Inflammatory Bowel Disease - Crohn's

Question 1

What is the epidemiology of Crohn’s disease?

Answer 1

Peak age of onset is 15-40 years of age

Equally prevalent among males and females

More common in white people + smokers

Question 2

What is the pathophysiology of Crohn’s disease?

Answer 2

Affects all GI tract – esp. terminal ileum and ascending colon, rectum

Starts as an inflammatory infiltrate around intestinal crypts

Develops into ulceration of the superficial mucosa

Question 3

What is the general appearance on endoscopy?

Answer 3

Cobblestone appearance on endoscopy

Skip lesions - lesions are separated by healthy areas

Chronic inflammation leads to scarring, luminal narrowing and stricture formation

Question 4

What is the prognosis of Crohn’s disease?

Answer 4

Chronic disease with variable frequency of relapses and complications

Appropriate medical and surgical management can give patients a reasonable quality of life

Question 5

What is the aetiology of Crohn’s disease?

Answer 5

Unclear - genetic + environment (smoking)

Question 6

What are the risk factors associated with Crohn’s disease?

Answer 6

· White ancestry. 
· Age 15-40 or 60-80 years. 
· Family history of CD. 
· Smoking.
· Diet high in refined sugar.
· OCP.

Question 7

What are the signs and symptoms associated with Crohn’s disease?

Answer 7

Abdominal pain:
- Cramping/Constant.
- RLQ. Can be partially relieved by defecation.
- Prolonged diarrhoea:
· Bloody or non-bloody.
· Nocturnal diarrhoea.
- Peri-anal lesions: skin tags, fistulae, abscesses, scarring or sinuses.

Question 8

What investigations would you do if Crohn’s disease was suspected?

Answer 8

· Stool studies - faecal calprotectin test.

· FBC:

• Anaemia
• Leukocytosis
• Thrombocytosis - marker of active inflammation.

· Iron studies.
· Vitamin B12 + folate levels. 
· CRP and ESR. 
· CT abdomen. 
·  Colonoscopy with biopsie

Question 9

Suggest some differential diagnoses?

Answer 9

· Ulcerative colitis. 
· Infectious colitis. 
· Pseudomembranous colitis. 
· Ischaemic colitis. 
· Colorectal cancer. 
· Diverticular disease.
· Appendicitis.
· Ectopic pregnancy. 
· PID
· IBS

Question 10

What are the treatment options for Crohn’s disease?

Answer 10

· Drug:

• Steroids.
• Budesonide
• 5-ASA.
• Immunosuppressants - azathioprine, methotrexate.

· Surgery

Question 11

What is the management plan for Crohn’s disease?

Answer 11

· Lifestyle – smoking cessation, nutrition.
· Screening – screen for CRC, ensure the risk of osteoporosis is managed.
· Pain – manage with analgesics, paracetamol preferred.

Question 12

What complications can occur?

Answer 12

· Extra-intestinal involvement. 
· Intestinal obstruction.
· Abscess formation.
· Sinuses.
· Fistulae.
· Anaemia. 
· Toxic megacolon. 
· Short-bowel syndrome. 
· Complications related to malabsorption. 
· Pregnancy complications associated with immunosuppression. 
· Intra-abdominal sepsis.