(!) Crohns disease

Question 1

Define Crohns disease

Answer 1

AID -transmural inflammation of the GI tract (can be at any bit, or all fit)
usually terminal ileum or perianal
unlike UC-skip lesion (not just consistent.
causes fibrosis and obstruction, and perforation and abscesses

Question 2

Aetiology and risk factors of Crohns disease

Answer 2

Unclear, but genetic factors and environment factors
Initial lesions start as inflammatory infiltrates that develop into full depth ulcers-> granulomas
Discrete ulcers separated with skip lesions

risk factors
Biphasal age peak-15-25 and 60-90
White people
Northern climates, richer countries
FHx of IBD
Smoking
high sugar diet

Question 3

Epidemology of Crohns disease

Answer 3

IBD is 0.3% of everyone in US ~3 mil people
higher in north than south Europe
Highest in rich countries

Question 4

Signs and Sx of Crohns disease

Answer 4

Combination of Fatigue, diarrhoea, abdominal pain, weight loss, fever, GI bleed (looks like cancer)
often missed because so unspecific

can come with malabsorption related issues (vit deficiencies)

Exam-
abdo tenderness, abdo mass
Erythema nodosum
APtous ulcers
Clubbing

DRE-faecal blood, mucus

Question 5

Investigations of Crohns disease

Answer 5

DRE-Faecal blood, mucus
Bloods
FBC-microcytic anaemia
Ferritin low
B12/folate-can be low
CRP up
FIT test-blood
Abdominal xray- dilation of affected bowel, calcification
CT-shows location of issues, abscesses, fistulas

Severe-hypoalbuminia, hypocholestemia, hypocalcaemia

Question 6

Management of Crohns disease

Answer 6

Based on severity
Mild-no dehydration
Conservative-monitor on steroids (Budosemide) + manage GI Sx

Moderate-not responding to mild Mx
Initiate remission via
1st Steroids to induce remission
2nd Then add immunomodulator (Azothioprim, mercatopurine, metotrexate+folic acid)
3rd- Add Biotherapy to immunomodulator 
Infliximab (TNF inhib)+ azathio

Severe-not responding to Mx, high CRp
Hospital, steroids, biotherapy, immunotherapy
Surgery

Question 7

Complications of Crohns disease

Answer 7

Severe disease-dehydration, severe malabsorption -aneamia,hypoalbuminia, hypocalcaemia
Vit A, D, E,K low

Intestinal obstruction-common short term-nausea vom, pain
Abdo sepsis-use of immunosuppressants and Abx-C.difficiles

Increased risk of cancer
Kidney stone

metotrexate-liver toxicity-monitor

and many many more

Question 8

Prognosis of Crohns disease

Answer 8

Usually periods of latency/remission between exacerbation
most pt will need surgery as some point

does reduce life expectancy -decreases with the duration of the disease, higher comorbidity score, lower socioeconomic status,

main causes of death-colon cancer, PE, lymphoma, sepsis