- Concordance = 70% - Smoking ↑ risk - TH1/TH17-mediated

Crohns Flashcards by K D

Age of crohns

20s

F>M (just)

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Causes of crohns

Concordance = 70%
Smoking ↑ risk
TH1/TH17-mediated

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Macroscopic changes of crohns

Mouth to anus esp. terminal ileum ulcers
Skip lesions
strictures

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Microscopic changes in crohns

Transmural inflammation
cobblestone ulceration
marked fibrosis

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Symptoms of crohns?

Systemic: fever, malaise, anorexia, wt loss

Abdo: diarrhoea (not usually bloody), pain

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Abdominal Signs of crohns?

Ulcer

RIF mass/tenderness

Perianal disease (abscesses, fistulae, tags)

Anal / rectal strictures

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Dermatological signs of crohns and ulcerative colitis?

Clubbing

Erythema nodosum(red lumps)

Pyoderma gangrenous (esp. UC) (painful ulcers)

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Eyes signs of crohns and ulcerative colitis?

Iritis
Episcleritis
Conjunctivitis

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Joints signs of crohns and ulcerative colitis?

Arthritis (non-deforming, asymm)
Sacroiliitis
Ank spond

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Hepato-pancreato-biliary signs of crohns and ulcerative colitis?

Primary Sclerosing Cholangitits + cholangiocarcinoma (esp. UC)
Gallstones (esp. Crohn’s)
Fatty liver

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Kidney issues of crohns

Oxalate renal stones (esp. Crohns)

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Crohns malabsorption problems

Fat (steatorrhea)
B12 (megablastic anaemia)
Vit D (osteomalacia)
Protein (oedema)

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Complication of crohns?

Toxic megacolon

Cancer

Malabsorption

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Blood investigations for crohns?

FBC: ↓Hb, ↑WCC-

LFT: ↓albumin

Haematinics: Fe, B12, Folate

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CT Eneteroclysis aka?

AKA small bowel follow-through

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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