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large bowel > Crohns Disease > Flashcards

Crohns Disease Flashcards

1
Q

What is Crohn’s disease

A

One of the main types of inflammatory bowel diseases

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2
Q

what the bi-modal peak age of presentations of crohns

A

15-30 years

60-80 years

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3
Q

Which part of the GI system does crohns affect

A

Any part of the GI tract can be affected from the mouth to anus

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4
Q

which part of the GI tract is most commonly affected in crohns

A

Terminal ileum

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5
Q

What are the differences between UC and crohns

SIMM

A

Site - UC affects large bowel, crohns = anywhere in GI tract

Inflammation - UC = superficial mucosa, Crohn’s = transmural

Microscopic changes:
UC - crypt abscesses, reduced goblet cells, non-granulomatous

Crohn’s - granulomatous

Macroscopic changes:
UC - continuous inflammation, pseudopolyps and ulcers may form

Crohn’s - discontinuous inflammation - skip lesions, fissures and ulcers - cobblestone appearance, fistula formation ( perianal disease)

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6
Q

what type fistulas can form in crohns

A

Perianal Fistula

Entero-enteric fistula

Recto-vaginal

Enterocutaneous

Entero-vesicalar fistula

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7
Q

what are the risk factors for crohns

A

FH

Smoking

White European descent

Appendicectomy

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8
Q

What are the clinical feature of Crohn’s disease

A

Episodic abdo pain

Diarrhoea ( May contain blood/mucus )

Systemic sx
- malaise, anorexia and low-grade fever

Oral aphthous ulcers

Perianal disease

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9
Q

what are the MSK extra-intestinal features of Crohns

A

Enteropathic arthritis

Metabolic bone disease

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10
Q

what are the skin extra-intestinal features of Crohns

A

Erythema nodusum - tender subcut nodules typically on the shins

Pyoderma gangrenosum - erythematous papules/pustules that develop into deep ulcers ( not for UC however )

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11
Q

What are the extra intestinal features of crohns that affect the eyes

A

Episcleritis, anterior uvetitis, or iritis

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12
Q

How would you investigate Crohn’s disease using lab tests

A 
FBC for anaemia 
Serum albumin 
CRP
AXR
Faecal calprotectin 
Stool sample
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13
Q

Which imaging modalities do you use to investigate crohns

A

Colonoscopy with biopsy - this is the gold standard, can see cobblestone appearance + granulomatous appearance on histology after biopsy

CT scan for severe Crohn’s disease

MRI scan

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14
Q

What is the management of IBD

A

Refer to gastroenterologist for confirmation of IBD and initiation of treatment

( anti-Motility drugs such as loperamide should be avoided as they can pre-dispose to toxic megacolon )

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15
Q

What treatment would you give for acute flare ups for IBD

A

Fluid resuscitation

Nutritional support

Prophylactic heparin ( IBD flare ups induce pro-thrombotic state)

Ted stockings

Medical management - corticosteroid therapy and immunosuppressive agents such as azathioprine and sulfasalizine

Biologics - infliximab

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16
Q

How do you maintain remission of crohns

A

Azathioprine/ mercaptopurine

Methotrexate if above cannot be tolerated

Smoking cessation

colonoscopic surveillance is offered

Referral to IBD nurse specialist

Enteral nutritional support

17
Q

When is surgery indicated for crohns

A

Surgical intervention is indicated in those with failed medical management, severe complications (such as strictures or fistulas), or growth impairment in younger patients.

18
Q

What surgeries are available for crohns

A

Ileocaecal resection (removal of terminal ileum and caecum with primary anastomosis)

Surgery for peri-anal disease (e.g. abscess drainage, seton insertion, or laying open of fistulae)

Stricturoplasty (division of a stricture that is causing bowel obstruction)

Small bowel or large bowel resections

19
Q

What must surgeons beware of whist planning surgery

A

bowel-sparing approach must be taken to prevent short gut syndrome

20
Q

What are the GI complications of someone with Crohns

A

Fistulas

Strictures - leads to obstruction

Recurrent perianal abscesses/fistula

GI malignancy - 3% increased risk of colorectal cancer

21
Q

What are the extra-intestinal complications of crohns

A

Malabsorption - growth delay

Osteoporosis

Increased risk of gall stones

Increased risk of renal stones

large bowel (7 decks)

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