Crohns Flashcards
Age of crohns
20s
F>M (just)
Causes of crohns
- Concordance = 70%
- Smoking ↑ risk
- TH1/TH17-mediated
Macroscopic changes of crohns
- Mouth to anus esp. terminal ileum ulcers
- Skip lesions
- strictures
Microscopic changes in crohns
- Transmural inflammation
- cobblestone ulceration
- marked fibrosis
Symptoms of crohns?
Systemic: fever, malaise, anorexia, wt loss
Abdo: diarrhoea (not usually bloody), pain
Abdominal Signs of crohns?
Ulcer
RIF mass/tenderness
Perianal disease (abscesses, fistulae, tags)
Anal / rectal strictures
Dermatological signs of crohns and ulcerative colitis?
Clubbing
Erythema nodosum(red lumps)
Pyoderma gangrenous (esp. UC) (painful ulcers)
Eyes signs of crohns and ulcerative colitis?
- Iritis
- Episcleritis
- Conjunctivitis
Joints signs of crohns and ulcerative colitis?
- Arthritis (non-deforming, asymm)
- Sacroiliitis
- Ank spond
Hepato-pancreato-biliary signs of crohns and ulcerative colitis?
- Primary Sclerosing Cholangitits + cholangiocarcinoma (esp. UC)
- Gallstones (esp. Crohn’s)
- Fatty liver
Kidney issues of crohns
Oxalate renal stones (esp. Crohns)
Crohns malabsorption problems
- Fat (steatorrhea)
- B12 (megablastic anaemia)
- Vit D (osteomalacia)
- Protein (oedema)
Complication of crohns?
Toxic megacolon
Cancer
Malabsorption
Blood investigations for crohns?
FBC: ↓Hb, ↑WCC-
LFT: ↓albumin
Haematinics: Fe, B12, Folate
CT Eneteroclysis aka?
AKA small bowel follow-through
Enteroclysis findings of crohns
Skip lesions
Rose-thorn ulcers
Cobblestoning
String sign of Kantor
Cobblestoning
ulcers + mural oedema
String sign of Kantor
terminal ileum narrowing
crohns
Endescopy investigations for crohns?
- Ileocolonoscopy + regional biopsy: Ix of choice
- Wireless capsule endoscopy
- Small bowel enteroscopy
Management of Severe crohns attack
NBM+ fluids
Hydrocortisone
Abx (metronidazole PO or IV)
Dietician I. Elemental diet II. Consider parenteral nutrition
Elemental diet
Liquid prep of amino acids, glucose and fattyacids
If no improvement after the initial management of severe crohns attack, what is the treatment?
- Medical: methotrexate ± infliximab
- consider surgical
Secondary management of severe crohns after improvement post-primary care?
- oral therapy
- Switch to oral pred (40mg/d)
Oral therapy for crohns?
1st line
- Ileocaecal: budesonide
- Colitis: sulfasalazine
2nd line:- prednisolone (tapering)
3rd line: - methotrexate
4th line: - infliximab or adalimumab
Perianal disease in crohns: how common?
Occurs in ~50%
Perianal disease in crohns: investigations?
Ix: MRI + Examination under anaesthesia Rx
Perianal disease in crohns: managements?
- Oral Abx: metronidazole
- Immunosuppression ± infliximab
- Local surgery ± seton insertion
Maintaining remission in crohns drugs?
1st line: azathioprine or mercaptopurine
2nd line: methotrexate
3rd line: Infliximab / adalimumab
Indications for emergency surgery on crohns patients?
- Failure to respond to medical Rx
- Intestinal obstruction or perforation
- Massive haemorrhage
Indications for Elective surgery on crohns patients?
- Abscess or fistula
- Perianal disease
- Chronic ill health
- Carcinoma
Surgical options available to crohns patients?
Limited resection: e.g. ileocaecal
Stricturoplasty
Defunction distal disease with temporary loop ileostomy
Complications of surgery on crohns?
Stoma complications
Enterocutaneous fistulae
Anastomotic leak or stricture
Short gut syndrome features?
- 1-2m small bowel
- Steatorrhoea- ADEK and B12 malabsorption
- Bile acid depletion → gallstones
- Hyperoxaluria → renal stones
Management of short gut syndrome?
- Dietician
- Supplements or TPN
- Loperamide
Supportive management of crohns?
- High fibre diet
- Vitamin supplements
