IBD - Crohn's Disease Flashcards
1
Q
How common is it?
A
Incidence = 5-10/100,000/yr Prevalence = 0.5-1/1000
2
Q
Who does it affect?
A
Asians less affected. M:F ratio = 1:1. Presentation mostly at ~ 20-40yrs.
Associated with cell-mediated altered immunity. Smoking increases risk by 3-4x, NSAIDs may exacerbate disease.
3
Q
What causes it?
A
- Chronic inflammatory GI disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus (esp terminal ileum and proximal colon).
- Characterised by skip lesions (unlike UC).
4
Q
Risk factors?
A
- Smoking
- NSAIDs
- Family history
- Age
5
Q
How does it present?
A
Symptoms
- Diarrhoea/urgency, abdominal pain, weight loss/failure to thrive.
- Fever, malaise, anorexia.
Signs
- Apthous ulcerations
- Abdominal tenderness/mass
- Perianal abscess/fistulae/skin tags
- Anal strictures
- (Beyond gut) clubbing, skin, joint and eye problems.
6
Q
Similar presentations?
A
UC, IBS, Gastroenteritis, diverticulitis, coeliac disease, cancer.
7
Q
How would you investigate the patient?
A
- Bloods – FBC, ESR, CRP, U&E, LFT, INR, ferritin, TIBC, B12, folate.
- Stool – MC&S and CDT to exclude C.diff, campylobacter, E.coli.
- Colonoscopy + rectal biopsy.
- MRI can assess pelvic disease and fistulae. Small bowel MRI assesses disease activity and shows site of strictures.
8
Q
Treatments?
A
Mild attacks – Prednisolone 30mg/d PO for 1wk, then 20mg/d for 4 wks. If symptoms resolve, reduce and stop steroids when parameters normal.
Severe – IV steroids, nil by mouth, IV fluids. Hydrocortisone 100mg/6h IV.
- Treat rectal disease; steroids (hydrocortisone)
- Monitor temp, pulse, bp and record stool frequency/character on stool chart.
- Physical exam daily. Daily bloods.
- Consider need for blood transfusion and parenteral nutrition.
- If improving after 5d, transfer to oral prednisolone. If not, infliximab and adalimumab have a role.
- Consider abdominal sepsis complicated Crohn’s especially if abdominal pain.
