Crohn's disease

Question 1

Symptoms of crohn’s disease?

Answer 1

Rectal bleeding
Diarrhoea
Abdo pain/ distension
Anaemia
Malabsoprtion- weight loss
Extraintestinal manifestations

Question 2

Characterisation of Crohn’s disease?

Answer 2

Deep ulceration throughout whole GI tract, Inflammation, thickening of the GI wall, strictures

Question 3

Name the extraintestinal manifestations of crohn’s disease

Answer 3

Arthiritis
Problems with the eyes and skin (e.g., uveitis)
Finger clubbing
Osteoporosis
hypoproteinaemia + oedema
erythema nodosum of lower legs

Question 4

Causes of Crohn’s disease?

Answer 4

Mycobacterium Paratuberculosis
Smoking
High protein diets
Genetic componement

Question 5

1st line for first presentation or first in 12 months exacerbation in crohn’s disease?

Answer 5

Mehtylprednisolone/ Prednisolone

Question 6

1st line for Crohn’s exacerbation if distal ileal, right-sided colonic disease, or ileocaecal disease and in whom a standard coroticosteroid is not tolerated/ CI?

Answer 6

Budesonide or 5-ASAs ( but not to be used in severe disease as considered less effective)

Question 7

When is add-on treatment considered for crohn’s disease?

Answer 7

If corticosteroid cannot be reduced (due to relapse) or 2+ exacerbations in 12 months

Question 8

Add-on treatment options in crohn’s disease?

Answer 8

Mercaptopurine or Azathioprine or methotrexate (If TMPT deficient) to be added to corticosteroids including budesonide

Question 9

Examples of Aminosalicylates?

Answer 9

Mesalazine and Sulfasalzaine

Question 10

Examples of immunomodulators used in crohn’s disease?

Answer 10

Mercaptopurine, Azathioprine, Methotrexate

Question 11

When can Azathioprine or Mercaptopurine be used for maintenance treatment in crohn’s disease?

Answer 11

If oral corticosteroids have been used to induce remission

Question 12

When can Methotrexate be used for maintenance treatment in crohn’s disease?

Answer 12

When Methotrexate was needed to induce remission and Azathioprine/Mercaptopurine not suitable

Question 13

What should not be used to maintain remission in crohn’s disease?

Answer 13

Corticosteroids/ Budesonide

Question 14

What are the only drugs indicated following surgery for bowel resection in the last 3 months?

Answer 14

Azathioprine and Metronidazole

Question 15

What is used in crohn’s disease for diarrhoea?

Answer 15

Loperamide/codiene except if evidence of colitis
Colestyramine also licensed

Question 16

Lifestyle advice for crohn’s disease

Answer 16

High-fibre diet and smoking cessation

Question 17

Monitoring requirements for Sulfasalazine specifically

Answer 17

FBC every month for the first 3 months
LFTs every month for the first 3 months

Question 18

Monitoring requirements for aminosalicylates generally

Answer 18

U&Es before starting treatment, at 3 months, then annually

Question 19

Side effects of Sulfasalazine

Answer 19

Blood dyscrasias within first 3-6 months, discolouration of bodily fluids, orange urine

Question 20

Action if blood dyscrasias suspected with sulfasalazine use?

Answer 20

Stop treatment and carry out FBC

Question 21

Interaction between Mesalazine and Lactulose

Answer 21

Lactulose lowers pH so active ingredient cannot be released in E/C or M/R preparations