Gastro

Question 1

Features of Crohn’s disease

Answer 1

• Diarrhoea usually non-bloody
• Weight loss more prominent
• Upper GI symptoms, mouth ulcers, perianal disease
• Abdominal mass palpable in the right iliac fossa - may have pain

Question 2

2 extraintestinal signs of Crohn’s disease

Answer 2

• Gallstones are more common secondary to reduced bile acid reabsorption
• Oxalate renal stones

Question 3

Describe the pathology of Crohn’s disease

Answer 3

• Lesions may be seen anywhere from the mouth to anus
• Inflammation occurs in all layers, down to the serosa

Question 4

What is the most common site affected by Crohn’s disease

Answer 4

terminal ileum

Question 5

Describe the investigation of Crohn’s

Answer 5

• raised CRP
• increased faecal calprotectin
• anaemia
• low vitamin B12 and vitamin D
• negative PANCA
• colonoscopy

Question 6

Describe the histology of Crohn’s disease

Answer 6

• Inflammation in all layers from mucosa to serosa
• increased goblet cells
• granulomas

Question 7

What features would suggest Crohn’s disease on colonoscopy

Answer 7

• Deep ulcers
• skip lesions (cobblestone appearance)

Question 8

What features would suggest Crohn’s disease in a small bowel enema

Answer 8

strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae