Crohns Disease

Question 1

Where is the pain felt in Crohn’s disease

Answer 1

Lower right quadrant of the abdomen

Question 2

Symtpoms of Crohn’s disease

Answer 2

Arthritis
Conjunctivitis
Fatty liver disease
Gall stones
Anaemia
Mouth ulcers
Fever
Fatigue
Weight loss
Diarrhoea with or without mucus/blood

Question 3

Diagnosis of Crohn’s disease [6]

Answer 3

Cobblestone appearance
Ulcers
Skip lesions
Positive faecal calprotectin
Raised CRP and ESR
Low Hb

Question 4

First line for inducing remission

Answer 4

Glucorticoid ( oral prednisolone/ oral aminosalicylate)

or oral aminosalicylate

Question 5

Before adding add on therapy what do you need to do

Answer 5

Check TPMT

Question 6

First line add on therapy for inducing remission

Answer 6

Azathioprine or mercaptopurine

Question 7

Which add on therapy for inducing remission should be given to a patient with low TPMT

Answer 7

Methotrexate

Question 8

Whats the last option for add on therapy for inducing remission

Answer 8

Biologic with immunosuppressant

E.g. Infliximab/ Adalimumab

Question 9

First line for maintaining remission

Answer 9

Azathioprine or Mercaptopurine

Question 10

2nd line for maintaining remission

Answer 10

Methotrexate

Question 11

3rd line for maintaining remission

Answer 11

Surgery

Question 12

When should surgery be considered in maintaining remission

Answer 12

If patient has had Azathioprine or Mercaptopurine and methotrexate but it is ineffective

Disease is limited to distal ileum

Question 13

What should be given to patients who have had surgery for Crohn’s disease limited to the distal ileum

Answer 13

Azathioprine and postoperative metronidazole