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GI > Crohn's disease > Flashcards

Crohn's disease Flashcards

1
Q

What type of disease is Crohn’s?

-2

A

IBD

autoimmune

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2
Q

describe/define Crohn’s succinctly?

A

Chronic disconnected transmural inflammation of the bowel anywhere from mouth to anus.

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3
Q

disconnected nature of inflammation leads to what feature.

A

skip lesions

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4
Q

transmural nature of inflammation leads to what feature.

A

fistulas

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5
Q

what is a granuloma

A

pocket of macrophages

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6
Q

which ethnicities are at risk?

-2

A

Caucasian

Ashkenazic Jew

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7
Q

which gene is implicated?

A

HLA-B27

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8
Q

which lifestyle factor increases risk?

-1

A

smoking

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9
Q

Is FHx a risk factor?

A

yes

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10
Q

is family history required for you to have crohn’s?

A

no

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11
Q

where is inflammation worst?

as a result what vitamin is deficient?

A

terminal ileum

B12

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12
Q

why is there anaemia?

-3 reasons

A

low B12, low folate, low iron

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13
Q

which phenomena in adolescent is delayed?

A

puberty

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14
Q

what blood tests increase in flare ups?

-4

A

FCP
CRP
ESR
leukocytes

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15
Q

why is there diarrhoea?

A

inflamed intestines can not absorb water & nutrients

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16
Q

why is there fatigue?

A

anaemia

malabsorption

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17
Q

what happens to weight and why?

A

weight loss

not absorbing nutrients

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18
Q

which inflammatory marker allows you to differentiate IBD from IBS?

A

FCP

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19
Q

what does FCP stand for?

A

faecal calprotectin

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20
Q

what does ESR stand for?

A

erythrocyte sedimentation rate

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21
Q

high ESR indicates what?

A

inflammation

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22
Q

most common symptom in adults?

A

diarrhoea

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23
Q

most common symptom in children?

A

abdo pain

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24
Q

where is abdo pain particularly bad?

-which quadrant

A

LRQ

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25
Q

3 layers of the gut?

A

mucosa
sub mucosa
muscularis

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26
Q

define transmural?

A

going through wall

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27
Q

crohns pt has blood in stool and pain on defecation.

what might be cause in respect to crohn’s?

A

anal fissure

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28
Q

what is an anal fissure?

A

tear in anal lining

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29
Q

hallmark feature of toxic megacolon on AXR?

A

big colon

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30
Q

treatment for toxic megacolon

A

resect colon

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31
Q

bowel perforation on AXR, what is hallmark feature?

A

sub-diaphragmatic air

32
Q

which complications of crohn’s can cause distended abdomen?

-2

A

toxic megacolon

strictures/obstruction

33
Q

why might crohn’s pt be at increased risk of skin cancer?

A

SE of thiopurines

34
Q

Complications of IBD that requires regular screening?

A

bowel cancer

35
Q

where do apthous ulcers most commonly arise?

A

mouth

36
Q

symptoms of crohn’s?

-4

A

diarrhoea
abdominal pain
bloody stools
fatigue/lethargy

37
Q

potential features on rectal exam?

-6

A

blood, skin tags, erythema, fissures, fistulas, ulceration

38
Q

cutaneous extra-intestinal manifestations?
-2

describe what each of these things are?

A

Erythema nodosum - fat under skin gets inflamed, causing tender red nodule to form on skin, mainly on shins

Pyoderma gangrenosum - pustule or nodule becomes ulcer and keep growing

39
Q

MSK extra-intestinal manifestations?

-3

A

arthritis
Osteoporosis
clubbing

40
Q

low oestrogen and crohn’s is a risk factor for what MSK condition, particularly for women?

A

osteoporosis

41
Q

most common extra-intestinal manifestation in both Crohn’s & UC ?

A

arthritis

42
Q

hepatobiliary extra-intestinal manifestation that is way more common in UC?

A

Primary sclerosing cholangitis

43
Q

most common place to see erythema nodosum on body?

A

legs

44
Q

extra-intestinal manifestation in eyes?

-2

A

episcleritis

uveitis

45
Q

give all potential blood results for crohn’s?

-10

A

↓B9, ↓B12, ↓D, ↓Fe, ↑FCP, ↑CRP, ↑ESR, ↑WBC

LFTs – low albumin

U&Es - ↑urea, high urea:creatinine ratio, from dehydration

46
Q

what do you want to exclude on stool culture?

-2

A

gastroenteritis & pseudomembranous colitis

47
Q

in the context of crohn’s,

low albumin shows what?

what blood test is done to check albumin?

A

malabsorption

LFT

48
Q

features seen on colonoscopy?

- 3

A

deep ulcers
skip lesions
cobblestone appearance

49
Q

features seen on histology?

-3

A

transmural inflammation

granulomas

goblet cells

50
Q

gold standard Ix?

A

Colonoscopy + biopsy

51
Q

which serum antibody marker is high in crohn’s?

A

ASCA

52
Q

features seen on barium fluoroscopy?

-3

A

o Kantor’s string sign = strictures
o “rose thorn” ulcers
o Fistulae

53
Q

what do you call a fistula between bowel and bowel?

A

enteroenteric fistula

54
Q

what do you call a fistula between bowel and skin?

A

enterocutaneous

55
Q

what do you call a fistula between bowel and bladder?

A

enterovesical

56
Q

what do you call a fistula between bowel and vagina?

A

enterovaginal

57
Q

give all potential blood results for crohn’s?

A

↓B12, ↓D, ↓Fe, ↑FCP, ↑CRP, ↑WBC

LFTs – low albumin

U&Es - ↑urea, high urea:creatinine ratio, from dehydration

58
Q

what is seen on colonoscopy?

-3

A

o Deep ulcers, skip lesions, cobblestone mucosa

59
Q

what is seen on histology?

A

transmural inflammation, granulomas, goblet cells

60
Q

antibody marker for crohn’s?

A

ASCA

61
Q

antibody marker for UC?

A

pANCA

62
Q

a stricture is seen on barium fluoroscopy.

What name is given to this type of stricture?

A

Kantor’s string sign

63
Q

group of drugs used to induce remission?

give two named examples in this group?

A

Glucocorticoids

prednisolone or hydrocortisone

64
Q

name two 1st line drugs used to maintain remission?

what group are these two drugs?

what class?

A

Azathioprine or Mercaptopurine

immunomodulators

purine synthesis inhibitors

65
Q

2nd line drug to maintain remission?

A

methotrexate

66
Q

last resort drug for refractory crohn’s?

group of drug?

moa of this drug (class)?

A

Adalimumab

monoclonal antibody

TNF alpha blocker

67
Q

Adalimumab & methotrexate belongs to what group of drugs?

A

immunosuppressant

68
Q

what class is ciprofloxacin?

A

flucloxacillin

69
Q

what class is metronidazole?

what type/group of drugs does it belong to?

A

nitroimidazole

antibiotics

70
Q

azathioprine causes risk of what cancer?

A

skin cancer

71
Q

definitive treatment for abscess?

A

incise+drain

72
Q

definitive treatment for fistulae?

A

resect affected part of bowel

73
Q

definitive treatment for highly damaged/inflamed ileum?

A

ileocecal resection

74
Q

panproctocolectomy is done.

what type of stoma is needed?

A

ileostomy

75
Q

peri-anal disease from Crohn’s.

which two drugs can be given?

what group to these two drugs belong to?

A

ciprofloxacin or metronidazole

antibiotics

GI (25 decks)

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