IBD: Crohn's Disease Flashcards
What is Crohn’s Disease (CD)?
IBD characterised by transmural inflammation that can affect any part of the GI tract (mouth - anus).
Peak incidence = 20-30 years
What are the genetic risk factors for Crohn’s Disease?
NOD2/CARD15 gene mutations + other genetic mutations.
These mutations are associated with an increased risk of developing Crohn’s Disease.
What environmental factors are associated with Crohn’s Disease?
- Smoking
- Diet (high in sugar/fats/processed food)
- NSAIDs
- Appendectomy.
These factors can increase the risk of developing Crohn’s Disease.
What infectious agents are implicated in Crohn’s Disease?
Bacteria + microbiota (imbalance in the gut microbiota).
An imbalance in gut microbiota may trigger inflammatory responses.
Where does Crohn’s Disease commonly affect the GI tract?
Commonly affects the terminal ileum and colon but may be seen anywhere from mouth to anus.
This differentiation helps in diagnosis and treatment planning.
What layers of the GI tract are affected by inflammation in Crohn’s Disease?
Inflammation occurs in all layers down to the serosa.
This transmural inflammation distinguishes Crohn’s from other types of IBD.
What are common complications of Crohn’s Disease?
- Strictures
- Fistulas
- Adhesions.
These complications can lead to significant morbidity and may require surgical intervention.
What are the key symptoms of Crohn’s Disease?
- Abdominal pain
- Diarrhoea (blood and mucus common)
- Weight loss
- Perianal disease
- Oral manifestation (ulcers)
- Other symptoms (Fatigue, N/V, abdominal distention, constipation)
- Extra-intestinal manifestations (arthritis, uveitis, erythema nodosum, anaemia).
Symptoms can vary widely among individuals.
What is the gold standard investigation for diagnosing Crohn’s Disease?
Colonoscopy + biopsy.
It allows for direct visualization and histological examination of the intestinal mucosa.
What histological findings are associated with Crohn’s Disease?
- Inflammation in all layers from mucosa to serosa
- Ulceration, fibrosis
- skip lesions
- increased goblet cells
Granulomas are a key histological feature that can help in diagnosis.
What is the significance of faecal calprotectin in the investigation of Crohn’s Disease?
Specific test for IBD, measures calprotectin (protein) found in stool and assesses for inflammation.
It helps to rule out differential diagnoses such as IBS and C. Difficile colitis.
What imaging methods are used to assess complications in Crohn’s Disease?
- Ultrasound
- CT
- MRI.
These imaging techniques help identify complications like fistulae, abscesses, and strictures.
What are the differential diagnoses for Crohn’s Disease?
- Ulcerative Colitis (UC)
- Irritable Bowel Syndrome (IBS)
- Intestinal Tuberculosis.
Each condition has distinct features that aid in differentiation.
What is the gold standard technique for Crohns diagnosis?
Colonoscopy + biopsy
Deep ulceration + skip lesions
Which lifestyle changes are recommended for managing Crohn’s Disease?
- Stop smoking
- Avoid NSAIDs and oral contraceptive pill.
Smoking is known to exacerbate Crohn’s Disease.
What is the first-line treatment for maintaining remission in Crohn’s Disease?
Azathioprine or Mercaptopurine monotherapy.
Immunosuppressive therapy is essential for long-term management.
What is the seond-line treatment for maintaining remission in Crohn’s Disease?
Methotrexate
What characteristics of acute flare managment in Crohn’s disease determines the treatment pathway?
1) 1st flare or 1 flare in last 12 months
2) 2+ flares in 12 months
What treatment for Crohns acute flare for patient on their 1st presentation/only 1 flare in last 12 months?
1st: Corticodteroids (Prednisolone/IV hydrocartisone)
2nd: Buedsonide or Aminosalicylates
Corticosteroids are effective in reducing inflammation during acute exacerbations.
What treatment for Crohns acute flare for patient on their 2nd flare in 12 months?
1st: Corticosteroids/Budesonide AND Azathiopine/Metaptpurine
2nd: Corticosteroid + Methotrexate
Fill in the blank: In Crohn’s Disease, the presence of deep ulceration and skip lesions is indicative of _______.
Crohn’s diagnosis.
These findings are characteristic when performing a colonoscopy.
What surgical options are available for Crohn’s Disease?
- Ileocaecal resection
- Segmental small bowel resections
- Stricturoplasty
- Management of perianal disease (Metronidazole or Anti-TNF agents)
- Incision and drainage for perianal abscess.
Surgical intervention may be necessary for complications or refractory disease.
What alternative treatment may be considered in special cases for Crohn’s Disease?
Enteral feeding.
This can help in managing nutritional status and reducing inflammation.
