Chronic bowel disorders Flashcards
what is coeliac disease?
an intolerance in gluten found in wheat, barley and rye, found in small intestine. Cause an immune response in intestinal mucosa
what can be caused by coeliac disease?
malabsorption of other nutrients
what is the aim of treatment?
manage symptoms: diarrhoea, bloating
avoid malnutrition: give vit D, calcium and other nutrients (under supervision)
what is diverticulosis?
small pouches but asymptomatic
what is diverticular disease? symptoms
-small pouches but symptomatic
-abdominal pain , constipation, diarrhoea or rectal bleed
what is acute diverticulitis? symptoms
when pouches become inflamed or infected
-severe abdominal pain , fever , significant rectal bleeding
what is complicated acute diverticulitis? symptoms
-abscess, perforatiin, fistula, obstruction, sepsis, haemorrhage
how do you treat diverticular disease ?
pain with paracetamol
fibre and bulk forming laxatives
what is crohn’s disease?
affects the whole gastro-intestinal tract, associated with thicker wall, extending through all layers with deep ulcerations
what type of complication may occur?
-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
what is the first line treatment for acute flare up for crowns disease?
-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
what is second line treatment for acute crohns disease ?
aminosalicylates e.g. sulfasalazne or mesalazine) -less side effects but less effective
what is the treatment for crohns if the patient has had 2+ flare ups in 12 month period?
-add azathioprine or mercaptopurine
-methotrexate maybe added if ago/merc is contraindocated
-severe: monoclonal antibodies
what is maintenance for crohns?
-encourage stop smoking
monotherapy= azathioprine or mercaptopurine
-methotreaxte can be used if used in induction
what is maintenance therapy for after surgery?
azathioprine + metronidazole
azathioprine alone if metronidazole isn’t tolerated
what can be used for diarrhoea in crohns?
loperamide and codeine (not in UC)
colestyramine
what is fistulating crohns disease?
when fistula develops between intestine and perianal skin, bladder and vagina
can fistulating CD be left alone?
yes if asymptomatic
how do you improve symptoms (not fully heal)?
metronidazole +/- ciprofloxacin
metronidazole only for 1 month (no longer than 3 months due to peripheral neuropathy
what is used for fistulating CD for maintenance?
azathioprine or mercaptopurine (infliximab if not resopnding)
-trearment must last at leastoone year
what is ulcerative colitis?
can affect from rectum to the whole colon- associated with bloody diarrhoea, defecation urgency or abdominal
what may UC lead to complications like?
-colerectal cancer
-secondary osteoporosis
-venous thromboembolism
-toxic megacolon
what age group is affected mostly by UC?
15-25yrs
what are the different types of UC?
proctitis
proctosigmviditis
distal/left sided
extensive colitis
pancolitis
what is treatment for acute (mild-moderate)? what drugs to avoid
-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
what can be used to treat proctitis in mild-moderate CD?
-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
how do you treat mild-moderate proctosigmviditis and left -sided UC?
-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
what is used if aminosalicylates are contraindicated?
use topical or oral corticosteroids for 4–8weeks
what is used to treat mild-moderate extensive UC?
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
how should you should treat acute (severe) uc?
-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
what is used for maintnence of UC?
-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
what colour can sulfasalizine change colour of body fluids to what?
orangey-yellow
what are examples of aminosalicyalets?
sulfaslaizine, balsalazide, mesalazine olsalazine
what is some cautions for aminosalcylates and the morning for it?
-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
when is aminoslaicylates contraindicated?
in salicylate hypersensitivity
