Crohn's Disease

Exam Cram

• Crohn's Disease, with ulcerative colitis, is a type of inflammatory bowel disease

• Presentation: blood diarhoea + abdo pain for weeks, weight loss

• Screening test: faecal calprotectin

• Diagnosis: biopsy on colonoscopy/ endoscopy

• Acute management: steroids

Outline

Background 

Diagnosis

Diagnostic criteria: 

History:

Examination:

Ix

Differentials

Acute Management

Goals of care: stabilise patient & achieve remission

1. Prednisolone 50mg PO

2. Ciclosporin IV

3. Colectomy

Chronic Management

Goals of care: prevent relapse with minimal side effects

• Mesalazine

• Azathioprine or mercaptopurine if > 2 exacerbations/ year or unable to taper steroids

  • • TPMT levels should be check prior to starting

• Tumour necrosis factor alpha inhibitor, e.g. infliximab 

• Ustekinumab (IL-12 & IL-23 blocker) or Vedolizumab

Med Reg Notes

Indications for Colectomy

1. Trialed of steroids or ciclosporin for 4 days

2. Failed therapy

   • Bowel movements > 6/d

   • Temp > 38 degrees, BP < 90/60

   • Abdomen tender

   • AXR: caecal/ colonic dilatation

Total vs subtotal colectomy: total colectomy has benefit of being curative but downside of worsening short bowel syndrome. 

Short Bowel Syndrome Complications

• Calcium oxalate urinary stones

Crohns Complications

Crohn's typically affects terminal ileum. Terminal ileum is responsible for B12 and bil acid resorption. Therefore, terminal ileum resection produces: 

1. B12 Deficiency

2. Bile acid induced diarrhoea 

References and Resources

1. NICE Guidelines

Written in 2025