Crohn's Disease

Question 1

Crohn’s Disease

Sites %

Answer 1

40% occur in the Small Intestine
30% in the Large Intestine
30% in both Small/Large Intestine.

Question 2

Race and Genetics

Crohn’s Disease

Answer 2

More common in Caucasians and Jews

• Associations = Smoking increases the risk by 4 times, and NSAIDs exacerbates the disease.
• Associated gene = NOD2.

Question 3

Symptoms: Crohn’s Disease

Answer 3

Classically a long history of diarrhoea - Abdominal pain - Weight loss.
Diarrhoea with urgency
(eg. gets up at 4am, and goes 4/5 times in the next 45 minutes - may have blood in stool),
Abdominal Pain (most common presentation in children),
Anorexia
Weight Loss
Malaise Failure to thrive
Fever

Question 4

Signs: Crohn’s Disease

Answer 4

Aphthous ulcerations (small lesions in the mouth)
Anal strictures Abdominal mass/tenderness (palpable in the right iliac fossa; more common in crohn’s), Perianal abscess/fistulae
Extra-intestinal manifestations:
Finger Clubbing
Skin (Erythema Nodosum)
Joint (Sacroilitis)
Eye (Uveitis, Conjunctivitis) Problems.

Question 5

Investigations: Crohn’s Disease

Answer 5

Colonoscopy
Rectal Biopsy
Barium Enema (can show kantors string sign, rose-thorn ulcers, fistulae)
Bloods (FBC, ESR, CRP, U&E, LFT, INR, TIBC, Ferritin, Folate)
Stool MC&S/CDT (to exclude C.difficile, Campylobacter, E.Coli)
Capsule Endoscopy
MRI
Inflammation Markers

Question 6

Inflammation Markers - Crohn’s Disease

Answer 6

- Increased -
ESR
CRP
Platelet Count
White Cell Count  
- Decreased - 
Haemoglobin
Albumin

Question 7

Treatment for Crohns/Ulcerative Colitis:

Answer 7

Biologics
Immunosuppressant's (Methotrexate, Infliximab, Mercaptopurine, AZA - Azathioprine)
Steroids (Prednisilone, Hydrocortisone (give this first)
Surgery (Colectomy)
5ASA (5 Aminosalicylate)
Metronidazole
Optimise nutrition
Blood transfusion