Chronic Bowel Disorder Flashcards
What is coeliac disease
Occurs in the small intestine
Associated with gluten: wheat, barley and rye
- causes an immune response in intestinal mucosa
May cause malabsorption of nutrients
Aime is to
- manage symptoms: diarrhoea, bloating and abdominal pain
- avoid malnutrition: give vit D, calcium and other nutrients (under supervision )
Only effective option is to avoid gluten
What is meant by diverticular disease and diverticulitis
Diverticulosis: small pouches but asymptomatic
Diverticular disease: small pouches but symptomatic
-abdominal pain, constipation, diarrhoea, or rectal bleeding
Acute diverticulitis: when pouches becomes inflamed or infected
-severe abdominal pain, fever, significant rectal bleeding
Complicated acute diverticulitis: abscess, perforation, fistula, obstruction, sepsis, haemorrhage
Treat with fibre, bulking forming laxatives or paracetamol if needed
What is meant by crohns disease
Affects the whole GI tract - associated with thickened walls, extending through all the layers, with deep ulcerations
What complications does Crohn’s disease lead to
Intestinal strictures or fistulas
Anaemia and malnutrition
Colorectal and bowel cancer
Growth failure and delayed puberty in children
Extra-intestinal manifestation: arthritis or joints, eyes, liver or skin abnormalities
What is the acute treatment of Crohn’s disease
First flat up in 12 month period
- mono therapy with either prednisone, methylprednisalone or IV hydrocortisone
- if patient has distal ileal, ileocaecal or right sided disease:
- use budesonide if normal treatment doesn’t work
- aminosalicylates may be used ( sulfasalazine or mesalazine)
- less side effects, b it less effective
2+ flare up in 12 month period
- add azathirprine or mercaptopurine
- methotrexate may be added if azo/merc is contraindicated
-severe: monoclonal antibodies
What is the maintenance treatment for Crohn’s disease
Encourage the person to stop smoking
Monotherapy of either azathioprine or mercaptopurine
Methotrexate can be used in induction or can not tolerate Aza/merc. Can be continued if on the acute stage can be used for the maintenance dose
After surgery:
Azathioprine + metronidazole
Azathioprine alone if metronidazole is not tolerated
Diarrhoea associated:
-loperamide
- coDeine
- colestyramine
What is meant by fistulating Crohn’s disease
When a fistula develops between intestine and perianal skin, bladder and vagina
Can be left alone if asymptomatic
To improve symptoms (not fully heal)
Metronidazole +/- ciprofloxacin
- metronidazole usually given for 1 month (no longer than 3 months due to peripheral neuropathy)
Maintenance :
Azathioprine or mercaptopurine (infliximab if not responding)
- treatment must last at least 1 year
What is meant by ulcerative colitis
Can affect the region from the rectum to the whole colon, associated with bloody diarrhoea, defecation urgency and abdominal pain
May lead to complications such as
Colorectal cancer
Secondary osteoporosis
Venous thromboembolism
Toxic megacolon
Most common ages is between 15-25 years old and
What is the difference between ulcerative colitis and Crohn’s disease
Ulcerative colitis has a continuous pattern whereas Crohn’s disease is patchy
There are 5 different types of ulcerative colitis
Procititis (just the base affected)
Proctosigmoiditis ( just the tail bit)
Distal/left sided (left side affected)
Extreme colitis (3/4 affected)
Pancolitis (whole thing is affected)
What is the treatment for acute (mild-moderate) for ulcerative colitis
Distal- rectal preparation (suppositories or enemas)
- foam preparation is used if patient has difficulty retaining liquid enema
Extended- systemic medication needed
Diarrhoea- avoid loperamide or codeine as this can cause toxic megacolon ( massive infection) and loperamide and codeine would slow down the gastric emptying so there will be build up in the colon and infection will occur
-only to be initiated under specialist advice
What is the treatment plan for proctitis just the base for ulcerative colitis (mild-moderate)
1- topical aminosalicylates
2- add oral aminosalicylates if no improvement after 4 weeks
3- still no improvement- topical or oral corticosteroids for 4-8 weeks
Patients can use oral aminosalicylates as first line if preferred (not as effective) if aminosalicylates is contraindicated - topical or oral corticosteroids for 4-8 weeks
What is the treatment for proctosigmoiditis and left sided ulcerative colitis (mild-moderate)
1- topical aminosalicylates
2- add high dose oral aminosalicylates if no improvement after 4 weeks
OR
Switch to high dose oral aminosalicylates + 4-8 weeks of topical corticosteroids
3- stop topical treatment and offer oral aminosalicylates + 4-8 weeks of oral corticosteroids
Patients can use high dose oral aminosalicylates first line is preferred (less effective)
If aminosalare contraindicated - topical or oral corticosteroids for 4-8 weeks
What is the treatment for extensive ulcerative colitis (mild-moderate)
1- topical aminosalicylates + high dose oral aminosalicylates
2- if there is no change after 4 weeks - stop topical aminosalicylates and offer high dose oral aminosalicylates + oral corticosteroid for 4-8 weeks
If aminosalicylates are contraindicated - oral corticosteroid are 4-8 weeks
What is the treatment for acute ulcerative colitis when it is SEVERE
Life threatening - medical emergency
- IV hydrocortisone or methylprednisalone and assess for need of surgery
- if IV steroids are contraindicated - use IV ciclosporin or surgery
If symptoms has not helped within 72 hours - Iv steroid + IV ciclosporin or surgery
Patients who have been treated with infliximab if ciclosporin is contraindicated
What is the maintenance treatment for ulcerative colitis
Oral aminosalicylates recommended
- corticosteroids are not suitable due to their side effects
-More effective as once daily dose- however may be more side effects
Procitis or proctosigmoiditis: rectal +/- oral aminosalicylates
- oral can be given alone if rectal is not wanted
Left sided or extensive : low dose oral aminosalicylates
2+ flares in 12 months: oral azathiprine or mercaptopurine
- give monoclonal antibodies if no effect
