Flashcards in Crohns Deck (12):
Inflammatory GI disease characterised by granulomatous inflammation anywhere from mouth to anus. Common in terminal ileum and proximal colon. Exacerbations and remissions.
Transmural, asymmetrical, sometimes granulomatous.
Bimodal age distribution.
Involves immune system dysfunction. Increase TNFa.
Certain gene mutations increase risk.
Gut organism. Eg mycobacterium, pseudomonas.
Triggers eg AB, smoking, infection, fatty diet.
RFs- family history, smoking, female, URTIs, NSAIDs.
Diarrhoea or urgency, bad smell.
Abdo pain severe, usually low right.
Parasite, gastroenteritis, fungal infection.
Lymphoma, Colon CA
Abdo tenderness or mass. More frequent and severe abdo pain than UC.
Aphthoid and deep ulcers- cobblestoning.
Perianal abcess, fistulae, skin tag.
Skin, joint, eye problems.
Azathioprine steroid sparing
Sulfasalazine not proven in crohns
CS, steroid analogues
Immunosuppressants. Methotrexate anti folate (risk leukopenia, infection, pulmonary fibrosis, teratogenic).
TNFa inhibitors eg infliximab
Surgery not curative but can help strictures and fistulae, or respect parts repeatedly flare up.
Discrete superficial ulcers and deeper ulcers= cobblestone.
Thickening bowel wall
Bloods- anaemia. FBC, UE, LFT, CRP.
CT and MRI- thickening, obstruction, extramural issues, string sign of kantor (incomplete lumen filling due to spasm due to ulcer).
Barium enema or follow through- stricture, fistulae.
Iliocolonoscopy and biopsy.
Fistulae eg colovesical, colovaginal, perianal. And strictures.
Colon CA, cholangioCA
OP and osteomalacia
Fe, folate, B12 deficiency
Renal disease eg ureter obstruction by iliocecal disease
Abortion, miscarriage, stillbirth.
Anti metabolite eg Methotrexate
Not antifolate in crohns MOA. Maybe inhibit purine metabolism and T activation.
Low dose can combine with other DMARDs, NSAIDs, steroids.
AE-pneumonitis, hepatotoxicity, mucositis, teratogenic.
Monitor all bloods
DDI- binding competition with eg NSAID, phenytoin, tetracyclines, penicillin= increase myelosuppression.
Anti TNF eg infliximab
Dont escalate dose.
Reduce inflammation, angiogenesis.
AE- risk new malignancy if had one previously. Risk serious infections. TB reactivation.