Crohn’s disease

Symptoms

• Diarrhoea, abdo pain and weight loss
• FTT in children
• In active disease there can be fever, malaise and anorexia

Signs

• Apthous ulcers
• Abdo tenderness
• Right iliac fossa mass
• Perianal abscess/fissure/skin tags
• Anal/rectal strictures
• Extraintestinal signs;
  • Clubbing
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Conjunctivis
  • Episcleritis
  • Iritis
  • Large joint arthritis
  • Sacroilitis
  • AS
  • Fatty liver
  • PSC
  • Cholangiocarcinoma
  • Renal stones
  • Osteomalacia
  • Malnutrition
  • Amyloidosis

Complications

• Small bowel obstruction
• Toxic dilation
• Abscess formation
• Fistulae
• Perforation
• Rectal haemorrhage
• Colonic carcinoma (rarer than in UC)

Tests

• Blood – FRB, ESR, CRP, U&Es, LFT, blood cultures, serum iron, B12, red cell folate in anaemic
• Markers of activity – reduced Hb, raised ESR, CRP, WCC, reduced albumin
• Stool culture
• Barium enema – may show cobble stoning, ‘rose thorn’ ulcers and colon strictures with rectal sparing
• Colonoscopy

Management

• Prednisolone – milder attacks
• Azothioprine can be useful as a steroid sparing agent
• Severe attacks;
  • Admit, IV steroids, nil by mouth, IV hydration
  • Hydrocortisone
  • Treat rectal disease with topical steroids
  • Metronidazole
  • Consider blood transfusion
  • If no response consider surgical opinion
    • 50-80% need an operation at some point
    • Indications for surgery are;
      • Failure to respond to medication
      • Intestinal obstruction from strictures
      • Intestinal perforation
      • Local complications e.g. abscess formation, fistulae

Perianal disease

• Occurs in 50%
• MRI and examination under anaesthesia are important part of assessment
• Treat with oral antibiotics, immunosuppressant therapy +/- infliximab

Causes of erythema nodosum (painful purple patches on shins)

• UC
• Crohn’s
• Sarcoidosis
• Drugs
• Streptococcal infection
• TB