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PACES Abdominal Station > Crohn's disease > Flashcards

Crohn's disease Flashcards

1
Q

What are the abdominal findings in Crohn’s?

A
  1. Scars
  2. Fistula
  3. Stomas
  4. Masses
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2
Q

What are the extra-abdominal findings in Crohn’s?

A
  1. Mouth ulcers
  2. Erythema nodosum
  3. Pyoderma gangrenosum
  4. Joint involvement
  5. Treatment related e.g. cushing face or gum hypertrophy
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3
Q

What are the differentials for Crohn’s?

A
  1. Malignancy
  2. Abscess
  3. UC, coeliac, IBS
  4. Bowel infection
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4
Q

What are the investigations for Crohn’s? (7)

A
  1. Vitals
  2. Weight
  3. PR and inspection of anus
  4. Stool culture
  5. FBC (inflammation), U&Es (dehydration), LFTs (PSC), haematonings, TTG
  6. abdo XR, CT abdoment, MRI abodmen/perineum is good at looking for tracts and fistulas
  7. Colonoscopy, sigmoidoscopy - biopsy
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5
Q

What are the classical features of Crohn’s?

A
  1. Skip lesions
  2. Cobblestoning
  3. Along length of GI tract, full thickness of the bowel wall
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6
Q

How is Crohn’s disease managed?

A
  1. Induce remission with steroids and ASAs (oral or PR) +PPI +bone protection
  2. Azothiprine or mercaptopurine if remission not induced
  3. Maintain remission wiht azothioprine or agents like methotrexate
  4. Active/fistualting - infliximab
  5. Dietician input - elemental diets, parentral nutrition
  6. Surgical intervention if medical management failing
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7
Q

What are the side effects of ASAs?

A

Headache, nausea, abdo pain

Rare but serious:
agranulocytosis, pancreatitis, SJS

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8
Q

What are the side effects of steroids?

A

Weight, mood, sleep, hyperglycaemia, dyspepsia

> 12 weeks, AVN, iatrogenic Addison’s

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9
Q

What test can be done prior to the commencement of azothioprine/ mercatopurine?

A

TPMT - assess risk of leukopenia

Regular FBC monitoring

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10
Q

What are poor prognostic factors in Crohn’s? (7)

A
  1. <40
  2. Female
  3. Perianal fistuals
  4. Strictures
  5. Perforating
  6. Early steroid requirements
  7. Upper GI involvement
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11
Q

What investigations should be done prior to immunsupressive therapy?

A

Hep B, Zoster, TB
Ensure live vaccines are up to date

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12
Q

What factors affect fertility in Crohn’s disease?

A
  1. Pelvic surgery
  2. Malnutrition
  3. Psychological
  4. Drugs e.g. methotrexate
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13
Q

What risk factors increase risk of bowel CA?

A
  1. Disease >10 years
  2. PSC
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PACES Abdominal Station (11 decks)

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