Crohns

Question 1

Which part of the bowel is effected in crohns?

Answer 1

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

Question 2

How does Crohns appear on abdo Xray?

Answer 2

Cobblestone

Question 3

IBD bloods

Answer 3

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

Question 4

Investiagtions for IBD

Answer 4

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

Question 5

Differentials for IBD

Answer 5

Colitis
GE
STIs affecting the rectum
Coeliac disease
Haemorrhoids
IBS
Lymphoma

Question 6

Initial management for acute presentiation IBD

Answer 6

IV fluid
IV steroids
Analgesia

Question 7

Crohns biopsy results

Answer 7

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

Question 8

What skin condition is seen in crohns?

Answer 8

Erythema nododsum

Question 9

What cessation is importatnt in crohns?

Answer 9

Smoking

Question 10

What monitoring nutrition deficiencies in crohns?

Answer 10

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

Question 11

Medical management of crohns

Answer 11

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

Question 12

Why avoid anti-diarrhoeals in crohns?

Answer 12

Risk of toxic megacolon

Question 13

Crohns surgery management

Answer 13

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

Question 14

Is antibody testing for pANCA negative or positive in crohns?

Answer 14

Negative

Question 15

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

Answer 15

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

Question 16

Which symptoms are specific to Crohsns (not UC)

Answer 16

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

Question 17

What conditions are ass with UC?

Answer 17

Iritis
Cholangitis

Question 18

Crohns skin/joints symtpoms

Answer 18

• Erythema nodosum
• arthritis
• Pyoedema gangronosum
  -Osteopenic
  -

Question 19

What is crohns?

Answer 19

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

Question 20

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

Answer 20

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

Question 21

How does transmural infalmmation lead to complciations in crohns?

Answer 21

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

Question 22

When is ileocaecal resection offered in early disease?

Answer 22

Isolated terminal ileum disease
Prolongs and maintains remission

Question 23

What causes of anaemia in crohns?

Answer 23

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

Question 23

What causes of anaemia in crohns?

Answer 23

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

Question 24

What are used 2nd line to glucocorticoids in crohns?

Answer 24

aminosalicyclates eg 5ASAs eg mesalazine

Question 25

What immunosuppressants are used in crohns and when?

Answer 25

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

Question 26

Why important to monitor bowel in corhns

Answer 26

Risk of bowel cnacer, fistulas, stricutres

Question 27

Risk factors for Crohns

Answer 27

Smoking FH Infectious GE CARD15 gene mutation Appendectomy Drugs

Question 28

Why does CARD15 mutation increase risk for crohns?

Answer 28

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

Question 29

What drugs increase risk of crohns relapse and exacerbation?

Answer 29

NSAIDs, COCP

Question 30

Intestinal symptoms of crohns

Answer 30

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

Question 31

What eye conditions are ass with crohns?

Answer 31

Conjunctivitis, episcleritis, iritis

Question 32

Joint condiitons ass with crohns

Answer 32

Large joint arthritis, sacroilitis, ankylosing spondylitis

Question 33

Liver conditions ass with crohns

Answer 33

Fatty liver, primary sclerosing cholangitis and cholangiocarcinoma 9RARE0

Question 34

Skin conditions ass with crohns

Answer 34

erythema nodosum Pyoderma gangrenosum

Question 35

What bone and protein problems are ass with corhns?

Answer 35

Osteomalacia Amyloidosis

Question 36

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

Answer 36

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

Question 37

What can be seen on barium enema in crohns?

Answer 37

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

Question 38

Crohns appearnace in investigations

Answer 38

Cobblestone - skip lesions

Question 39

What does kantors string sign show

Answer 39

Stricture in crohns

Question 40

What are rose thorn ulcers?

Answer 40

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

Question 41

Crohns vs UC where inflamed

Answer 41

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

Question 42

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

Answer 42

Biologics - Infliximab, adalinumab