Crohn's disease

	chronic inflammatory disease.
Etiology	Transmural granulomatous inflammation with skip lesions.
Epidemiology
Clinical presentation	symptoms: diarrhoea/urgency, abdo pain, weight loss (more common cf UC), fever, malaise, anorexia signs: aphthous ulcers, perianal abscess/skin tags/anal strictures, clubbing, ant uveitis, iriitis, Fe deficiency anaemia
Pathogenesis
Diagnostic investigations	Endoscopy: crypt abscesses, strictures, granulomas, cobblestone appearance = linear mucosal ulcers Biopsy: granulomas, neuromuscular hyperplasia, fissuring Inflammation in all layers ± penetrating lesions Stool culture if worsening s/s, CMV PCR, travel history
Management	Complications: SBO from strictures, entero-vesical fistula (which apparently should come under care of surgeons rather than urology) Inducing remission: - glucocorticoid - hydrocortisone 100mg QDS? - 2nd line: aminosalicylate - add AZT or mercaptopurine if glucocorticoid cannot be tapered, or >2 exacerbations in 12 months - 3rd line: infliximab/adalimumab - May require surgical treatment, either electively or emergently

Vaccinations:

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