Crohns disease

Question 1

define crohns disease?

Answer 1

Crohn’s disease is a form of inflammatory bowel disease. It commonly affects the terminal ileum and colon but may be seen anywhere from the mouth to anus.

Question 2

what are the risk factors of crohns?

Answer 2

• interaction between genetic and environmental factors

- smoking

Question 3

which layers does crohns affect?

Answer 3

Inflammation occurs in all the layers

Question 4

what is the epidemiology of crohns disease?

Answer 4

• Affects any age but peaks in teens, 20s and 40s

Question 5

what are the presenting symptoms of crohns disease?

Answer 5

• Crampy abdominal pain common in children
• Diarrhoea common in adults
• fever, malaise and weight loss
• perianal disease

Question 6

signs of crohns on examination?

Answer 6

• Weight loss
• Clubbing
• Signs of anaemia
• Aphthous ulcers in mouth
• Perianal skin tags, fistulae and abscesses
• Uveitis, erythema nodosum, pyoderma gangrenosum

Question 7

what will the bloods show for crohns?

Answer 7

o	FBC - low Hb, high platelets, high WCC, low B12 
o	U&Es 
o	LFTs - low albumin 
o	Raised inflammatory markers (CRP) 
o	Low vitamin D

Question 8

what might an AXR show?

Answer 8

could show evidence of toxic megacolon

Question 9

what might a small bowel barium follow through show?

Answer 9

o Fibrosis/strictures
o (string sign of Kantor)
o Deep ulceration (rose thorn ulcers)
o Cobblestone mucosa

Question 10

what is the gold standard investigation?

Answer 10

colonoscopy

Question 11

what might a colonoscopy show?

Answer 11

• Deep ulcers and skip lesions
• Fistulae and abscesses
• Transmural chronic inflammation with infiltration of macrophages, lymphocytes and plasma cells

Question 12

management plan for exacerbation of crohns?

Answer 12

o Fluid resuscitation
o IV/oral hydrocortisone
o Anti-TNFa (Infliximab)
o 5-ASA analogues (e.g. mesalazine and olsalazine)
o Analgesia
o Parenteral nutrition may be necessary
o Monitor markers of disease activity e.g. fluid balance, ESR, CRP, platelets, Hb

Question 13

what is the long term management for crohns?

Answer 13

o Steroids - for acute exacerbations
o 5-ASA analogues - decreases the frequency of relapses (useful for mild to moderate disease)
o Immunosuppression: using steroid-sparing agents (e.g. azathioprine, 6-mercaptopurine, methotrexate) reduces the frequency of relapses
• Remember to check TPMT activity before prescribing

o Anti-TNF agents: (e.g. infliximab and adalimumab) - very effective at inducing and maintaining remission. Usually reserved for refractory Crohn’s.

Question 14

general advice for crohns patients?

Answer 14

o Stop smoking

o Dietician referral

Question 15

when is surgery indicated?

Answer 15

o Medical treatment fails
o Failure to thrive in children in the presence of complications
o Involves resection of affected bowel and stoma formation

Question 16

what are the possible GI complications of crohns?

Answer 16

o	Haemorrhage  
o	Strictures  
o	Perforation  
o	Fistulae (between bowel, bladder, vagina)  
o	Perianal fistulae and abscesses  
o	GI cancer  
o	Malabsorption

Question 17

what are the possible Extraintestinal Features of crohns disease?

Answer 17

o	Uveitis  
o	Episcleritis 
o	Gallstones  
o	Kidney stones  
o	Arthropathy 
o	Sacroiliitis  
o	Ankylosing spondylitis 
o	Erythema nodosum  
o	Pyoderma gangrenosum 
o	Amyloidosis

Question 18

what is the prognosis of crohns disease?

Answer 18

• It is a chronic relapsing condition

* 80% patients will require surgery at some stage