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ms3 - gi > Crohns disease > Flashcards

Crohns disease Flashcards

1
Q

Epidemiology of crohns

Prevalence? age? F:M?

A

50 to 100 /100,000
20s
F>M (just)

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2
Q

Causes of crohns

A
  • Concordance = 70%
  • Smoking ↑ risk
  • TH1/TH17-mediated
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3
Q

Macroscopic changes of crohns

A
  • Mouth to anus esp. terminal ileum ulcers
  • Skip lesions
  • strictures
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4
Q

Microscopic changes in crohns

A
  • Transmural inflammation
  • cobblestone ulceration
  • marked fibrosis
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5
Q

Symptoms of crohns?

A

I. systemic: fever, malaise, anorexia, wt loss
II. Abdo:
- Diarrhoea (not usually bloody)
- Abdominal pain

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6
Q

Abdominal Signs of crohns?

A
  • Aphthous ulcers, glossitis
  • Abdominal tenderness
  • RIF mass
  • Perianal abscesses, fistulae, tags
  • Anal / rectal strictures
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7
Q

Dermatological signs of crohns and ulcerative colitis?

A
  • Clubbing
  • Erythema nodosum(red lumps)
  • Pyoderma gangrenous (esp. UC) (painful ulcers_
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8
Q

Eyes signs of crohns and ulcerative colitis?

A
  • Iritis
  • Episcleritis
  • Conjunctivitis
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9
Q

Joints signs of crohns and ulcerative colitis?

A
  • Arthritis (non-deforming, asymm)
  • Sacroiliitis
  • Ank spond
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10
Q

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

A
  • Primary Sclerosing Cholangitits + cholangiocarcinoma (esp. UC)
  • Gallstones (esp. Crohn’s)
  • Fatty liver
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11
Q

Other signs of crohns and ulcerative colitis?

A
  • Amyloidosis

- Oxalate renal stones (esp. Crohns)

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12
Q

Complication of crohns?

A
  1. fistula
  2. stricture
  3. abscess
  4. toxic megacolon and cancer
  5. Malabsorption
    - Fat (steatorrhea)
    - B12 (megablastic anaemia)
    - Vit D (osteomalacia)
    - Protein (oedema)
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13
Q

Blood investigations for crohns?

A
  • FBC: ↓Hb, ↑WCC
  • LFT: ↓albumin
  • ↑CRP/ESR
  • Haematinics: Fe, B12, Folate
  • Blood cultures
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14
Q

Stool investigations for crohns?

A
  • MCS: exclude Campy, Shigella, Salmonella…

- CDT: C. diff may complicate or mimic

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15
Q

Imaging investigations for crohns?

A

I. AXR: obstruction, sacroileitis
II. CXR: perforation
III. MRI
- Assess pelvic disease and fistula
IV. Small bowel follow-through or enteroclysis
- Skip lesions
- Rose-thorn ulcers
- Cobblestoning: ulceration + mural oedema
- String sign of Kantor: narrow terminal ileum

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16
Q

Endescopy investigations for crohns?

A
  • Ileocolonoscopy + regional biopsy: Ix of choice
  • Wireless capsule endoscopy
  • Small bowel enteroscopy
17
Q

Management of Severe crohns attack

A
  1. Resus: Nil by mouth, IV hydration
  2. Hydrocortisone: IV + PR if rectal disease
  3. Abx (metronidazole PO or IV)
  4. Dietician
    I. Elemental diet
    II. Consider parenteral nutrition
18
Q

Elemental diet

A

Liquid prep of amino acids, glucose and fatty

acids

19
Q

If no improvement after the initial management of severe crohns attack, what is the treatment?

A
  • Medical: methotrexate ± infliximab

- consider surgical

20
Q

Secondary management of severe crohns after improvement post-primary care?

A
  • oral therapy

- Switch to oral pred (40mg/d)

21
Q

Overview of management of crohns

A
  1. Inducing remission in mild/mod disease (outpatient)
  2. Supportive
  3. Oral therapy
22
Q

Oral therapy for crohns?

A 
1st line
- Ileocaecal: budesonide
- Colitis: sulfasalazine
2nd line:
- prednisolone (tapering)
3rd line: 
- methotrexate
4th line: 
- infliximab or adalimumab
23
Q

Perianal disease in crohns: how common?

A

Occurs in ~50%

24
Q

Perianal disease in crohns: investigations?

A

Ix: MRI + Examination under anaesthesia Rx

25
Q

Perianal disease in crohns: managements?

A
  • Oral Abx: metronidazole
  • Immunosuppression ± infliximab
  • Local surgery ± seton insertion
26
Q

Maintaining remission in crohns drugs?

A

1st line: azathioprine or mercaptopurine 2nd line: methotrexate
3rd line: Infliximab / adalimumab

27
Q

How many crohns patients get surgery?

A
  • 50-80% need ≥1 operation in their life
28
Q

Indications for emergency surgery on crohns patients?

A
  • Failure to respond to medical Rx
  • Intestinal obstruction or perforation
  • Massive haemorrhage
29
Q

Indications for Elective surgery on crohns patients?

A
  • Abscess or fistula
  • Perianal disease
  • Chronic ill health
  • Carcinoma
30
Q

Surgical options available to crohns patients?

A

I. Limited resection: e.g. ileocaecal
II. Stricturoplasty
III. Defunction distal disease with temporary loop ileostomy

31
Q

Complications of surgery on crohns?

A

I. Stoma complications
II. Enterocutaneous fistulae
III. Anastomotic leak or stricture

32
Q

Short gut syndrome features?

A
  • 1-2m small bowel
  • Steatorrhoea
  • ADEK and B12 malabsorption
  • Bile acid depletion → gallstones
  • Hyperoxaluria → renal stones
33
Q

Management of short gut syndrome?

A
  • Dietician
  • Supplements or TPN
  • Loperamide
34
Q

Supportive management of crohns?

A
  • High fibre diet

- Vitamin supplements

ms3 - gi (16 decks)

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