Crohns Flashcards
what is Crohns and what is it characterised by
chronic inflame GI disease, transmural granulomatous inflammation
what part of the GI tract is affected, where does it especially affect
any part of the tract, especially terminal ileum and proximal colon.
is there unaffected bowel between areas of active disease?
Yes (unlike Ulcerative colitis)
what gene being mutated increases risk
NOD2/CARD15
when is presentation
20-40 years
associations
altered cell mediated immunity
what risk factors are associated
smoking- increases by 3-4x. NSAIDS may exacerbate
symptoms
diarrhoea/urgency. abdo pain, weight loss, failure to thrive, fever, malaise, anorexia
signs(gut)
apthous ulcerations (mouth), abdo tender/mass, perianal abscess/fistulae/skin tags; anal strictures.
signs(not gut)
clubbing, skin, joint and eye problems
complications
small bowel obstruction, toxic dilatation, abscess (abdo, pelvic, ischiorectal), fistulae, perforation, rectal haemorrhage, colon cancer, fatty liver, cholangiocarcinoma, renal stones, osteomalacia
tests- blood
FBC, ESR, CRP, U&E, LET, INR, ferritin, TIBC, B12, folate
tests
blood, stool (exclude C dif, campylobacter, E coli); colonoscopy and rectal biopsy; small bowel enema; capsule endoscopy; barium enema; colonoscopy; MRI
what can a small bowel enema detect
ileal disease
what can barium enema show
cobblestoning, rose thorn ulcers, colon strictures
what can MRI show
pelvic disease and fistulae
what can be used in the treatment
optimise nutrition; aminosalicylates, steroids, immunosuppressants,; TNF inhibitors; antibiotics; diet/supplements
what can be used in a mild attack (symptomatic, systemically well)
prednisolone- 30mg/d PO for 1 week then 20mg/day for 4 weeks
what can be used in a severe attack
hydrocortisone. metronidazole. if not improving- infliximab and adalimumab
what % of patients have perianal disease
50
treatment of perianal disease
oral antibiotics, immunosuppressant therapy, infliximab, local surgery, seton insertion
name additional therapies in Crohns
azathioprine, sulfasalazine, TNFalpha inhibitors (infliximab, adalimumab), methotrexate, IV immunoglobulin
what autoantibody test is -ve
ANCA (positive in UC)
what autoantibody test is +ve
ASCA
