Chronic bowel disorders Flashcards
What is Coeliac disease?
Autoimmune condition - chronic inflammation of small intestine.
Gluten in wheat, barley, rye - activate abnormal immune response leads to malabsorption of nutrients
How is Coeliac disease treated?
strict, life long gluten free diet.
Supplements may be required. Pts should be advised NOT to self medicate with OTC vits
What are coeliac pts at increased risk of due to malabsorption?
Osteoporosis and active treatment of any bone disease
Need calcium and vit D
Treatment used for confirmed cases of refractory coeliac disease?
Prednisolone can be used whilst waiting for specialist advice.
What is diverticular disease?
condition where diverticula (in colon wall) cause intermittent lower abdo pain in the absence of inflammation or infection.
What is diverticuitis?
Inflammation and infection of the diverticula - causing lower abdo pain.
usually accompanied by fever, general malaise and sometimes large rectal bleeding
Sulfasalazine belongs to which group of medicines?
Aminosalicylates
Sulfasalazine is made up of 5 aminosalicylic acid and sulfapyridine - what’s the function of sulfapyridine ?
acts as a carrier to the colonic site of action bit still causes side effects
What other newer aminosalicylates are available? (3)
The sulfonamide related side effects are avoided but 5-ASA still cause side effects including …(2)
- mesalazine (5-aminosalicylic acid (5-ASA))
- Balsalazide sodium (pro-drug of 5-ASA)
- Olsalazine sodium
- Blood disorders
- Lupus like syndrome
What 3 groups of drugs are used in chronic bowel disorders?
examples of each
- Aminosalicylates
- Cytokine modulators e.g Infliximab, Adalimumab, Golimumab
- Dugs affecting immune response e.g. folic acid given to reduce methotrexate toxicity
How do Cytokine modulators e.g Infliximab, Adalimumab, Golimumab work?
They are monoclonal antibodies which inhibit the proinflammatory
cytokine, tumour necrosis factor alpha. They
should be used under specialist supervision.
What is Crohn’s disease?
What is fistulating crohn’s disease?
chronic inflammatory disease mainly affects gastro intestinal tract.
Characterised by:
thickened areas of gastro wall, ulceration etc
Fistulating Crohn’s disease is a complication that involves
the formation of a fistula between the intestine and adjacent
structures, such as perianal skin, bladder, and vagina.
Symptoms of Crohn’s disease? (5)
- abdo pain
- rectal bleeding
- diarrhoea
- fever
- weight loss
Drug and non drug treatment for crohn’s disease?
Add on treatment?
non -drug:
smoking cessation
attention to nutrition
drug:
1. corticosteroid (prednisolone or methylprednisolone or intravenous hydrocortisone) - used for first presentation or flare up in a 12 month period
- budesonide if above contraindicated in certain pts
Add on treatment for more than two exacerbations in 12 month period:
1. Azathioprine (immunosuppressant) or Mercaptopurine (cytotoxic /antimetabolite /chemo)
What treatments can be used for diarrhoea associated with crohn’s disease?
in those without colitis:
- Loperamide
- Codeine
- Colestyramine brand name: Questran ( bile acid sequestrants)
licensed for diarrhoea associated with crohn’s disease
What is Ulcerative colitis?
When does it usually present itself?
Symptoms? (3)
chronic inflammatory condition
characterised by diffuse mucosal inflammation - it has relapsing-remitting pattern
between 15-25 years old
Symptoms:
- urgent need for defaecation
- bloody diarrhoea
- abdo pain
What are some complications associated with ulcerative colitis? (4)
- Increased risk of colorectal cancer
- Secondary osteoporosis
- Venous thromboembolism
- Toxic megacolon
What’s first line treatment for acute mild to moderate UC?
Aminosalicylate with or without corticosteroid
What common side effects with aminosalicyates? (11)
- Arthralgia (pain in joint)
- Cough
- Diarroheoa
- Dizziness
- Fever
- GI discomfort
- Headache
- Leucopenia
- Nausea
- Skin reactions
- Vomiting
What patient advice should be given with aminosalicyates?
& what should be done if pts show signs?
To report any unexplained: bleeding bruising purapura (purple spots/bruises on skin) sore throat fever malaise
Drug should be stopped immediately and a blood count done if any suspicion of blood dyscrasia
