Crohns Disease Flashcards
What is Crohn’s disease?
Chronic inflammatory disorder characterised by patchy, transmittal inflammation of intestinal mucosa
Where does Crohn’s disease affect?
GI tract from mouth to anus
What is the main identifier of Crohn’s disease?
Skip lesions
What microscopic histological changes are seen in Crohn’s disease? (5)
Transmural ulceration = Inflammation in all layers form mucosa to serosa
Hyperplasia of lymph nodes
Granulomas
Increased goblet cells
Skip lesions
Defining features of coeliac disease can be remembered using CROHNS and NESTS. What do they stand for?
Cobblestone appearance
Rose thorn ulcers
Obstruction
Hyperplasia of lymph nodes
Narrowing of lumen
Skip lesions
No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum most effected and transmural inflammation
Smoking is a risk factor
What is faecal calprotectin?
Released by the intestines
Marker for intestinal inflammation
Specific to IBD in adults
What are the macroscopic changes seen on endoscopy in Crohn’s disease?
Cobblestone appearance caused by superficial ulcers which become deep
Bowel wall thickening
Lumen narrowing
Deep ulcers
Fistulae
Fissures
What are the complications of Crohn’s disease?
Bowel obstruction
- thickening of wall causes narrowing of bowel
Fistula
- inflammation goes through bowel wall and creates tunnels
Abscesses
Anal fissures
Ulcers
Malnutrition
Inflammation of other areas
Colorectal cancer
Eye conditions.
What are the symptoms of Crohn’s disease?
N&V
Fatigue
Fever
Weight loss
Abdo pain
Diarrhoea
Rectal bleeding
Perianal disease
What signs can indicate Crohn’s disease?
Pyrexia
Dehydration
Angular stomatitis
Aphthous ulcers
Pallor
Tachycardia
Hypotension
Abdo pain, mass, distension
How is remission induced in Crohn’s disease?
First line = steroids e.g oral pred
If steroids don’t work consider adding immunosuppressant medication under specialist guidance:
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab
Apply nutritional alterations
Exclusive enteral nutrition (EEN) is a liquid diet that excludes all food + drink expect water.
Supplement drink at 25kcal/kg/day
1g/kg/day of protein
How do you maintain remission in coeliac disease?
First line = thiopurines:
- Work through purine synthesis inhibition in lymphocytes -> immunosuppressive properties
- E.g.Mercaptopurine + Azathioprine
- SE: pancreatitis + hepatotoxicty
Alternatives:
- Methotrexate
▪ Inhibits dihydrofolate reductase
▪ Immunomodulatory + anti-inflammatory properties
▪ SE: bone marrow suppression, hepatotoxicity + pulmonary toxicity
- Monoclonal antibodies
▪ E.g. Infliximab + Adalimumab
▪ SE: numbness/tingling, vision problems, leg weakness, chest pain, SOB, new joint pain, hives/itching
What is the first line treatment in inducing remission in Crohn’s disease?
Steroids
If steroids don’t work in inducing remission in Crohn’s what medication would you consider?
Immunosuppressants
Under specialist guidance
What is the first line treatment in maintaining remission in Crohn’s?
Thiopurines
How do thiopurines work?
Work through purine synthesis inhibition in lymphocytes -> immunosuppressive properties
What are the main side effects of thiopurines?
Pancreatitis
Hepatotoxicity
Name 2 examples of thiopurines?
Mercaptopurine
Azathioprine
What alternatives can be used to the first line treatment in maintaining remission in Crohn’s?
Methotrexate
Monoclonal antibodies
How do methotrexates work?
Inhibit dihydrofolate
Immunomodulatory and anti-inflammatory properties
What are the side effects of methotrexates?
Bone marrow suppression
Hepatotoxicity
Pulmonary toxicity
What are the side effects of monoclonal antibodies in Crohn’s treatment?
Numbness/tingling
Vision problems
Leg weakness
Chest pain
Sob
Joint pin
Hives/itching
What are the 2 main surgical treatments of Crohn’s disease?
Ileocecal resection = of disease only effects the distal ileum can resect and prevent flares
- often recurs in 10 years
Stoma
- Colostomy = created with loop of large intestine, solid waste
- Ileostomy = created with end of small intestine, liquid waste + undigested food
What is a colostomy?
Created with a large loop of intestines
Solid waste
