Crohns Disease Flashcards
Definition of Crohns disease
Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from mouth to anus, most commonly the terminal ileum and colon
What are the key features of Crohn’s disease according to the CROWS NESTS mnemonic?
(N) No blood or mucus in stools
(E) Entire GI tract involvement is possible
(S) Skip lesions on endoscopy
(T) Terminal ileum and transmural inflammation
(S) Smoking as a risk factor
What is the primary genetic predisposition associated with Crohn’s disease?
NOD2 gene
What are the three main pathophysiological mechanisms behind Crohn’s disease?
(1) Persistent activation of T cells and macrophages by bacterial LPS
(2) Inflammation doesn’t self-limit
(3) Excessive pro-inflammatory cytokine production and neutrophilic inflammation
How do people attract this disease?
- NOD2 gene
- Developed country
- Faulty immune response
- Environmental factors - aggravated by smoking and NSAIDs
- Dysbiosis
What are the typical symptoms associated with Crohn’s disease?
Chronic diarrhoea (potentially bloody)
Abdominal pain
Weight loss
Periods of acute exacerbation and remission
Children;
Growth delays
Delayed puberty
Malnutrition
bone demineralisation
What type of inflammation characterizes Crohn’s disease in the ileum and/or colon?
Chronic active mucosal inflammation, often accompanied by cryptitis and crypt abscesses
What areas of the gastrointestinal tract can be affected by Crohn’s disease?
Any area, including the terminal ileum and colon.
What distinguishes skip lesions in Crohn’s disease from ulcerative colitis?
Skip lesions are unaffected areas of bowel in Crohn’s disease, whereas in ulcerative colitis, the bowel is continually affected.
Name one extra-intestinal manifestation of Crohn’s disease related to skin issues
Pyoderma gangrenosum
Erythema nodusum
Which diagnostic test is specific for detecting inflammation in the bowel and can distinguish between IBS and IBD?
The fecal calprotectin test
What are some typical findings during colonoscopy for Crohn’s disease?
Thickened bowel walls
Transmural inflammation
Increased goblet cells
Fissuring ulcers
Non-caseating granulomas
What is the first-line treatment for Crohn’s disease during mild attacks?
Steroids, such as prednisolone.
What is the recommended action regarding colonoscopy in Crohn’s disease patients ten years post-diagnosis?
Recommended ten years post-diagnosis to check for an increased risk of colorectal cancer
What are the possible complications associated with Crohn’s disease?
Increased risk of colorectal cancer Malabsorption
Association with primary sclerosing cholangitis (PSC)
Risk of toxic megacolon
Osteoporosis
What lifestyle change is recommended for Crohn’s disease patients?
Smoking cessation
Name one immunosuppressant used in the management of Crohn’s disease
azathioprine
What is the last-line therapy before surgery in Crohn’s disease patients?
Anti-TNF therapy.
What is the key diagnostic feature for severe Crohn’s disease flare-up?
Presence of bloody diarrhoea six or more times a day
+
long with fever, elevated pulse, elevated ESR, or anaemia
Name the extra-intestinal manifestations of Crohn’s disease related to the joints
Arthritis
Ankylosing spondylitis
Name the extra-intestinal manifestations of Crohn’s disease related to the eyes
Uveitis
Oxalate renal stones is another what?
Extra-intestinal manifestations of Crohn’s disease
Signs of Crohns disease
- Evidence of weight loss
- Right iliac fossa mass (+ pain)
- Malaise
- Fever
- Peri-anal signs - abscesses, fistulas, skin tags, sphincter damage, anal fissures
What would a blood test look like with a person with Crohn’s disease?
- ↑ CRP
- ↓ albumin and platelets
- ↓ B12 if terminal ileum affected
Why would a stool sample be used as a form of test?
To rule out infective causes (of diarrhoea)
IV hydrocortisone is used for what?
Severe flare ups to induce remission
What’s the first-line diagnostic?
Colonoscopy + biopsy - not used for acute attacks
What is the best test to confirm the Crohn’s disease? via imaging
MRI small bowel
A 21-year-old female presents with a one-month history of diarrhoea, weight loss and fatigue. She has also noticed that her stools are pale-coloured and difficult to flush. She denies any abdominal pain and does not drink alcohol. She was diagnosed with Crohn’s disease at the age of 16 and underwent bowel resection last year due to a flare-up.
What is the most likely cause of her symptoms?
Short bowel syndrome
A 20-year-old female presents to her GP complaining of recent weight loss, cramp-like abdominal pain, bloating and frequent diarrhoea. She denies any foreign travel. On examination, a palpable mass is felt in the right iliac fossa. There are also 2 small shallow white ulcers noted within the mouth.
Which diagnostic test would be best to confirm the likely diagnosis of Crohn’s disease?
Colonoscopy with tissue biopsy (primary)
Erythema nodosum is what?
painful erythematous nodules/plaques on the shins
Pyoderma gangrenosum is what?
a well-defined ulcer with a purple overhanging edge
Crohn’s disease has a bimodal age of onset of what?
Age of onset is bi-modal with peaks at 15-40 and 60-80
A 26-year-old man has been suffering from diarrhoea for the last 5 weeks. During this time, he has lost 4kg in weight. The gastroenterologist decides to perform a colonoscopy.
Which histological findings would be consistent with a diagnosis of Crohn’s disease?
Submucosal fibrosis
Faecal calprotectin test suggests what?
nflammatory bowel disease,
Colonoscopy was normal. what tests do you do now?
Assess the small bowel; options for this include
MRI or small bowel capsule endoscopy
A 21 year old female presents with a one-month history of diarrhoea, weight loss and fatigue. She has also noticed that her stool are pale coloured and difficult to flush. She denies any abdominal pain and does not drink alcohol. She was diagnosed with Crohn’s disease at the age of 16, and underwent bowel resection last year due to a flare-up.
What is the most likely cause of her symptoms
Short bowel syndrome
Flare of Crohn’s disease shows up as what?
feel unwell, and would likely have raised inflammatory markers
A 23 year old female with a history of Crohn’s disease presents with three months of diarrhoea and fatty stools. She has previously required bowel surgery but is now well with normal inflammatory markers and no fever. She denies any blood in the stool and has not had any recent courses of antibiotics or been travelling abroad.
What is the most likely cause of her diarrhoea?
Bile acid malabsorption
A 48-year-old man presented with symptoms of indigestion and regurgitation of food. In addition, he had a painful epigastric mass on palpation of the abdomen. Upper gastrointestinal endoscopy revealed a gastric mass and biopsy revealed it to be a gastrointestinal stromal tumour. He was commenced on treatment with imatinib. Which describes the mode of action of imatinib?
Inhibition of tyrosine kinase
Crohn’s disease, ulcerative colitis, malignancy and coeliac disease. What test is used to distinguish between them?
Ileocolonoscopy with biopsies
A 26-year-old female presents to the general practitioner with an acute flare of Crohn’s disease. She reports passing six watery stools per day with abdominal pain and malaise. This is her first flare of Crohn’s disease in 18 months and she is not taking any regular medication. On examination vital signs are in normal range, abdomen is soft with tenderness in the right lower quadrant but no distension or guarding.
What is the most appropriate next step in managing this patient?
Prednisolone
Medication for inducing remission
glucocorticoids
Medication for Maintaining remission
Azathioprine - 2 or more excebations
Management of peri-anal abscess includes what?
The patient should be started on intravenous antibiotics e.g. ceftriaxone + metronidazole
Describe the difference in symptoms between crohns and UC
C- Abdominal pain, non-bloody diarrhoea, weight loss
UC - Bloody diarrhoea, abdominal cramps
Describe the difference in Complications between crohns and UC
C - Fistulas, strictures, abscesses
UC - Toxic megacolon, colon cancer risk
