Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Karan - MBBS Year 1: Gastrointestinal Week 5 > IBD - Crohn's Disease > Flashcards

IBD - Crohn's Disease Flashcards

1
Q

Define Crohn’s.

A
  • Chronic, relapsing-remitting, non-infectious inflammatory disease of GI tract.
  • Patients typically present between 20-40 years old
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe possible aetiologies of Crohn’s.

A
  • Still unclear
  • Thought to be inappropriate immune responses to environmental triggers in genetically susceptible individuals
  • 15% have family history
  • Affects patient anywhere from mouth to anus - 80% have evidence of small bowel disease - most commonly in distal ileum. 25% have perianal disease
  • Mixture of genetic, lifestyle and environmental factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe microscopic changes of Crohn’s.

A
  • Inflammatory infiltration, characterised by lymphoid hyperplasia
  • Non-caseating granulomas.
  • Transmural inflammation is also seen.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe macroscopic changes of Crohn’s.

A
  • Aphthous ulcers)form due to inflammation.
  • Cobblestone appearance, which can be seen on endoscopy.
  • Bowel wall thickening, fistulae and fissures.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for Crohn’s?

A

Family history
Cigarette smoking
Previous infectious gastroenteritis
NSAID usage
A diet high in refined sugar and low in fibre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List some symptoms that are typical in Crohn’s. PART 1

A
  • Abdominal pain: most commonly in the right lower quadrant (terminal ileum) and peri-umbilical regions
  • Diarrhoea: bloody or non-bloody, may be accompanied by mucus, and nocturnal diarrhoea may occur
  • Perianal pain/itching: if perianal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List some symptoms that are typical in Crohn’s. PART 2

A
  • Oral ulceration (aphthous ulcers)
  • Nausea and vomiting
  • Fever
  • Fatigue
  • Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe some extra-intestinal manifestations of Crohn’s.

A
  • Musculoskeletal: enteropathic arthritis
  • Eyes: episcleritis, uveitis and conjunctivitis
  • Skin: erythema nodosum (Figure 3) and pyoderma gangrenosum
  • Hepatobiliary: primary sclerosing cholangitis, fatty liver disease and gallstones
  • Renal: nephrolithiasis
  • Haematological: anaemia, B12 deficiency and thromboembolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some typical clinical findings for someone with Crohn’s?

A
  • Abdominal tenderness or mass
  • Perianal tenderness or pain, anal or perianal skin tags, fissure, fistula or abscess
  • Features of anaemia (e.g. pallor, fatigue and conjunctival pallor)
  • Joint pain
  • Clubbing
  • Oral lesions: aphthous ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some differential diagnoses to consider alongside Crohn’s?

A

Ulcerative colitis
Infectious colitis
Pseudomonas colitis
Diverticular disease
Irritable bowel syndrome (this is a diagnosis of exclusion)
Radiation colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some laboratory investigations to be done during suspected Crohn’s?

A
  • FBC - anaemia, leucocytosis, thrombocytosis
  • Liver function tests: hypoalbuminaemia
  • Bone profile: hypocalcaemia
  • Iron studies: normal or may demonstrate iron deficiency
  • Serum B12 / folate: normal or low
  • Inflammatory markers (CRP and ESR): elevated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe stool testing in someone with Crohn’s.

A
  • Faecal calcoprotectin - marker of GI inflammation - distinguish IBD from non inflammatory GI conditions
  • Raised in Crohn’s
  • MCS needed to exclude infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the preferred methods of endoscopy in someone suspected to have Crohn’s.

A
  • Colonoscopy and biopsy - to assess colon and terminal ileum
  • Upper GI endoscopy to assess for gastroduodenal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List some macroscopic features of Crohn’s on endoscopy.

A
  • Cobblestone appearance: small superficial ulcers
  • Skip lesions
  • Oedema
  • Hyperaemia
  • Aphthous ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List some microscopic features of Crohn’s on endoscopy.

A
  • Transmural involvement with non-caseating granulomas
  • Lymphoid hyperplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe imaging in Crohn’s. PART 1

A
  • Abdominal X-ray: may identify bowel dilatation and perforation in acute settings
  • Abdominal ultrasound: can be used to assess bowel thickening, free-fluid or abscess formation
17
Q

Describe imaging in Crohn’s. PART 2

A
  • CT abdomen: usually used in the acute setting and to assess for complications (especially extra-mural complications)
  • MRI small bowel/pelvis: can be used for ‘disease mapping’; assesses the extent of inflammation in the small bowel or fistulae formation
18
Q

How is remission induced in Crohn’s?

A
  • Corticosteroids : used to induce remission in patients with first presentation or a single inflammatory exacerbation in a 12-month period.
  • Budesonide: if conventional steroid use is unsuitable, however, it is less effective.
  • Aminosalicylates - cause fewer side effects than corticosteroids and budesonide but are not as effective; they are unsuitable for severe presentations.
19
Q

Describe add-on treatment in someone with Crohn’s.

A
  • Added to corticosteroid after 2 or more exacerbations in 12 month period or if corticosteroid dose cannot be reduced
  • EXAMPLES: thiopurines, biologics and methotrexate
20
Q

How is remission maintained in Crohn’s?

A
  • Azathioprine
  • Mercaptopurine
  • Methotrexate can be used in patients who required it to induce remission
21
Q

List the indications for surgical management of Crohn’s.

A
  • Patient choice: patients with ileocaecal disease may be offered medicines or surgery
  • Failure of medical management: medications do not improve disease activity or are not suitable
  • Development of implications: strictures, abscesses, fistulas, obstruction or perforation
22
Q

List some common surgical management options for Crohn’s. PART 1

A
  • Strictureplasty: widens narrowed areas of the bowel that could lead to obstruction
  • Fistula removal: closes, opens, drains or removes a fistula that doesn’t heal with medications
  • Abscess drainage
  • Colectomy: removes diseased colon, sparing the rectum
23
Q

List some common surgical management options for Crohn’s. PART 2

A
  • Proctocolectomy: removes diseased colon and rectum
  • Ileostomy/colostomy
  • Bowel resection: removal of the diseased small or large bowel and connection of the two healthy ends
24
Q

What are the complications of Crohn’s?

A
  • Psychosocial impact (e.g. on school, work or leisure)
  • Intestinal complications: strictures, fistulas, dilation, perforation and haemorrhage
  • Perianal disease
  • Anaemia
  • Malnutrition, faltering growth or delayed pubertal development
  • Cancer of the small and large intestine
25
Q
A

Karan - MBBS Year 1: Gastrointestinal Week 5 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions