Crohns Flashcards
1
Q
Symptoms
A
RL quadrant pain (ileum) Diarrhoea Blood in stool Malabsorption Extra-intestinal manifestations e.g. iritis, arthritis, fatty liver
2
Q
Epidemiology
A
Incidence = 83mil/year
Prevalence = 10.6/100,000 in UK
Median age of onset = 30
3
Q
Risk factors
A
Smoking Family history - NOD2 gene NSAIDs + contraceptive pill Appendectomy Infectious gastroenteritis
4
Q
Pathophysiology
A
Immune related (not autoimmune) Triggered by a pathogen - large immune response activated. Th1 detects pathogen - TNFa, IFNg - cause macrophages to release platelet activating factor, proteases + free radicals - destruction of healthy tissue as unregulated
Defect in epithelial barrier - pathogen gets through layers - immune system invades deeper into layers - into deep mucosa + forms granulomas then get ulcers forming through entire depth
5
Q
Characteristics
A
Skip lesions
Transmural ulcers
Most commonly affects ileum + colon but can be mouth to anus
6
Q
Diagnosis
A
FBC, U+E, LFT, CRP, stool culture
Fecal calprotectin - higher correlates
Biopsies confirm
7
Q
Treatment
A
Steroid e.g. prednisolone/hydrocortisone
Liquid diet/enteral feed can bring on remission
If 2+ active in 12 months or steroids can’t be reduced - mercaptopurine
