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Title: Crohn's Disease
Description: Crohn's Disease affects 10 in 100,000 worldwide. These notes are aimed for medical students and beyond. They consist of information which are easy to read but comprehensive enough for clinical years.
Description: Crohn's Disease affects 10 in 100,000 worldwide. These notes are aimed for medical students and beyond. They consist of information which are easy to read but comprehensive enough for clinical years.
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Crohn’s Disease
Incidence of Crohn’s Disease is 10 per 100000 annually
Prevalence of Crohn’s Disease is 100 per 100000
Clinical Feature
•
•
•
•
Abdominal Pain
Diarrhoea
Weight Loss
Anaemia
Extraintestinal Manifestations
Association of Crohn’s Disease with extragastrointestinal manifestations with HLA B27
a
...
Liver and Biliary Tree
•
•
•
•
•
Primary Sclerosing Cholangitis
Fatty Liver Disease
Chronic Hepatitis
Cirrhosis
Gallstones
c
...
Joints
•
•
•
•
Type I [Pauarticular] Arthropathy
o Pauarticular----> Less than 5 joints involved
o Acute attacks which occurs with IBD relapse
o Associated with other extraintestinal manifestations of IBD activity
Type II [Polyarticular] Arthropathy
o Polyarticular----> More than 5 joints involved
o Last from months to years
o Independent of IBD activity and usually associated with uveitis
Ankylosing Spondylitis
Sacroiliitis
e
...
Nephrolithiasis
Risk Factors
a
...
Smoking
c
...
Appendectomy
•
Increase risk of developing Crohn’s Disease
e
...
Macroscopic Changes
•
•
•
Affected bowel is thickened and often narrowed
Deep-ulcers and fissures in mucosa----> Cobblestone
Appearance
Fistulae and abscesses
b
...
•
•
•
ii
...
•
Blood Test
Anaemia
Iron deficiency
Folate deficiency
Raised CRP and ESR
Can also be used to monitor disease severity
Faecal Calprotectin
Elevated in Crohn’s showing migration of neutrophils to intestinal mucosa
iv
...
•
•
vi
...
Induction of Remission
•
Glucocorticoids----> Prednisone
b
...
Biological Therapy
•
•
Indicated in patients with disease refractory of conventional immunosuppressive therapy
Requires work up:
o HBV
o Hep C
o HIV
o Tuberculosis
• Infliximab:
o Anti TNF-α
o Induce immune cell apoptosis
o Given via intravenous
• Adalimumab [Humira]:
o Anti TNF-α
o Induce immune cell apoptosis
o Given via subcutaneous
*Avoid biologicals in patients with NYHA Class III or IV heart failure
*Adverse reactions include opportunistic infections such as tuberculosis, nervous system demyelination such as multiple
sclerosis and malignancy such as skin cancers and lymphoma
d
Title: Crohn's Disease
Description: Crohn's Disease affects 10 in 100,000 worldwide. These notes are aimed for medical students and beyond. They consist of information which are easy to read but comprehensive enough for clinical years.
Description: Crohn's Disease affects 10 in 100,000 worldwide. These notes are aimed for medical students and beyond. They consist of information which are easy to read but comprehensive enough for clinical years.