Chronic Bowel Disorders Flashcards
what is coeliac disease?
autoimmune condition associated with chronic inflammation of small intestine unable to absorb nutrients
what nutrients are at high risk of not being absorbed in coeliac disease?
calcium and vit d
what are the 3 parts to treatment of coeliac disease?
1 gluten free
2 - assss risk for osteoporosis and treat bone disease
3 - vitamin and mineral supplements
Diverticulitis is when pockets (diverticula) develop in the lining of the intestine and become inflammed/infected. What are the 3 parts to management?
1 - high fibre diet
2 - bulk forming drugs to help with diarrohea or constipation
3 - antibiotics for signs of infection
name 4 complications of ulcerative colitis
- colorectal cancer
- secondary osteoporosis (corticosteroid, dietary changes)
- VTE
- toxic megacolon (deeper spread of inflammation)
what drugs should NOT be given to patients during a flare of UC?
loperamide and codiene - avoid anti-motility drug/antispasmodics: paralytic ileus = increased risk of toxic megacolon)
when would oral therapy, suppositories, enemas, and foam preperations be most appropriate for treatment of UC?
Oral - extensive (proximal) colitis
Suppositories - inflammtion of rectum (proctitis)
Enemas - inflammation up to descending colon (left-sided colitis)
Foam - inflammation of rectum and sigmoid colon (proctosigmoiditis)
first line treatment in proctitis (inflammation of rectum) and proctosigmoiditis (inflammtion of rectum and sigmoid)?
What-s the alternative?
1st - rectal aminosalicylate (mesalasine, sulfasalasine)
2nd - rectal corticosteroid or PO pred
first line treatment in extensive and left-sided colitis (up descending colon)?
what’s second line?
1st = high dose oral aminosalicaylate + rectal aminosalicylate or oral beclometasone if necessary
2nd = oral prednisolone
what’s 1st line for moderate-severe UC and what’s 2nd?
1st = oral prednisolone
2nd = monoclonal antibodies
what’s 1st line in treatment failure in mild-moderate UC?
what do you add in if no response after 2 - 4 weeks?
add oral pred after 4 weeks with aminosalicyate
add oral tacrolimus if no response after 2 - 4 weeks
what’s 1st line for severe acute UC?
what’s 2nd line option (if symptoms don’t improve/worsen in 72 hours)?
1st line = IV corticosteroid and assess need for surgery, or could use IV ciclosporin or surgery
2nd line = IV ciclosporin + IV corticosteroids or steroids
what’s an alternative to ciclosporin for management of acute severe UC?
infliximab
what’s an alternative to ciclosporin for management of acute severe UC?
infliximab
what are the differences in maintaining remission in proctitis and proctosigmoiditis compared to extensive colitis and left sided colitis?
Proctitis + proctosigmoiditis = rectal aminosalicylate alone or with oral aminosalicylate
Extensive + left-sided colitis = low-dose oral aminosalicylate + oral azathioprine/mercaptopurine if 2+ flare ups in 12 months that require steroids or if remisison not maintained by aminosalicylates + MAbs continued if effective
when is oral azathioprine/mercaptopurine added into maintained remission in extensive/left-sided UC?
if 2+ flare ups in 12 months needign steroids or if remission not maintained by aminosalicylates
when is oral azathioprine/mercaptopurine added into maintained remission in extensive/left-sided UC?
if 2+ flare ups in 12 months needign steroids or if remission not maintained by aminosalicylates
where in the body does Chron’s affect?
GI tract (mouth to anus)
name some lifestyle adivce you could give to someone with chron’s
- high fibre diet
- smoking cessation reduces risk of relapse
- loperamide or codeine treats diarrhoea - not in colitis
what’s the treatment for 1+ acute flare in 12 months/1st presentation of Chron’s?
what are the alternatives?
corticosteroids
alternatives = budesonide or aminosalicylate in patients with distal ileal, iliealcaecal or right sided disease
what’s the treatment for 2+ acute flare ups in 12 months? (or if corticosteroid dose cannot be reduced)
azathioprine or mercaptopurine
alternative = methotrexate
alternative = MAbs
what’s the maintenace of remission in Chrons disease with and without srugery?
without = azathioprine or mercaptopurine
alternative = methotrexate
after surgery = azathioprine or mercaptopurine OR aminosalicylate
what’s an interaction involving mesalazine you should counsel patients about?
lactulose - lactulose lowers stool pH in the intestines. This prevents sufficent release of the active ingredient EC or MR preperations
what should be monitored with aminosalicylates?
what are some general counselling points?
renal function
itching and hives, can get yellow/orange bodily fluids with sulfasalasine (stain contact lenses)
blood dyscrasias (unexplained bleeding, bruising, sore throat, fever)
