Crohns disease Flashcards
What is the cause of Crohn’s disease?
An inappropriate immune response against the gut flora in a genetically susceptible individual
What are the symptoms of Crohn’s disease?
Diarrhoea, abdominal pain, weight loss/failure to thrive.
Name some of the extra-articular manifestations of Crohns disease?
Bowel ulceration
Perianal abscess/fistulae/skin tags
Clubbing
Erythema nodosum
Eye pathology
Name some complications of Crohn’s disease?
Small bowel obstruction
Dilatation of the bowel (rarer in Crohn’s than in UC)
Malnutrition
Malignancy
What investigations (imaging) would you order to diagnose Crohn’s disease
In small bowel pathology: capsule endoscopy
Pelvic disease and fistulae: MRI
Colonic disease: Colonoscopy and biopsy regardless of whether any abnormality detected
How do you treat mild-moderate Crohn’s disease?
Prednisolone 40mg/d PO for 1 week then taper by 5mg/week every week for 7 weeks.
This is in the event that a patient is systemically well but presenting with symptoms
How do you treat severe Crohn’s disease?
Admit to hospital.
IV fluid resuscitation
IV steroids (eg. hydrocortisone 100mg/6hr)
Thromboembolism prophylaxis
In Crohn’s patients, how do you investigate and manage perianal disease?
Occurs in around 50% of patients. MRI is performed as an investigation and examination under anaesthetic.
Treatment: oral Abx, immunosuppressant therapy +/- biologic such as infliximab.
Which drug do you have to check TPMT levels for?
Azathioprine.
At what point would you introduce a DMARD into a treatment regimen for Crohns disease?
Azathioprine is given to patients who show refractory exacerbation of their Crohn’s disease despite steroids.
When is surgery indicated in a patient with Crohns disease?
Complications such as intestinal obstruction, perforation, fistulae and abscesses.
How does smoking affect the incidence of Crohns disease?
It actually exacerbates disease and increases your likelihood of developing disease.
