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Flashcards in FN: Crohns disease: Management Deck (24):
1

Investigations

Bloods
Stool
Imaging
Endoscopy

2

Bloods

(top 3 are severity markers)
1. FBC: reduce Hb, raised WCC
2. LFT: reduced albumin
3. Raised CRP and ESR
4. Haematinics: Fe, B12, Folate
5. Blood cultures

3

Stool

MCS: exclude Campy, Shigella, Salmonella
CDT: C. difff may complicate or mimic

4

Imaging

AXR: obstructino, sacroileitis
CXR: perforation
MRI
1. Assess pelvic disease and fistula
2. ASsess disease severity

Small bowel follow-through or enteroclysis
1. skip lesions
2. Rose-thorn ulcers
3. Cobblestonin: ulcerating + mural oedema
4. String sign of kantorL narrow terminal ileum

5

Endoscopy

Ileocolonoscopy + regional biopsy: x of choice
Wireless capsule endoscopy
Small bowel enteropscopy

6

Sever attack symptoms

Raised temp
Raise dHR
Raised ESR
Raised CRP
Raised WCC
reduced albumin

7

Management of severe attack

REsus: admit, NBM, IV hydration
2. Hydrocortisone: IV + PR if rectal disease
3. Abx: metronidazole PO or IV
4. Thromboprophylaxis: LMWH
5. dietician REview
6. Monitoring
Vitals + stool chart
Daily examination

8

Dietician Review

Elemental diet - liquid prep of amino acids, f=glucose and fatty acids
Consider parenteral nutrition

9

Improvement in therapy

Switch to oral pred (40mg/d) --> oral theraoy

10

No improvement --> rescue therapy

1. Discussion between pt, physcian and surgeon
2. Medical: methotrexate ± infliximab
3. Surgical

11

Inducing remission:
Supportive therapy
Oral therapy
Perianal disease

supportive therapy:
1. High fibre diet
2. Vitamin supplements

12

Oral therapy

1st line:
ileocaecal: budesonide]2. ColitisL sulfasalazine
2nd line: prednisolone (tapering)
3rd line: methotrexate
4th line: infliximab or adalimumab

13

Perianal disease

1. Occurs in 50%
Ix: MRI + EUA
Rx:
1. ORal Abx: metronidazole
2. Immunosuppression ± infliximab
3. Local surgery ± seton insertion

14

Maintaing remission

1st line: azathioprine or mercaptopurine
2nd line: methotrexate
3rd line: infliximab/adalimumab

15

Perianal disease

1. Occurs in 50%
Ix: MRI + EUA
Rx:
1. Oral Abx: metronidazole
2. Immunosuppression ± infliximab
3. Local surgery ± seton insertion

16

Maintaining remission

1st line: azathioprine or mercaptopurine
2nd line: methotrexate
3rd line: infliximab/adalimumab

17

urgery

50-80% need >1 operation in life
Never curative
Should be s conservative as possible

18

Indiciation sfor surgery emergency

Failure to respond to medical Rx
Intestinal obstruction or perforation
Massive haemorrhage

19

Indication for elective

Abscess or fistula
Perianal disease
Chronic ill health
Carcinoma

20

Procedures

1. Limited resection e.g. ileocaecal
2. Stricturoplasty
3. Defunction distal disease with temporary loop ileostomy

21

Complications

Enterocutaneous fistulae
Stoma complications
Anastomotic leak or stricture

22

Short gut

23

Short gut features

Steatorrhoea
ADEK and B12 malabsorption
Bile acid depletion = gallstones
Hyperoxaluria - renal stones

24

Treatment of short gut

Dietician
Supplements or TPN
Loperamide

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