Chronic bowel disorders

Question 1

what is coeliac disease?

Answer 1

an intolerance in gluten found in wheat, barley and rye, found in small intestine. Cause an immune response in intestinal mucosa

Question 2

what can be caused by coeliac disease?

Answer 2

malabsorption of other nutrients

Question 3

what is the aim of treatment?

Answer 3

manage symptoms: diarrhoea, bloating
avoid malnutrition: give vit D, calcium and other nutrients (under supervision)

Question 4

what is diverticulosis?

Answer 4

small pouches but asymptomatic

Question 5

what is diverticular disease? symptoms

Answer 5

-small pouches but symptomatic
-abdominal pain , constipation, diarrhoea or rectal bleed

Question 6

what is acute diverticulitis? symptoms

Answer 6

when pouches become inflamed or infected
-severe abdominal pain , fever , significant rectal bleeding

Question 7

what is complicated acute diverticulitis? symptoms

Answer 7

-abscess, perforatiin, fistula, obstruction, sepsis, haemorrhage

Question 8

how do you treat diverticular disease ?

Answer 8

pain with paracetamol
fibre and bulk forming laxatives

Question 9

what is crohn’s disease?

Answer 9

affects the whole gastro-intestinal tract, associated with thicker wall, extending through all layers with deep ulcerations

Question 10

what type of complication may occur?

Answer 10

-intestinal strictures or fistulae
-anaemia and malnutrition
-colorectal and small bowel cancer
-growth failure and delayed puberty in children
-extra-intestinal manifestations: arthiritis or joint eyes, liver and skin abnormalities

Question 11

what is the first line treatment for acute flare up for crowns disease?

Answer 11

-Monotherapy with traditional glucocorticosteroid (at first presentation or a single inflammatory exacerbation in a 12 month period)
-Prednisolone, methylprednisolone, hydrocortisone (IV)

-if distal ileal, ileaocaecal or right sides then Budesonide may also be considered

Question 12

what is second line treatment for acute crohns disease ?

Answer 12

aminosalicylates e.g. sulfasalazne or mesalazine) -less side effects but less effective

Question 13

what is the treatment for crohns if the patient has had 2+ flare ups in 12 month period?

Answer 13

-add azathioprine or mercaptopurine
-methotrexate maybe added if ago/merc is contraindocated
-severe: monoclonal antibodies

Question 14

what is maintenance for crohns?

Answer 14

-encourage stop smoking
monotherapy= azathioprine or mercaptopurine
-methotreaxte can be used if used in induction

Question 15

what is maintenance therapy for after surgery?

Answer 15

azathioprine + metronidazole
azathioprine alone if metronidazole isn’t tolerated

Question 16

what can be used for diarrhoea in crohns?

Answer 16

loperamide and codeine (not in UC)

colestyramine

Question 17

what is fistulating crohns disease?

Answer 17

when fistula develops between intestine and perianal skin, bladder and vagina

Question 18

can fistulating CD be left alone?

Answer 18

yes if asymptomatic

Question 19

how do you improve symptoms (not fully heal)?

Answer 19

metronidazole +/- ciprofloxacin
metronidazole only for 1 month (no longer than 3 months due to peripheral neuropathy

Question 20

what is used for fistulating CD for maintenance?

Answer 20

azathioprine or mercaptopurine (infliximab if not resopnding)
-trearment must last at leastoone year

Question 21

what is ulcerative colitis?

Answer 21

can affect from rectum to the whole colon- associated with bloody diarrhoea, defecation urgency or abdominal

Question 22

what may UC lead to complications like?

Answer 22

-colerectal cancer
-secondary osteoporosis
-venous thromboembolism
-toxic megacolon

Question 23

what age group is affected mostly by UC?

Answer 23

15-25yrs

Question 24

what are the different types of UC?

Answer 24

proctitis
proctosigmviditis
distal/left sided
extensive colitis
pancolitis

Question 25

what is treatment for acute (mild-moderate)? what drugs to avoid

Answer 25

-distal-rectal preps= suppositories or enemas)
foam preps used if patient has difficulty retaining liquid enema
-extended= systemic medication needed
-diarrhoea- avoid loperamide or codeine as can cause toxic megacolon
only to be instated under specialist advice

Question 26

what can be used to treat proctitis in mild-moderate CD?

Answer 26

-TOPICAL aminosalicylate
-add oral aminosalicylate if no improvement after 4 weeks
-still no improvement =topical or orL CORTIOCOSTERIOD for 4-8 weeks
-patients can use oral first line if preferred (not as effective)
-if amiosalicylates are contraindicated, topical or oral corticosteroid for 4-8 weeks

Question 27

how do you treat mild-moderate proctosigmviditis and left -sided UC?

Answer 27

-topical amino salicylates
-add high dose oral aminosalcylates if no improvement OR switch to high dose oral aminosalicylate + 4-8 weeks of topical cortisteroids
-if that’s does work, stop topical treatment and offer oral aminosalicylate +4-8 weeks of oral corticosteriods
-patients can use high dose oral aminosalyclates if preferred as first line

Question 28

what is used if aminosalicylates are contraindicated?

Answer 28

use topical or oral corticosteroids for 4–8weeks

Question 29

what is used to treat mild-moderate extensive UC?

Answer 29

1- topical aminosalclates + high dose oral aminosalicyalte
-if not change after 4 weeks, stop topical and offer high dose oral aminosalyclate + oral corticosteroid for 4-8 weeks

Question 30

how should you should treat acute (severe) uc?

Answer 30

-life threatening= medical emergency
-IV hydrocortisone or methylpredinosloen and asses for need of surgery
-If IV steroids is contraindicated use cyclosporin or surgery
-if symptoms have not helped within 72hrs use IV steroids + IV ciclosporin or surgery
-can use inflixamab if cyclosporin is contraindicated

Question 31

what is used for maintnence of UC?

Answer 31

-oral aminosalicylaytes recommended
-corticosteroids not suitable due to SE
-more effective as once daily dose- however may cause more SE.
-proctitis or proctosigmoditis: rectal +/- oral aminosalicylates
oral can be given alone if reactl is not wanted.
-left sided or extensive: low-dose oral aminosalicylates
-2+ flares in 12 months: oral azathioprine or mercaptopurine, give monoclonal anitbiotied if not effect

Question 32

what colour can sulfasalizine change colour of body fluids to what?

Answer 32

orangey-yellow

Question 33

what are examples of aminosalicyalets?

Answer 33

sulfaslaizine, balsalazide, mesalazine olsalazine

Question 34

what is some cautions for aminosalcylates and the morning for it?

Answer 34

-nephrotoxic: monitor before ignition, 3 months then annually
-hepatoxtic: monitor monthly intervals for first 3 months
-blood disorders: monitors at monthly intervals for first 3 months. perform blood counts and stop drug immediately if signs of blood dyscrasia

Question 35

when is aminoslaicylates contraindicated?

Answer 35

in salicylate hypersensitivity