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Year Two - Gastroenterology System > Crohn's Disease > Flashcards

Crohn's Disease Flashcards

1
Q

What is inflammatory bowel disease (IBD)?

A

It is defined as chronic, relapsing-remitting conditions in which there is inflammation of the gastrointestinal tract

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2
Q

What are the two inflammatory bowel disease disorders?

A

Ulcerative colitis (UC)

Crohn’s disease

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3
Q

What is Crohn’s disease?

A

It is an intermittent inflammatory bowel disease that most commonly affects the terminal ileum and colon; however, it can affect the entire gastrointestinal tract

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4
Q

What is the aetiology of Crohn’s disease?

A

The underlying aetiology remains unclear

However, there is evidence that the combination of an altered intestinal microbiota and compromised colonic epithelial integrity, results in the inappropriate exposure of non-sterile intestinal contents to the underlying immunological tissue – resulting in inflammation

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5
Q

What are the six risk factors of Crohn’s disease?

A

Young Age < 30 Years Old

Ashkenazi Jewish Descent

IBD Family History

HLA-B27 Positive

Gastrointestinal Infection

Smoking

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6
Q

What gene is associated with Crohn’s disease?

A

NOD-2

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7
Q

What are the five clinical features of Crohn’s disease?

A

Non-Bloody Diarrhoea

Right Iliac Fossa Pain/Mass

Perianal Disease

Mouth Ulcerations

Weight Loss

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8
Q

What is the most common clinical feature of Crohn’s disease in children?

A

Abdominal pain

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9
Q

What are the nine extra-intestinal manifestation of Crohn’s disease?

A

Gallstones

Oxalate Renal Calculi

Colorectal Cancer

Arthritis

Osteoporosis

Erythema Nodosum

Pyoderma Gangrenosum

Uveitis

Episcleritis

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10
Q

What pneumonic is used to remember the extra-intestinal manifestations of Crohn’s disease?

A

A PIE SAC

Aphthous Ulcers

Pyoderma Gangrenosum

Iritis

Erythema Nodosum

Sclerosing Cholangitis

Arthritis

Clubbing

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11
Q

What are the three most common extra-intestinal manifestations of Crohn’s disease?

A

Gallstones

Oxalate Renal Calculi

Episcleritis

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12
Q

What four investigations are used to diagnose Crohn’s disease?

A

Blood Tests

Stool Tests

Endoscopy + Biopsy

Abdominal X-Ray (AXR)

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13
Q

What are the five blood test results that indicate Crohn’s disease?

A

Decreased RBC Levels

Increased WCC Levels

Increased CRP Levels

Decreased Albumin Levels

Decreased Vitamin B12 Levels

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14
Q

What are the two stool tests used to diagnose Crohn’s disease?

A

Faecal Calprotectin

Stool Culture

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15
Q

What is faecal calprotectin?

A

It is an inflammatory marker, which is released during colitis

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16
Q

What faecal calprotectin result indicates Crohn’s disease?

A

There are elevated levels of this inflammatory marker present in stool cultures – usually > 200ug/g

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17
Q

How is faecal calprotectin used to investigate Crohn’s disease?

A

This stool test is useful for distinguishing between inflammatory bowel syndrome and inflammatory bowel disease

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18
Q

How are stool cultures used to investigate Crohn’s disease?

A

They are used to exclude gastrointestinal infections

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19
Q

What three gastrointestinal infections present similarly to Crohn’s disease, and are therefore important to exclude?

A

Salmonella

E.coli

Campylobacter

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20
Q

What is the gold standard investigation used to diagnose Crohn’s disease?

A

Endoscopy with biopsy

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21
Q

What are the four macroscopic features of Crohn’s disease on endoscopy?

A

Skip Lesions of Inflamed Mucosa

Cobble-Stone Appearance

Erythematous Mucosa

Transmural Inflammation

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22
Q

What is transmural inflammation?

A

It is defined as the infiltration of inflammatory cells to all layers - from mucosa to serosa

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23
Q

What are the two microscopic features of Crohn’s disease on endoscopy?

A

Increased Goblet Cell Abundance

Granuloma Formation

24
Q

What are the four features of Crohn’s disease on abdominal x-ray?

A

Proximal Bowel Dilation

Kantor’s String Sign

Rose Thorn Ulcers

Fistulae

25
Q

What is Kantor’s string sign?

A

It is a severe narrowing of bowel loop

26
Q

What is rose thorn ulcers?

A

They are sections of stenosed terminal ileum, which are filled with barium enema

27
Q

How do we conservatively manage Crohn’s disease?

A

We advise patients about smoking cessation

28
Q

What is the first line management option for the induction of remission in Crohn’s disease?

A

Corticosteroids

29
Q

Name two corticosteroids are used to manage Crohn’s disease

A

Oral prednisolone

IV hydrocortisone

30
Q

What is the second line management option for the induction of remission in Crohn’s disease?

A

Aminosalicylates (5-ASA)

31
Q

Name an aminosalicylate (5-ASA) used to manage Crohn’s disease

A

Mesalazine

32
Q

What is the third line management option for the induction of remission in Crohn’s disease?

A

Thiopurines

33
Q

Name two thiopurines used to manage Crohn’s disease

A

Azathioprine

Mercaptopurine

34
Q

What are the two fourth line management options for the induction of remission in Crohn’s disease?

A

Biologics

Immunosuppressants

35
Q

What are the four side effects of azathioprine?

A

Bone marrow depression

Nausea & vomiting

Pancreatitis

Increased non-melanoma skin cancer

36
Q

What blood test should be conducted prior to administration of azathioprine? Why?

A

Thiopurine Methyltransferase (TPMT) Activity

When very low/absent, azathipurine should not be administered. When decreased, hower not deficient, it should be commenced at a lower dose

37
Q

What blood test should be conducted to monitor complication development of azathioprine? Why?

A

Full blood count

This is to monitor development of bone marrow depression

38
Q

Name two biologics used to manage Crohn’s disease

A

Infliximab

Adalimumab

39
Q

What is the mechanism of action of infliximab?

A

Anti-TNFa

40
Q

What is the mechanism of action of adalimumab?

A

Anti-TNFa

41
Q

Name an immunosuppressant used to manage Crohn’s disease

A

Methotrexate

42
Q

What should patients be aware of when taking methotrexate?

A

They require effective contraception during and for at least 6 months after treatment

This applies to both men and women

43
Q

What is the first line management option for remission maintenance in Crohn’s disease?

A

Thiopurines

44
Q

What is the second line management option for remission maintenance in Crohn’s disease?

A

Immunosuppressants

45
Q

What is the third line management option for remission maintenance in Crohn’s disease?

A

Biologics

46
Q

What is a surgical management option of Crohn’s disease?

A

Proctectomy

47
Q

When is proctectomy used to manage Crohn’s disease?

A

It is used to manage severe rectal Crohn’s disease, in which rectal complications such as haemorrhae and fistulae have developed

48
Q

What are the eight complications of Crohn’s disease?

A

Anal fissure

Perianal Fistulae

Perianal Abscess

Bowel Obstruction

Gallstones

Malnutrition

Vitamin B12 deficiency anaemia

Small Bowel Cancer

Colorectal Cancer

49
Q

In Chron’s disease, what is th most likely cause of bleeding post-defecation?

A

Anal fissure

50
Q

What is the management option used to manage perianal abscesses in Crohn’s disease?

A

Incision and drainage

51
Q

What is the gold standard investigation used to investigate perianal fistulae in Chron’s disease?

A

MRI Pelvis

52
Q

What is the management option for simple perinal fistulae in Crohn’s disease?

A

Oral Metronidazole

53
Q

What is the management option for complex perinal fistulae in Crohn’s disease?

A

Draining Seton

54
Q

What is a seton?

A

It is a piece of surgical thread that is run through the fistula to allow continuous drainage while the fistula is healing

This ensures that the fistula doesn’t heal containing pus within, which would result in further abscess formation

55
Q

What pneumonic is used to remember the key features of Crohn’s disease?

A

crowns NESTS

No blood or mucus

Entire GI tract

Skip lesions

Terminal ileum/Transmural inflammation

Smoking risk factor

56
Q

How do we remember that smoking is a risk factor of Crohn’s disease?

A

Smoking sets a NEST on fire

57
Q

What pharmacological management option is only used to treat Crohn’s disease and not ulcerative colitis?

A

Methotrexate

Year Two - Gastroenterology System (33 decks)

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