Crohns disease

Question 1

Risks

Answer 1

Smoking
NSAIDs
Genetic/Fx - NOD2 gene

Question 2

Females or males affected more?

Answer 2

Females

Question 3

Where does crohns effect?

Answer 3

Mouth to anus - but esp terminal ileum

Question 4

What are the macroscopic changes?

Answer 4

Skip lesions

Strictures

Question 5

Microscopic changes?

Answer 5

Inflammation - transmural
Ulceration - thin and deep = cobblestone mucosa
Fistula’s and granulomas

Question 6

What will be seen pathologically that differentiates this from UC?

Answer 6

Fistulas
Granulomas
Peri-anal disease

Question 7

Symptoms?

Answer 7

Abdo pain
Diarrhoea with no blood (usually)
Weight loss/anorexia
—> malaise and malabsorptive signs such as vit. deficiencies and anemia

Question 8

Types of investigations?

Answer 8

Bloods
Imaging
Stools

Question 9

What will be seen in bloods?

Answer 9

Raised CRP/ESR
Raised WCC
Raised Platelets
Low Hb
Low Albumin

Question 10

What is stool tested for?

Answer 10

Calprotectin

and to test for campylobactor/c. diff

Question 11

What imaging is done and why?

Answer 11

AxR - obstructions
CxR - perforations
MRI - assess severity
Endoscopy - for a biopsy

Question 12

1st line treatment to induce remisson?

Answer 12

Ileocaecal = Budesonide (Steroid)
Colitis = Sulfasalazine/5-ASAs

Question 13

2nd line?

Answer 13

Prednisolone

Question 14

3rd line?

Answer 14

Methotrexate

Question 15

4th line?

Answer 15

Biologics like infliximab

Question 16

Describe surgery.

Answer 16

It is never curative and should be conservative

Will be a resection or an ileostomy