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MRCS med school > Crohns > Flashcards

Crohns Flashcards

1
Q

Age of crohns

A

20s

F>M (just)

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2
Q

Causes of crohns

A
  • Concordance = 70%
  • Smoking ↑ risk
  • TH1/TH17-mediated
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3
Q

Macroscopic changes of crohns

A
  • Mouth to anus esp. terminal ileum ulcers
  • Skip lesions
  • strictures
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4
Q

Microscopic changes in crohns

A
  • Transmural inflammation
  • cobblestone ulceration
  • marked fibrosis
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5
Q

Symptoms of crohns?

A

Systemic: fever, malaise, anorexia, wt loss

Abdo: diarrhoea (not usually bloody), pain

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6
Q

Abdominal Signs of crohns?

A

Ulcer

RIF mass/tenderness

Perianal disease (abscesses, fistulae, tags)

Anal / rectal strictures

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7
Q

Dermatological signs of crohns and ulcerative colitis?

A

Clubbing

Erythema nodosum(red lumps)

Pyoderma gangrenous (esp. UC) (painful ulcers)

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8
Q

Eyes signs of crohns and ulcerative colitis?

A
  • Iritis
  • Episcleritis
  • Conjunctivitis
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9
Q

Joints signs of crohns and ulcerative colitis?

A
  • Arthritis (non-deforming, asymm)
  • Sacroiliitis
  • Ank spond
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10
Q

Hepato-pancreato-biliary signs of crohns and ulcerative colitis?

A
  • Primary Sclerosing Cholangitits + cholangiocarcinoma (esp. UC)
  • Gallstones (esp. Crohn’s)
  • Fatty liver
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11
Q

Kidney issues of crohns

A

Oxalate renal stones (esp. Crohns)

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12
Q

Crohns malabsorption problems

A
  • Fat (steatorrhea)
  • B12 (megablastic anaemia)
  • Vit D (osteomalacia)
  • Protein (oedema)
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13
Q

Complication of crohns?

A

Toxic megacolon

Cancer

Malabsorption

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14
Q

Blood investigations for crohns?

A

FBC: ↓Hb, ↑WCC-

LFT: ↓albumin

Haematinics: Fe, B12, Folate

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15
Q

CT Eneteroclysis aka?

A

AKA small bowel follow-through

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16
Q

Enteroclysis findings of crohns

A

Skip lesions

Rose-thorn ulcers

Cobblestoning

String sign of Kantor

17
Q

Cobblestoning

A

ulcers + mural oedema

18
Q

String sign of Kantor

A

terminal ileum narrowing

crohns

19
Q

Endescopy investigations for crohns?

A
  • Ileocolonoscopy + regional biopsy: Ix of choice
  • Wireless capsule endoscopy
  • Small bowel enteroscopy
20
Q

Management of Severe crohns attack

A

NBM+ fluids

Hydrocortisone

Abx (metronidazole PO or IV)

Dietician I. Elemental diet II. Consider parenteral nutrition

21
Q

Elemental diet

A

Liquid prep of amino acids, glucose and fattyacids

22
Q

If no improvement after the initial management of severe crohns attack, what is the treatment?

A
  • Medical: methotrexate ± infliximab
  • consider surgical
23
Q

Secondary management of severe crohns after improvement post-primary care?

A
  • oral therapy
  • Switch to oral pred (40mg/d)
24
Q

Oral therapy for crohns?

A

1st line

  • Ileocaecal: budesonide
  • Colitis: sulfasalazine

2nd line:- prednisolone (tapering)

3rd line: - methotrexate

4th line: - infliximab or adalimumab

25
Q

Perianal disease in crohns: how common?

A

Occurs in ~50%

26
Q

Perianal disease in crohns: investigations?

A

Ix: MRI + Examination under anaesthesia Rx

27
Q

Perianal disease in crohns: managements?

A
  • Oral Abx: metronidazole
  • Immunosuppression ± infliximab
  • Local surgery ± seton insertion
28
Q

Maintaining remission in crohns drugs?

A

1st line: azathioprine or mercaptopurine

2nd line: methotrexate

3rd line: Infliximab / adalimumab

29
Q

Indications for emergency surgery on crohns patients?

A
  • Failure to respond to medical Rx
  • Intestinal obstruction or perforation
  • Massive haemorrhage
30
Q

Indications for Elective surgery on crohns patients?

A
  • Abscess or fistula
  • Perianal disease
  • Chronic ill health
  • Carcinoma
31
Q

Surgical options available to crohns patients?

A

Limited resection: e.g. ileocaecal

Stricturoplasty

Defunction distal disease with temporary loop ileostomy

32
Q

Complications of surgery on crohns?

A

Stoma complications

Enterocutaneous fistulae

Anastomotic leak or stricture

33
Q

Short gut syndrome features?

A
  • 1-2m small bowel
  • Steatorrhoea- ADEK and B12 malabsorption
  • Bile acid depletion → gallstones
  • Hyperoxaluria → renal stones
34
Q

Management of short gut syndrome?

A
  • Dietician
  • Supplements or TPN
  • Loperamide
35
Q

Supportive management of crohns?

A
  • High fibre diet
  • Vitamin supplements

MRCS med school (44 decks)

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