Crohns_Disease_Flashcards

Question 1

Q

Answer 1

A

Question 2

What are the gold-standard guidelines for paediatric Crohn’s Disease management?

Answer 2

ECCO-ESPGHAN guidelines (2020).

Question 3

How should children be risk stratified at diagnosis?

Answer 3

Using the Paris classification into low, medium, or high risk.

Question 4

What criteria are used to risk-stratify children with Crohn’s Disease?

Answer 4

Predictors of poor disease outcomes identified at endoscopy.

Question 5

What characterizes low-risk children in Crohn’s Disease?

Answer 5

Children with purely inflammatory disease, with no strictures or penetrating disease.

Question 6

What characterizes medium-risk children in Crohn’s Disease?

Answer 6

Low-risk children with no sign of clinical or biochemical remission 12 weeks after initial treatment, children with growth delay.

Question 7

What characterizes high-risk children in Crohn’s Disease?

Answer 7

Children with stricturing or penetrating disease, or any additional risk factors (e.g. growth delay, extensive disease, deep ulceration, perianal disease).

Question 8

What is the first-line treatment for high-risk children with Crohn’s Disease?

Answer 8

Anti-TNF therapy (e.g. infliximab).

Question 9

What combination might be considered with anti-TNF therapy for high-risk children?

Answer 9

Combination with immunomodulation (e.g. methotrexate).

Question 10

What is the maintenance therapy if anti-TNF induction treatment is effective in high-risk children?

Answer 10

Maintenance anti-TNF monotherapy.

Question 11

What should be done if induction treatment is ineffective in high-risk children?

Answer 11

Optimize anti-TNF therapy, add immunomodulator (e.g. methotrexate), consider increasing dosage or frequency of anti-TNF therapy, or switch anti-TNF agent (e.g. to adalimumab).

Question 12

What is the first-line treatment for low-risk children with Crohn’s Disease?

Answer 12

Exclusive enteral nutrition (EEN) for 12 weeks.

Question 13

What may be considered if EEN is not an option for low-risk children?

Answer 13

Corticosteroids.

Question 14

What is the maintenance therapy if EEN or corticosteroids are effective in low-risk children?

Answer 14

Maintenance therapy with methotrexate or thiopurine, with escalation to anti-TNF therapy if needed.

Question 15

What should be done if first-line treatment is not effective at inducing remission in low-risk children?

Answer 15

Step-up early to anti-TNF therapy with immunomodulation.

Question 16

What methods can be used for disease activity monitoring in Crohn’s Disease?

Answer 16

Biochemical: Faecal calprotectin (with CRP) or trough concentration levels of anti-TNF agents; Clinical: Paediatric Crohn’s Disease Activity Index; Imaging: MRI small-bowel or endoscopy.

Question 17

What recent trials informed the shift in guidelines to start anti-TNF agents as first-line treatment in Crohn’s Disease?

Answer 17

TISKIDS and REACH trials.

Question 18

What is the most accurate measure of dehydration in Crohn’s Disease?

Answer 18

The degree of weight loss during the illness.

Question 19

What indicates clinical dehydration and shock in terms of percentage weight loss?

Answer 19

Clinical dehydration: ≥ 5%; Shock: > 10%.

Question 20

What is the mainstay of therapy for clinical dehydration in Crohn’s Disease?

Answer 20

Oral rehydration solution, 75 mL/kg every 4 hours.

Question 21

When are IV fluids indicated for Crohn’s Disease?

Answer 21

For shock, deterioration, or persistent vomiting.

Question 22

What are the key points to explain to parents about Crohn’s Disease?

Answer 22

It is a disease with an unknown cause that causes inflammation of the digestive system leading to malabsorption and bloody diarrhoea, it is a life-long condition with a risk of relapse, there are many medications available to manage flare-ups, complications include malabsorption and bowel cancer, there is no special diet but certain foods may exacerbate symptoms.

Question 23

What support group is recommended for Crohn’s Disease?

Answer 23

Crohn’s and Colitis UK.