Chronic Bowel Disorders Flashcards
What is coeliac disease?
Autoimmune condition associated with chronic inflammation in small intestine unable to absorb nutrients
Gluten intolerance
What are the symptoms of coeliac disease?
Diarrhoea
Abdominal pain
Bloating
Higher risk of malabsorption of key nutrients
How do you treat coeliac disease?
Gluten free diet
Osteoporosis treatment
Supplements
What is diverticula disease?
Small bulges or pockets develop in the lining of the intestine
What is diverticulitis?
When the pockets become inflamed or infected
What are the symptoms of diverticula disease?
Lower abdominal pain
Constipation
Diarrhoea
What is the treatment for diverticula disease?
High fibre diet
Bulk forming drugs
Antibiotics if diverticulitis
What is ulcerative colitis?
Mucosal inflammation and ulcers restricted to colon and rectum
What are the symptoms of ulcerative colitis?
Bloody diarrhoea
Abdominal pain, urgent need to defecate
Alternates between acute flare up and remission
Flare up - mouth ulcers, arthritis, sore skin, weight loss, fatigue
What are the long term complications of ulcerative colitis?
Colorectal cancer
Secondary osteoporosis
VTE
Toxic megacolon
What is contraindicated in ulcerative colitis?
Loperamide/codeine
Paralytic ileus - increased risk of toxic megacolon
What type of colitis is treated orally?
Extensive
What type of colitis is treated with enemas?
Left sided/distal
What type of colitis is treated with suppositories?
Proctitis
What type of colitis is treated with foam preparations?
Proctosigmoiditis
What is used to treat mild-moderate exercise ulcerative colitis?
Proctitis and proctosigmoiditis first line - rectal aminosalicylate
Extensive colitis or left sided colitis first line - high dose oral aminosalicylate + rectal aminosalicylate or oral beclometasone if necessary
What is used to treat subacute ulcerative colitis?
Oral prednisolone or mab
What is used if treatment failure in acute mild-moderate ulcerative colitis?
+ oral prednisolone
+ oral tacrolimus
What is used for severe acute colitis?
IV corticosteroid - assess for surgery
IV corticosteroid + IV ciclosporin
What is used to maintain remission in ulcerative colitis?
Proctitis + proctosigmoiditis - aminosalicylates
Extensive or left sided - low dose oral aminosalicylate
Oral azathioprine/mercaptopurine if 2+ flare ups in 12 months
Mab
What is Crohn’s disease?
Inflammation of GI tract from mouth to anus
What are the symptoms of chrons disease?
Abdominal pain Diarrhoea Rectal bleeding Weight loss Low grade fever Fatigue
What are the complications of Crohn’s?
Intestinal strictures, abscesses, fistulae
Malnutrition Anaemia Colorectal cancer Growth failure and delayed puberty Arthritis
What is the lifestyle advice for Crohn’s?
High fibre diet
Smoking cessation
Loperamide or codeine phosphate
What do you give for 1+ flare up of Crohn’s in 12 months?
Corticosteroid
Budesonide/aminosalicylate
What do you give for 2+ flare ups of Crohn’s in 12 months?
Azathioprine or mercaptopurine
Methotrexate
What is used to maintain remission in Crohn’s?
Azathioprine
Mercaptopurine
What is used to maintain remission in Crohn’s after surgery?
Azathioprine or mercaptopurine
Or aminosalicylates
What are the aminosalicylates used in IBD?
Balsalazide
Mesalazine
Olsalazine
Sulfasalazine
What are the corticosteroids used in IBD?
Beclometasone Budesonide Hydrocortisone Methylprednisolone Prednisolone
What are the drugs that affect the immune system that are used in IBD?
Azathioprine Ciclosporin Mercaptopurine Methotrexate Infliximab
What is the mechanism of action of aminosalicylates?
Reduce cytokine and free radical formation and inhibit prostaglandin synthesis
What are the side effects of aminosalicylates?
Blood dyscrasias
Nephrotoxicity
Salicylate hypersensitivity
Yellow/orange bodily fluids with sulfasalazine
What are the counselling points for aminosalicylates?
Report unexplained bleeding, bruising, sore throat, fever
What is the interaction between mesalazine and lactulose?
Lactulose lowers stool in pH in the intestines
Prevents sufficient release of the active ingredient in EC/MR preparations
What are the symptoms of IBS?
Lower abdominal pain
Bloating
Alternating constipation and diarrhoea
What are the antispasmodics used in IBS?
Alverine
Mebeverine
Peppermint oil
What are the antimuscarinics used in IBS?
Hyoscine butylbromide
Atropine
Dicycloverine
Propantheline bromide
What are the laxatives used in IBS?
Lactulose not recommended
Linoclotide
What antimotility drug is used in IBS?
Loperamide
Why are antidepressants used in IBS?
Abdominal pain/discomfort
TCA
SSRI
What is short bowel syndrome?
Characterised by malabsorption following extensive resection of the bowel
What vitamins are people with short bowel syndrome?
ADEK, fatty acids, zinc, selenium, hypomagnesaemia
What do you need to give higher doses of in short bowel syndrome?
Warfarin
Oral contraceptives
Digoxin
EC/MR not suitable
Liquid formulations may be suitable
