Crohns Disease Flashcards
What is Crohn’s disease
One of the main types of inflammatory bowel diseases
what the bi-modal peak age of presentations of crohns
15-30 years
60-80 years
Which part of the GI system does crohns affect
Any part of the GI tract can be affected from the mouth to anus
which part of the GI tract is most commonly affected in crohns
Terminal ileum
What are the differences between UC and crohns
SIMM
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)
what type fistulas can form in crohns
Perianal Fistula
Entero-enteric fistula
Recto-vaginal
Enterocutaneous
Entero-vesicalar fistula
what are the risk factors for crohns
FH
Smoking
White European descent
Appendicectomy
What are the clinical feature of Crohn’s disease
Episodic abdo pain
Diarrhoea ( May contain blood/mucus )
Systemic sx
- malaise, anorexia and low-grade fever
Oral aphthous ulcers
Perianal disease
what are the MSK extra-intestinal features of Crohns
Enteropathic arthritis
Metabolic bone disease
what are the skin extra-intestinal features of Crohns
Erythema nodusum - tender subcut nodules typically on the shins
Pyoderma gangrenosum - erythematous papules/pustules that develop into deep ulcers ( not for UC however )
What are the extra intestinal features of crohns that affect the eyes
Episcleritis, anterior uvetitis, or iritis
How would you investigate Crohn’s disease using lab tests
FBC for anaemia Serum albumin CRP AXR Faecal calprotectin Stool sample
Which imaging modalities do you use to investigate crohns
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
What is the management of IBD
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 )
What treatment would you give for acute flare ups for IBD
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
How do you maintain remission of crohns
Azathioprine/ mercaptopurine
Methotrexate if above cannot be tolerated
Smoking cessation
colonoscopic surveillance is offered
Referral to IBD nurse specialist
Enteral nutritional support
When is surgery indicated for crohns
Surgical intervention is indicated in those with failed medical management, severe complications (such as strictures or fistulas), or growth impairment in younger patients.
What surgeries are available for crohns
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
What must surgeons beware of whist planning surgery
bowel-sparing approach must be taken to prevent short gut syndrome
What are the GI complications of someone with Crohns
Fistulas
Strictures - leads to obstruction
Recurrent perianal abscesses/fistula
GI malignancy - 3% increased risk of colorectal cancer
What are the extra-intestinal complications of crohns
Malabsorption - growth delay
Osteoporosis
Increased risk of gall stones
Increased risk of renal stones
