Crohns Flashcards
What is Crohns?
Long term condition which causes inflammation of the digestive tract from mouth to anus. It is a relapsing-remitting disease. Mostly occurs in the last sections of the small intestine (ileum) and the colon.
What are the signs and symptoms of Crohns?
Mouth ulcers Weight loss and reduced appetite Diarrhoea Blood in stools Abdominal pain Fatigue Perianal disease
What other complications may occur outside the GI tract in a patient with Crohns?
Rashes
Anaemia
Arthritis
Inflammation of the eye
What are the risk factors for Crohns?
Genetic predisposition
Previous infection
Smoking
environmental factors
What type of lifestyle advice can be given to a patient with Crohns?
Stop smoking
Good hydration
Diet high in fibre
small meals frequently
How is Crohns treated?
Corticosteroids - reduces inflammation
Immunosuppressants - blood test needed to check if patient can have them
Anti -TNF agents e.g. infliximab
Aminosalicyclates e.g. mesalazine
Surgery - removing inflamed parts of the bowel and stitching healthy parts together
Ileostomy - stoma
How do corticosteroids work?
Diffuse into cytoplasm and bind to receptor. Complex moves to nucleus and binds to Hormone Receptor element.
Induces/Inhibits transcription
What are some ADRs of corticosteroids?
Oesteoporosis
Cushingoid effects
Suppresses HPA axis
How does azathioprine work?
It is an immunosuppressant and is a pro drug and is metabolised to 6-Mercaptopurine
This is a fradulent purine nucleotide that impairs DNA synthesis and has a cytotoxic action on cells.
What are some ADRs of Azathioprine?
Myelosuppresion
Increased infection susceptibility
How does methotrexate work?
Methotrexate is an anti folate, Competitively antagonises dihydrofolate reductase, this inhibits intermediates being formed which are used to produce purines and thymidine therefore it affects DNA synthesis.
How does infliximab work?
It is a monoclonal antibody.
Blcoks the effects of TNF alpha therefore decreases inflammation, angiogensis and joint destruction.
What is important to consider when prescribing methotrexate?
Weekly not daily diagnosing.
Metabolism produces polyglutatmates and these build up in the cells and bind strongly to Dihydrofolate reductase. Can be retained for months
What are some complications of Crohns?
Intestinal stricture Perforation of bowel Oesteoporosis - corticosteroid ADR Fistulas Abscesses
What is the pattern of disease in Crohns?
Skip Lesions
