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CSI year 2 > Case 15 Crohn's complications > Flashcards

Case 15 Crohn's complications Flashcards

1
Q

What are the symptoms of Crohn’s disease

A

fatigue
blood and mucus in stool
abdominal pain
diarrhoea
unintended weight loss

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2
Q

What are the Causes of Crohn’s disease

A

genetics
smoking
environment - diseases of the west, children grow up germ free environment
immune system- TNF alpha, attack healthy bacteria
infection

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3
Q

What questions would you ask in a history for Crohn’s disease

A

diet
recent travel
family hx
medications

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4
Q

What blood tests would you need for diagnosis of Crohn’s

A

inflammation- CRP, ESR
Anaemia- FBC
Infection- WCC count

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5
Q

What stool sample tests are needed for diagnosis of Crohn’s

A

Parasite
faecal calprotectin
Infections
Blood and mucus

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6
Q

what imaging tests are used in the diagnosis of Crohn’s disease

A

MRI, CT
Barium swallow- small bowel enema
Colonoscopy- biopsy

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7
Q

What tests are done in the examination in the diagnosis of Crohn’s disease

A

Pulse
BP
Height
Weight
Temp
Abdomen examination

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8
Q

What is initial treatment of Crohn’s disease

A

Corticosteroids
- prednisolone
- hydrocortisone injections

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9
Q

what is the additional treatment in Crohn’s disease

A

immunosuppressants
- azathioprine- safe for pregnancy
- methotrexate- not safe for pregnancy
- mercaptopurine

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10
Q

what is the treatment for severe Crohn’s disease

A

Biological Therapies
- Infliximab (IV drip)
- Adalimumab (injection)
- both are against TNF alpha

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11
Q

What are the two surgical options for Crohn’s disease

A

Resection- remove inflamed section
Ileostomy- Divert digestive waste away from inflamed colon

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12
Q

What are less common symptoms of Crohn’s

A

High temp
nausea
Mouth ulcers
Areas of red swollen skin
vomiting
joint pain and swelling

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13
Q

Where is the site of pain for
- Appendicitis
- small Bowel obstruction
-pancreatitis
- cholecystitis

A

umbilical, then RLQ

umbilical

LUQ, radiate to back

RUQ

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14
Q

Where is the character of pain for
- Appendicitis
- small Bowel obstruction
-pancreatitis
- cholecystitis

A

consistent with intermittent cramps

colicky and severe

constant and severe

constant and severe

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15
Q

what are the associated symptoms for
- Appendicitis
- small Bowel obstruction

A

Anorexia
nausea and vomiting
unable to pass flatus or stool

Rovsing sign for appendicitis
distension/bloating for SB obstruction

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16
Q

what are the associated symptoms for
-pancreatitis
- cholecystitis

A

Nausea and vomiting

Anorexia and dyspnoea for pancreatitis
Murphys sign for cholecystitis

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17
Q

What are the Exacerbating factors for
- Appendicitis
- small Bowel obstruction
-pancreatitis
- cholecystitis

A

Movement and coughing

oral intake

movement

fatty foods

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18
Q

What is Rovsing’s Sign

A

Appendicitis
Press hand on LLQ, pain in RLQ
due to inflamed peritoneum

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19
Q

What are the symptoms of bowel obstruction

A

Bloating
unable to pass flatus or stool
Colicky abdominal pain
nausea and vomiting
anorexia

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20
Q

how do symptoms differ depending on where the obstruction is

A

if proximal, vomiting is more common
If distal, Constipation is more common

21
Q

How does distention differ depending on where the obstruction is

A

Small bowel- central
Large bowel- peripheral

22
Q

What are Causes of Small Bowel Obstruction

A

Adhesions
- scar from surgery
-Hernias
-Crohn’s

23
Q

What is a main cause of Large Bowel Obstruction

A

Colon cancer

24
Q

what are the risks of bowel Surgery

A

Infection
Blood clots- travel to leg, need blood thinners
Scar may not heal properly- hernia
damage to surrounding structures- spleen, bladder, ureter
bleeding
pain

25
Q

What is the difference in a radiograph of small and large bowel obstruction in terms of its positioning?

A

Small bowel- central distention
Large bowel- peripheral distention

26
Q

What is the difference in a radiograph of small and large bowel obstruction in terms of its appearance

A

small Bowel
-valvulae conniventes
-go all the way through bowel
-thinner than haustra

large Bowel
-finger like projections into lumen of LI
-thicker than connective tissue in SI
-don’t go all the way through bowel
-can see faeces

27
Q

what is the 369 rule

A

to see the calibre of the bowel
SI- Less than 3cm
LI- less than 6 cm
Caecum- less than 9cm

28
Q

What are the physiological consequences of ileostomy

A

No water reabsorption in LB
- water goes out through stoma
Loss of electrolytes

29
Q

Which part of bowel reabsorbs the most water and how much

A

small bowel
6L in jejunum
2.5L in ileum

30
Q

what are three adaptations to change after ileostomy

A

Mucosal hyperplasia- enhanced absorption
hypomobility- increases time for absorption
Aldosterone upregulation
-increase sodium reabsorption in SI, sodium retention in kidney

31
Q

What are two ways to fix the bowel after resection

A

Stoma- bring end of bowel to skin
anastomose two loose ends of bowel, but if inflamed this will not work

32
Q

What are differences in stoma for ileostomy and colostomy for
-site
-content
-appearance

A

Ileostomy
- RLQ (generally)
-has more digestive juices, liquid, acidic
- therefore spout the stoma, more protruding so it does not irritate the skin

Colostomy
-LLQ
-Faecal matter
-closer to the skin

33
Q

What is a stricture

A

narrowing of digestive tract due to chronic inflammation

34
Q

What are the symptoms of a stricture

A

vomiting
abdominal pain -cramping
nausea
constipation

35
Q

what are the surgical treatments of a stricture

A

Strictureplasty
-open narrowed section of bowel
- most effective in jejunum and ileum, least effective in duodenum
-avoids need to remove part of SI

small bowel resection

36
Q

What is a fistula

A

when ulcers or abcesses formed penetrate through an organ wall, creates a tunnel to drain pus

37
Q

What are the symptoms for a SI and LI fistula

A

diarrhoea
passage of undigested food

38
Q

What are the symptoms for Intestinal and bladder fistula

A

UTI
cloudy urine
blood
burning when peeing

39
Q

What are the symptoms for Intestinal and skin fistula

A

bump/ boil that drains fluid and stool

40
Q

What are the symptoms for Intestinal and vaginal fistula

A

passage of stool through vagina

41
Q

what is first line treatment for fistula

A

Abx and medication

42
Q

What happens when first line medication for fistula is unsuccessful

A

surgery
- medical plug
-medical glue
-open up fistula to let it drain
-seton- tube to drain infection
-Ileostomy

43
Q

What is the treatment for Anal Fistula

A

fistulostomy

44
Q

What is an abcess

A

Collection of pus

45
Q

How do you treat an abscess

A

Antibiotics
drainage is sometimes needed to heal it fully

46
Q

what are symptoms of an abcess

A

abdominal pain
painful bowel movements
discharge of pus from anus
lump on the edge of the anus that is small red and tender
fever

47
Q

what is the procedure for removing an abcess

A

insert a tube
leave it in for a week
usually feel better within a couple of days

48
Q

what questions are asked to a doctor about a surgery from a patient

A

Preparation for surgery
complications of surgery
restrictions post surgery
supplies they need post surgery
How long the recovery time will be
how it affects their diet
Why is this surgery recommended

CSI year 2 (8 decks)

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