Crohns Disease Flashcards
1
Q
What is Crohns disease
A
Chronic inflammatory disease - TRANSMURAL GRANULOMATOUS INFLAMMATION
2
Q
How common is it
A
5-10 in 10,000
3
Q
What causes it
A
- Unknown
- Genetic
- -> 1 in 6 have FHx (NOD2/CARD15 mutation ^ risk)
4
Q
What are the risk factors for developing Crohns
A
- NOD2/ CARD15 mutation
- Smoking
- NSAIDs exacerbate
5
Q
What are the symptoms
A
- Diarrhoea
- Abdo pain
- Weight loss
- Failure to thrive in children
- fever, malaise, anorexia in active disease
6
Q
What are the signs (+ extra-intestinal) in Crohn’s
A
- Apthous ulceration
- Abdo tenderness
- RIF mass (caecum)
- Perianal abscess/ fistulae/ skin tags
- Anal/rectal stricture
EXTRA- INTESTINAL
- Clubbing
- erythema nodosum
- pyoderma gangrenosum
- Conjunctivitis
- Episcleritis
- Renal stones
- osteomalacia
7
Q
What are some of the differential diagnoses
A
- Coeliac disease
- Microscopic/ ischaemic / radiation colitis
- IBS
- Lactose intolerance
- NSAID enteropathy
8
Q
What investigations would you conduct
A
- BLOODS - + serum iron, B12, red cell folate (if anaemia)
- STOOL MC+S
- Sigmoidoscopy + rectal biopsy
- Barium enema - may show ‘cobblestoning’
- COLONOSCOPY
9
Q
What is the management for Crohns (and SEs) + what percentage have perianal disease
A
- Mild = PO prednisolone (SE: weight gain, infections, oesteoporosis)
- Severe = looks ill, admit IV steroids, NBM + IVI (0.9% saline + 2L dextrose0-saline)
Hydrocortisone IV
Metronidazole PO - SE: -OH intolerance, irreverisble neuropathy
Monitor temp, pulse, BP, stool, blood –> transfer to prednisolone if improve after 5 days
NOT IMPROVING = ciclosporin + infliximab
– 50% have perianal disease
