Crohns disease Flashcards
Where can Crohns disease affect?
any part of the GI tract from mouth to anus although usually distal ileum or proximal colon
What are increased risk factors for Crohns?
family history, smoking, Ashkenzi Jews, Appenicectomy
What is the inflammation like in Crohns?
Transmural
What is a microscopic change in Crohns?
Non caseating granulomatous
What are some macroscopic changes in Crohns?
Discontinous inflammation (skip lesions) Fissures and deep ulcers (cobblestone appearance) fistula formation
What are the clinical features of Crohns?
abdominal pain and diarrhoea, colicky, site depends on bowel region involved, blood or mucus in diarrhoea, malaise, fever, anorexia, malabsorption, malnutrition, oral ulcers and perianal disease
What would be found on examination of someone with Crohns?
abdominal tenderness, mouth to perianal lesions, malabsorption and dehydration signs
What are some extra-intestinal features of Crohns?
Enteropathic arthritis, nail clubbing, metabolic bone disease, erythema nodosum, pyoderma gangrenosum, Episcleritis, anterior uvetitis, iritis, Primary sclerosing cholangitis, cholangiocarcinoma, gallstones, renal stones
What investigations would you do for suspected Crohns?
routine bloods looking for anaemia, low albumin (malabsorption) inflammation, AXR or CT to exclude toxic megacolon or bowel obstruction, faecal calptoectin, stool sample
What imaging is used to diagnose crohns?
Colonoscopy with biopsy, CT scan and MRI
What is the management for Crohns to induce remission?
fluid resucusiation, nutritional support, prophylactic her pain and anti embolic stockings as prothrombotic state of IBS flares, corticosteroids and immunosuppressants sick as mesalazine, infliximab
What is the management for Crohns to maintain remission?
Azathioprine or mercaptupurine and methotrexate, infliximab can be used as a rescue therapy in acute flares, smoking cessation
What is the surgical management for Crohns?
Ileocaecal resection, peri anal disease surgery, stricturoplasty, small or large bowel resection
What are the complications of Crohns disease?
Fistula, strictures, recurrent perianal abscesses, GI malignancy, malabsorption, osteoporosis, increased risk of gallstones, increased risk of renal stones
