Chapter 1: GI System Flashcards
Are patients with coeliac disease recommended to self medicate with OTC vitamin and mineral supplements?
No
What are coeliac patients at increased risk of?
Malabsorption
Vitamin and mineral deficiency - could increase the risk of osteoporosis
What is diverticular disease?
Diverticula (sac-like protrusions of mucosa through the muscular colonic wall) cause intermittent lower abdominal pain in the absence of inflammation or infection.
Can cause large rectal bleeds
What is the treatment for uncomplicated diverticular disease?
Low residue (fibre) diet and bowel rest
Are antibacterials recommended in uncomplicated diverticular disease?
No unless the patient presents with signs of infection/immunocompromised
What is the treatment for complicated diverticular disease?
Hospital admission, IV antibacterials covering gram negative and anaerobes
Bowel rest
True or false:
There is insufficient evidence to justify the role of fibre, rifaximin, antispasmodics, mesalazine, and probiotics in the prevention or treatment of diverticulitis
True
What is the advantage of the newer aminosalicylates (mesalazine, balsalazide, olsalazine) over sulfasalazine?
Avoids the sulfonamide-related side effects of sulfasalazine
Sulfasalazine is a combination of what two compounds?
5-ASA and sulfapyridine
Sulfapyridine acts only as a carrier to the colonic site of action but still causes side effects
What compound is mesalazine?
5-ASA
Balsalazide is a pro drug of what?
5-ASA
What are extraintestinal manifestations?
When people with IBD develop conditions affecting the joints, eyes or skin. e.g. arthritis, osteoporosis
- In a patient with a first presentation or single inflammatory Crohn’s exacerbation in a 12 month period, what is used?
- If this is not suitable, or if the patient has right-sided colonic disease, what could be used? When would these not be appropriate and why?
- Corticosteroid - prednisolone, methylprednisolone or IV hydrocortisone
- Budesonide or aminosalicylates. Not appropriate if severe presentation as they are less effective (even though they have fewer side effects)
When would you add in additional treatment (on top of steroid monotherapy) in a Crohn’s disease exacerbation?
What would you add?
2 or more inflammatory exacerbations in 12 months, or if the steroid dose cannot be reduced
Azathioprine or mercaptopurine
Is mercaptopurine licensed in severe UC and CD?
No
- What can be added to a steroid to induce remission in a Crohn’s patient?
- If these are not suitable, what could be used?
- Azathioprine
Mercaptopurine can be added but unlicensed
- Methotrexate
What test do you need to do before starting someone on azathioprine or mercaptopurine?
TPMT levels
If activity is deficient, it may not be suitable
What monoclonal antibodies are licensed for Crohn’s?
Adalimumab
Infliximab-can also be used for active fistulating CD
Vedolizumab
- What is used for maintenance of remission for Crohn’s?
2. What would be second line and when would you use this?
- Azathioprine
Mercaptopurine (unlicensed)
- Methotrexate if the patient required it to induce remission, or if azathioprine/mercaptopurine is unsuitable
Should steroids be used for the maintenance of remission for Crohn’s?
No- only to induce remission
What can be used to manage Crohn’s associated diarrhoea?
Loperamide, codeine phosphate, colestyramine
What antibiotics can be used (alone or in combination) to improve symptoms of fistulating Crohn’s?
Metronidazole and ciprofloxacin (unlicensed)
If metronidazole is given for fistulating Crohn’s, how long for and what are the associated risks?
1 month (no longer than 3) due to risk of peripheral neuropathy
What is used to control the inflammation in fistulating Crohn’s disease (and continued for maintenance)? How long should they be on this for?
Azathioprine or mercaptopurine (unlicensed) or infliximab
At least 1 year