Oxford Medical Education

Crohn’s disease – Questions

oxfordmedicaleducation.com/gastroenterology/crohns-disease-questions/

July 29,
2015

Common Crohn’s disease exam questions for medical

finals, OSCEs and MRCP PACES

Question 1.
How does Crohn’s disease present?
Diarrhoea (can be bloody and/or chronic)
Abdominal pain
Weight loss
Malaise, anorexia, fever
Poor growth or delayed puberty in kids
Mouth ulcers

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 Abdominal
Abdominal tenderness and distension
Palpable masses
Anal/perianal skin tags, fissures and fistulas (may be asymptomatic)

Question 2.
What are the extra-intestinal manifestations of Crohn’s disease?
Arthritis
Conjunctivitis/Uveitis/Episcleritis
Erythema nodosum
Pyoderma granulosum (purulent ulcers with blue-black edge)
Clubbing

Question 3.
What are the macro and microscopic features of Crohn’s disease?
Macro:

Distribution
20% colonic; 30% ileocaecal; 40% small bowel
Bowel thickened and narrowed.
Deep fissures and ulcers in mucosa, giving a ‘cobblestone’ appearance.
Fistulae, abcesses and strictures.
Fat wrapping around affected bits of bowel
‘Skip lesions’ – areas of unaffected bowel between inflamed areas.
Mouth ulcers and anal/peri-anal disease (ulcers, fissures, fistulae)

Micro:

Full-thickness (transmural) inflammation

Increase in chronic inflammatory cells (macrophages)
Granulomata – not caseating

Question 4.
What are the complications of Crohn’s disease?
Toxic megacolon and perforation
Stricturing and bowel obstruction
Fistulae
Small bowel cancer (if ileal involvement)
NB. No overall increased risk of bowel cancer in IBD – only certain subgroups
have increased risk (NEJM 2013)
Iron, folate and B12 deficiencies (terminal ileum disease)
Osteoporosis from steroid therapy
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Short-bowel syndrome and malabsorption

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