilic, lymphocytes incl neutrophilic cryptitis, crypt abscesses or erosions/ulcers
Skip lesions - erosions or ulcers, vertical fissures, fistulas
Transmural inflammation with lymphoid aggregates
Granulomas

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8
Q

What skin condition is seen in crohns?

A

Erythema nododsum

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9
Q

What cessation is importatnt in crohns?

A

Smoking

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10
Q

What monitoring nutrition deficiencies in crohns?

A

B12, folate, fat soluble vits A,D E, K

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11
Q

Medical management of crohns

A

Steroids - induce remission, don;t maintain
5ASAs eg mesalazine - maintain remission
Immunosupressants eg azathioprine, cyclosporin - severe cases
Biologics - Adalimumad, infliximab
Use when steroids and 5 ASAs failed

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12
Q

Why avoid anti-diarrhoeals in crohns?

A

Risk of toxic megacolon

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13
Q

Crohns surgery management

A

Diseased segment resected, anastomoses formed
Local - drain abscesses, repair fistulas etc

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14
Q

Is antibody testing for pANCA negative or positive in crohns?

A

Negative

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15
Q

What scan can be used speicifically in Crohns vs just IBD?

A

MRE - MRI with small bowel enterography - neutral dye distends bowel and highlights inflammation etc
Similar accuracy to CT without radiation

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16
Q

Which symptoms are specific to Crohsns (not UC)

A

Perianal abscesses, fistulas, skin tags
Fatty liver disease
Ulcers
Erythema nodosum
Conjunctivitis
Renal stones

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17
Q

What conditions are ass with UC?

A

Iritis
Cholangitis

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18
Q

Crohns skin/joints symtpoms

A
  • Erythema nodosum
  • arthritis
  • Pyoedema gangronosum
    -Osteopenic
    -
19
Q

What is crohns?

A

IBD
Transmural granulomatous inflammation
Commonly affectss terminal ileum and colon but can be mouth to anus
Skip lesions
Extra intestinal features

20
Q

What is the difference in where is effected in UC and crohns?

A

Crohns - starts at terminal ileum/rectum. Unaffected areas of bowel between areas of active disease = skip lesions
UC - whole bowel effected

21
Q

How does transmural infalmmation lead to complciations in crohns?

A

Causes bowel wall thickening and lumen narrowing -> obstruction/deep ulceration -> fistulation as sinus tracts penetrate serosa, microperforation, abscess formation, adhesions and malabsorption

22
Q

When is ileocaecal resection offered in early disease?

A

Isolated terminal ileum disease
Prolongs and maintains remission

23
Q

What causes of anaemia in crohns?

A

IRon deficiecny - blood loss, nutrient deficiency
vit B12, folate - decreased absorption
Of chronic disease

23
Q

What causes of anaemia in crohns?

A

IRon deficiecny - blood loss, nutrient deficiency
vit B12, folate - decreased absorption
Of chronic disease

24
Q

What are used 2nd line to glucocorticoids in crohns?

A

aminosalicyclates eg 5ASAs eg mesalazine

25
Q

What immunosuppressants are used in crohns and when?

A

Azathioprine or mercapropurine - as add ons to induce remission
1st line to retain remission

26
Q

Why important to monitor bowel in corhns

A

Risk of bowel cnacer, fistulas, stricutres

27
Q

Risk factors for Crohns

A

Smoking
FH
Infectious GE
CARD15 gene mutation
Appendectomy
Drugs

28
Q

Why does CARD15 mutation increase risk for crohns?

A

Encodes NOD2 protein produced by intestinal epithelial cells -> inflam protective response maintain intestinal homeostasis

29
Q

What drugs increase risk of crohns relapse and exacerbation?

A

NSAIDs, COCP

30
Q

Intestinal symptoms of crohns

A

Diarrhoea - may be bloody
Abdo pain
Weight loss, lethargy
Perianal disease - skin taags, ulcers

31
Q

What eye conditions are ass with crohns?

A

Conjunctivitis, episcleritis, iritis

32
Q

Joint condiitons ass with crohns

A

Large joint arthritis, sacroilitis, ankylosing spondylitis

33
Q

Liver conditions ass with crohns

A

Fatty liver, primary sclerosing cholangitis and cholangiocarcinoma 9RARE0

34
Q

Skin conditions ass with crohns

A

erythema nodosum
Pyoderma gangrenosum

35
Q

What bone and protein problems are ass with corhns?

A

Osteomalacia
Amyloidosis

36
Q

What is first line for diagnosis of crohns? When is this contraindicated?

A

Ileocolonoscopy and biopsy of affected areas - microscopic evidence of crohns
Contraindicated in acute flare

37
Q

What can be seen on barium enema in crohns?

A

Highly sensitive and speciifc for terminal ileum exam ‘Kantors string sign, proximal bowel dilation, rose thorn ulcers and fistula

38
Q

Crohns appearnace in investigations

A

Cobblestone - skip lesions

39
Q

What does kantors string sign show

A

Stricture in crohns

40
Q

What are rose thorn ulcers?

A

deep penetrating linear ulcers or fissuring typically seen within stenosed terminal ileum with a thickened wall.

41
Q

Crohns vs UC where inflamed

A

Crohns - patchy inflammation through large and small bowel starting at terminal ileum
UC - continous inflammation in large bowel

42
Q

What use if refratory to 1st and 2nd line meds?

A

Biologics - Infliximab, adalinumab

GI, liver, kidney (50 decks)

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