Crohns

Question 1

what is Crohns and what is it characterised by

Answer 1

chronic inflame GI disease, transmural granulomatous inflammation

Question 2

what part of the GI tract is affected, where does it especially affect

Answer 2

any part of the tract, especially terminal ileum and proximal colon.

Question 3

is there unaffected bowel between areas of active disease?

Answer 3

Yes (unlike Ulcerative colitis)

Question 4

what gene being mutated increases risk

Answer 4

NOD2/CARD15

Question 5

when is presentation

Answer 5

20-40 years

Question 6

associations

Answer 6

altered cell mediated immunity

Question 7

what risk factors are associated

Answer 7

smoking- increases by 3-4x. NSAIDS may exacerbate

Question 8

symptoms

Answer 8

diarrhoea/urgency. abdo pain, weight loss, failure to thrive, fever, malaise, anorexia

Question 9

signs(gut)

Answer 9

apthous ulcerations (mouth), abdo tender/mass, perianal abscess/fistulae/skin tags; anal strictures.

Question 10

signs(not gut)

Answer 10

clubbing, skin, joint and eye problems

Question 11

complications

Answer 11

small bowel obstruction, toxic dilatation, abscess (abdo, pelvic, ischiorectal), fistulae, perforation, rectal haemorrhage, colon cancer, fatty liver, cholangiocarcinoma, renal stones, osteomalacia

Question 12

tests- blood

Answer 12

FBC, ESR, CRP, U&E, LET, INR, ferritin, TIBC, B12, folate

Question 13

tests

Answer 13

blood, stool (exclude C dif, campylobacter, E coli); colonoscopy and rectal biopsy; small bowel enema; capsule endoscopy; barium enema; colonoscopy; MRI

Question 14

what can a small bowel enema detect

Answer 14

ileal disease

Question 15

what can barium enema show

Answer 15

cobblestoning, rose thorn ulcers, colon strictures

Question 16

what can MRI show

Answer 16

pelvic disease and fistulae

Question 17

what can be used in the treatment

Answer 17

optimise nutrition; aminosalicylates, steroids, immunosuppressants,; TNF inhibitors; antibiotics; diet/supplements

Question 18

what can be used in a mild attack (symptomatic, systemically well)

Answer 18

prednisolone- 30mg/d PO for 1 week then 20mg/day for 4 weeks

Question 19

what can be used in a severe attack

Answer 19

hydrocortisone. metronidazole. if not improving- infliximab and adalimumab

Question 20

what % of patients have perianal disease

Answer 20

50

Question 21

treatment of perianal disease

Answer 21

oral antibiotics, immunosuppressant therapy, infliximab, local surgery, seton insertion

Question 22

name additional therapies in Crohns

Answer 22

azathioprine, sulfasalazine, TNFalpha inhibitors (infliximab, adalimumab), methotrexate, IV immunoglobulin

Question 23

what autoantibody test is -ve

Answer 23

ANCA (positive in UC)

Question 24

what autoantibody test is +ve

Answer 24

ASCA

Question 25

what is present in severe disease

Answer 25

hypoalbuminaemia. also get anaemia (normocytic, normochromic). deficiency of iron and folate

Question 26

what are raised in active colonic disease in stool tests

Answer 26

faecel calprotectin and lactoferrin