Chapter 1 BNF (Chronic Bowel Disorders) Flashcards

1
Q

What is coeliac disease? What are the symptoms and what is the treatment?

A

adverse reaction to gluten

Diarrhoea, abdominal pain, bloating

Life long gluten free diet
assess risk of osteoporosis
vitamins and suppliments

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2
Q

What is Diverticulitis, what are the symptoms and what are the treatments?

A

small bulges or pockets in the lining of the intestines (diverticula) and become inflammed.

lower abdominal pain, constipation, diarrhoea

High fibre diet
bulk forming drugs (evidence limited)
antibiotics

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3
Q

What drugs are containdicated in an acute flare up of ulcerative colitis?

A

codeine/loperamide (avoid antimotility and antispasmodics…risk of toxic megacolon

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4
Q

What is the best route of administration for treating:

Extensive colitis
Left sided colitis
proctosigmodoiditis
proctitis

A

Extensive: oral
left sided colitis: enema
proctosigmoditis: foam preparations
proctitis: suppositories

pancolitis (entire colon)

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5
Q

What is first line in acute mild-moderate ulcerative colitis (proctitis, proctosigmoditis)?

A

First Line: Aminosalicylate (rectal)

Alternative: rectal steroid or oral prednisolone

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6
Q

What is first line in acute mild-moderate ulcerative colitis (extensive colitis, left sided colitis)?

A

First Line: High Dose oral aminosalicylate
+ rectal aminosalicylate or oral beclometasone

alternative: oral prednisolone alone

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7
Q

What is first line in acute moderate-severe ulcerative colitis

A

oral prednisolne

alternative; monoclonal antibodies

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8
Q

Whats the next step if patient does not respond to aminosalicylate in ulcerative colitis?

A

if no response after 4 weeks
add oral prednisolone (discontinue any other steroid)

add tacrolimus

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9
Q

What should be used to treat very severe acute ulcerative colitis?

A

First line: IV Steroid or iv ciclosporin

second line (symptoms dont improve in 72hrs): iv ciclosporin (or infiximab) + iv steroid

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10
Q

What can be offered for maintainance of remission in ulcerative colitis?

A

Proctitis/Proctosigmoiditis - rectal ASA alone or with oral

extensive/left sided - low dose oral ASA

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11
Q

When can Azathioprine and mercaptopurine be used in ulcerative colitis?

A

2+ flare ups requiring steroids in 12 months

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12
Q

what lifestyle advice can be offered for Crohns Disease?

A

high fibre
smoking cessation
loperamide or codeine (not in UC)

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13
Q

Whats the treatment for 1 acute flare up in 12 months/ first presentation of Crohns Disease?

A

Prednisolone, methylprednisolone, IV hydrocortisone

budosenide

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14
Q

Whats the treatment for 2 acute flare ups in 12 months in crohns disease?

A

Azathioprine/ Mercaptopurine

Alternative: Methotrexate

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15
Q

Whats the treatment for maintance of remission in Crohns Disease?

A

Azathioprine or mercaptopurine

alternative: methotrexate

after surgery (ASA also an option)

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16
Q

Side effects of Aminosalicylates?

A

Blood dyscrasias
nephrotoxic
sensitivity (aspirin too)
orange bodily fluids

17
Q

Interactions with Aminosalicylates?

A

Loperamide - lowers stool pH

18
Q

Which laxative should not be used in IBD?

A

Lactulose