Inflammatory bowel disease: Crohn disease Flashcards
what is the average age of diagnosis and sex pattern ?
15-35 years
males more than females
what is the etiology of churns disease ?
unknown factors leading to imbalance between proinflammtory and antiinfalmmtory mediators
nicotine
difference with UC - where smoking is said to be preventive!
familial predisposition - mutation in NOD2 gene
HLA-B7
chlamidya and listeria monocytogens
what is the location of chrons disease ?
RECTUM SPARED
terminal ileum and colon- ILEOCOLIC - but can be located anywhere between mouth and naus
mostly - ileocolic , one in hepatic flexure , one lesion in transverse colon
one lesion in descending colon
what is the pathology of chrons disease ?
SKIPPED LESION
early findings
1) intestinal apathos ulcer halo of erythema they are barely visible
2) non casting granuloma
3) transmural deep linear fissures
4) cobble stoning
5) skipped lesions
6) transmural inflammation
= fistula and sinuses
7) granuloma
increased payers plaques
bowel thickens by fibrofatty change
corkscrew vessels
mesenteric lymphadenopathy
----------- histology fissures , sinuses , fistula lymphocytic infiltration transmural lymphoid aggregation fibrosis of ALL layers of wall epithelouid cell granulomas
what are the characteristics of chrons disease ?
occurs episodically - and recording inflammation
if symptoms persist more than 6 months = chronic
what are the intestinal symptoms of chrons disease ?
pain in the right LOWER QUADRANT palpable abdominal mass in righ lower quadrant low grade fever they have watery diarrhea progressive constipation flatulence right upper weight loss - due to malabsorption perianal abcess and perianal fistula
what are thee xtrainetsinal symptoms of chrons disease ?
just for chrons : nephrolithiaisis and cholelithiais, mouth - apthous ulcers
skin - pyoderma gangrenosum , erythema nodosum
joits - sacrolitlitis and spondylitis
eyes - uveitis , episcleritis , iritis
what are the ways of diagnosing chron’s disease ?
chrons diagnosisi - stool antigen testing for any bacterial inflammtion
glucose h2 breath test - for any bacterial infect
lactose h2 - breath test for lactose intolerance
stool blood testing
calprotecti and lactoferring for inflammtion
there is also serolongs - high levels of ASCA and low levels of pANCA
godlen there is colonoscopy and biopsy retrived = skipped lession and cobble stone appearnace
fibrofatty
stenosisn colon
ultrasound - can look sfor sinusues and fstulas and abcess
there is also doble contrast barium enema or barium swallow fluroscopy
blood test - show increased crp , lymphocytosisi , anemia , transerrin isincreased
deficicn in vit b12 and albumin and iron etc
what is the treatment of chrons ?
symtpomatic - mild / moderate
lactose free diet
malabsorption - sub vitamines , calories andportein
CEASE SMOKING / avoid nsaids
during acute epidodes - avoid fibre and consider parenteral nutrition
anti diarrhoea - loperamide
topical 5-ASA - sulfasalazine and mesalazine - suppository , foam ,enema
moderate - severe
oral corticosteroids - prednisolone
azathioprine and 6mp
if severe
IV corticosteroids - methylprednisolone
if steroid refactory
anti TNF alpha antibodies (infliximab and adalumimab) in combo with 6mp and azathioprine
maintenance - corticosteroids are inhibited
5-ASA have proven to be inefficent
azathioprine
6-mp
methotrexate
TNF alpha antibodies
(same for chrons
ustekinmumab
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surgery - resect affected and non functional intestinal loops while preserving intestinal length and function by end to end anastomosis
strictuoplasty
percutaneous drainage
ballon dilation
what are the complications ?
fistulae - between two loops
between bowel and bladder
sinus
obstruction - strictures / stenosis
due to serosistis adhesions of bowel loops
colon cancer
abcess formation in abdomen
malabsorption
what is the montreal classification of chrons disease ?
age
A1 below 16 years old
A2 above 17-40 years old
a3 - above 40
location L1- ileal alone l2 - colon alon L3 - ilocolonic L4 -isolaed upper disease
behaviour - B1 - non stricturing non penetration B2 - stricturing B3- penetrating periananal disease modified
difference between chrons and uc
non bloody watery diarrhea / constipation due to stricture
malnourished
constant pain in the right lower quadrant
and palpblabe abdominal mass
extra intestinal - nephrolithiais
common :
pyoderma gangrenous
erythema nodosum
uveitis / episcleritis
mouth - apthos stomatitis
joint - peripheral arthritis
spondylitis
for only chrons - fistula
strictures
perianal fissures
antibodies - asca
pattern - discontinuous
transmural
noncaseating granulomas
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uc
bloody mucus diarrhea
tenesmus - urge to defecation but ineffectual
good nutrition
constant pain in the left lower quadrant and painful defecation
extra intestinal - primary sclerosing cholangitis
and common
for only uc -
fulminant colitis
toxic megacolon
perforation
antibodies - p-anca
cancer - cholangiocarcinoma and colorectal
patter- continuous
confined to mucosa and submucosa
no granuloma
