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Gastro-intestinal System > Crohn's Disease, IBD & IBS & Ulcerative Colitis > Flashcards

Crohn's Disease, IBD & IBS & Ulcerative Colitis Flashcards

1
Q

What is Crohn’s Disease?

A

A chronic, inflammatory bowel disease that affects the gastro-intestinal tract.

Areas of the gastro-intestinal wall becomes thickened with inflammation, which extends to all layers; and could also have granulomas present.

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2
Q

What are the symptoms of Crohn’s disease?

A

May include:
- abdominal pain
- diarrhoea
- fever
- anal fissure
- weight loss
- rectal bleeding.

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3
Q

What are some complications of Cronh’s disease?

A
  • Stricture (narrowing of G.I tract) - causes passing food difficult, leading to vomiting and sickness
  • Perforation (holes in G.I tract) - contents of G.I tract leak out and cause infection or abscess in abdomen
  • Cancer (bowel cancer & colorectal) - higher risk of developing colon cancer
  • Fistula
  • Malnutrition
  • Anaemia
  • Osteoporosis
  • Arthritis
  • Growth failure and delayed puberty in children
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4
Q

What is fistulating Crohn’s disease?

A

A complication that involves the formation of fistula between the intestine and adjacent structures such as the bladder, vagina etc.

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5
Q

What is a fistula?

A

A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure.

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6
Q

Aim of treatment for Crohn’s disease?

A

Reducing symptoms, maintaining or improving quality of life whilst minimising toxicity of the drugs.

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7
Q

Aim of treatment for fistulating crohn’s disease.

A

Surgery and medical treatment to close and maintain closure of the fistula

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8
Q

What are the non-drug treatment for crohn’s disease?

A

Smoking cessation, stress management and diet change

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9
Q

Drug treatment for acute crohn’s disease?

A

A corticosteroid like prednisolone or methylprednisolone. or intravenous hydrocortisone, to induce remission.

If a simple corticosteroid is unsuitable or contra-indicated with patients with distal ileal, ileocaecal or right-sided colonic disease, use budesonide.

An alternative option is aminosalicylates like sulfasalazine and mesalazine.

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10
Q

What is the most effective treatment?

A

A corticosteroid like prednisolone.

Budesonide is less affective than a corticosteroid but has fewer side effects.

Aminosalicylates are less effective than both but have fewer side effects

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11
Q

When is an add-on treatment given in Crohn’s disease?

A

When there are two or more inflammatory exacerbations in a 12 month period, or the corticosteroid dose cannot be reduced

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12
Q

What are the add-on drug treatments for Crohn’s disease?

A

Azathioprine or mercaptopurine can be added to a corticosteroid or budesonide to induce remission.

If these are not tolerated, methotrexate can be added to a corticosteroid

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13
Q

Treatment for severe, active Crohn’s disease?

A

Adalimumab and infliximab, following inadequate response to other treatment.

These can be used as mono therapy or combined with immunosuppressant but there’s uncertainty about its effectiveness.

Vedolizumab and Ustekinumab is recommended for moderate to severely active Crohn’s disease, when adalimumab or infliximab is unsuccessful, not tolerated and contra-indicated.

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14
Q

What symptoms may suggest relapse in Crohn’s disease?

A

Unintended weight loss, abdominal pain, diarrhoea and general ill-health.

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15
Q

What should be done for those who reject maintenance treatment during remission?

A

A suitable follow up plan should be agreed, symptoms that could suggest relapse should be spoken about and information provided on how to access healthcare if a relapse occurs.

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16
Q

What is the drug treatment for maintenance of remission?

A

Azathioprine or mercaptopurine as monotherapy. Usually only if previously used with a corticosteroid to induce remission.

Methotrexate can also be used but ONLY in those that required methotrexate to induce remission; or if the patient is intolerant to or not suitable for Azathioprine or mercaptopurine for maintenance.

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17
Q

What drugs cannot be used for maintenance remission?

A

Corticosteroids or budesonide

18
Q

What drug should be used for maintaining remission following surgery?

A

Azathioprine in combination with up to 3 months postoperative metronidazole - for patients with ilecolonic Crohn’s disease who have had complete macroscopic resection within the previous 3 months.

If metronidazole cannot be tolerated, then Azathioprine should be used alone.

19
Q

What drugs cannot be used for maintaining remission following surgery?

A

Aminosalicylates - due to lack of clinical efficacy

Mercaptopurine - not cost-effective

Biological therapies - limited evidence

Budesonide

20
Q

What drug can be used for the management of diarrhoea associated with Crohn’s disease?

A

Loperamide hydrochloride or codeine phosphate.

Colestyramine is used for the relief of diarrhoea in Crohn’s disease aswell

21
Q

What must be considered for Fistulating Crohn’s disease?

A

Local drainage and surgery may be considered in conjunction with medical therapy

22
Q

What drugs are given for fistulating Crohn’s disease?

A

Metronidazole or ciprofloxacin, alone or in combination can improve symptoms of Crohn’s disease - compete healing is rare.

Metronidazole is usually given for 1 month but no more than 3 months due to concerns about peripheral neuropathy.

Other antibacterials can be given IF specifically indicated like sepsis associated with fistulae; and for managing bacterial overgrowth in the small bowel.

23
Q

What is used to control the inflammation in fistulating Crohn’s disease?

A

Azathioprine or mercaptopurine and they are continued for maintenance.

24
Q

If patients with active fistulating Crohn’s disease is not responding to conventional therapy, or who are intolerant of, or have contra-indications to conventional therapy, what can be given?

A

Infliximab.

This should be used after ensuring that all sepsis is actively draining.

25
Q

What are the conventional therapies for fistulating Crohn’s disease?

A

Antibacterials, drainage, and immunosuppressive treatments

26
Q

What can be done before infliximab treatment?

A

Abscess drainage, fistulotomy and seton insertion.

27
Q

What can be continued as maintenance for fistulating Crohn’s dosease?

A

Azathioprine, mercaptopurine or infliximab, for at least one year

28
Q

Difference between Cronh’s and ulcerative colitis?

A

Crohn’s can affect any part of the whole digestive system, from mouth to bottom (anus).

Ulcerative colitis affects the colon (large intestine).

29
Q

What is the treatment for acute mild to moderate ulcerative colitis?

A
  1. Proctitis - 1st line is topical aminosalicylate. If no improvement within 4 weeks then add oral aminosalicylate, if no improvement add oral or topical corticosteroid for 4-8 weeks.
  2. Proctosigmoiditis & left sided ulcerative colitis - 1st line is Topical aminosalicylate
  3. Extensive ulcerative colitis: 1st line is topical aminosalicylate and high dose oral aminosalicylate

Enemas, rectal foams and suppositories can also be used.

30
Q

What is the treatment for severe and remission ulcerative colitis?

A

Acute severe:
- I.V corticosteroid & infliximab

Remission in mild, moderate & severe:
- Use aminosalicylates

  • Oral azathioprine or mercaptopurine used when two or more inflammatory exacerbations in a 12 month period that required a systemic corticosteroid

AVOID CORTICOSERIODS

31
Q

How long are corticosteroids normally used for in Ulcerative colitis?

A

4-8 weeks usually

32
Q

What antidiarrhoeal drugs are used for ulcerative colitis?

A

Loperamide & Codeine phosphate.

NOT IN ACUTE ULCERATIVE COLITIS - as it can increase risk of toxic megacolon

33
Q

What are the side effects of Aminosalicylates? And which ones have more side effects?

A

Older aminosalicylates has more side effects.

Major side effects:
- Bone marrow suppression: unexplained bleeding, bruising purpura, sore throat, fever or malaise.
REPORT IF THESE DEVELOP.

  • Orange/yellow staining of bodily fluids.
    Stains contact lenses.
  • Nephrotoxicity
  • Salicylate hypersensitivity
34
Q

What monitoring must be done for those taking Aminosalicylates?

A
  • Perform blood count and stop drug immediately if suspicion of blood dyscrasia
  • Monitor renal function before starting, at 3 months and then annually.
35
Q

What are examples of newer amino-salicylates?

A
  • Mesalazine
  • Balsalazide
  • Olsalazine
36
Q

What is IBD and what is the cause? And what does it lead to?

A

Inflammatory bowel disease.

Causes are:
Genetic, environmental tiggers, stress, smoking, infection, air pollution, drugs and diet.

These triggers causes an autoimmune response, which causes antibodies to be released.
Either leading to Crohn’s disease or Ulcerative colitis

37
Q

Drugs used for IBD?

A
  • Aminosalicylates, e.g. mesalazine, balsalazide, olsalazine and sulphasalazine = reduce inflammation in gut
  • Immunosuppressants, e.g. methotrexate, azathioprine, mercaptopurine = reduce activity of immune system
  • Biological therapy (monoclonal antibodies), e.g. infliximab, adalimumab, golimumab. These require specialist supervision.
  • Corticosteroids e.g. oral prednisolone, hydrocortisone, budesonide, methylprednisolone = used for severe symptoms and not for maintenance.
  • Antibiotics

And meds to treat diarrhoea & constipation.

38
Q

What Mnemonic is used for IBD drugs?

A

IBD, ACTS BAD

Aminosalicylates
Corticosteriods
Thiopuine

Biological agents
Antibiotics
Diarrhoea

39
Q

What is IBS and what causes it?

A

Irritable bowel syndrome.

And causes include:
- Alcohol
- Stress
- Caffeine
- Certain foods like spicy or fatty food.

40
Q

What are the side effects of IBS?

A
  • Abdo pain
  • Bloating
  • Constipation
  • Diarrhoea
  • Flatulence
  • Passing mucus from bottom
  • Lethargy
  • Bowel incontinence

Symptoms worsen by eating and relieved by defaecation.

41
Q

What are the non drug treatments for IBS?

A
  • Diet and lifestyle changes
  • Increased physical activity
  • Eating regularly without missing meals
  • Limit fresh fruit consumption
  • Increase water intake (at least 8 cups daily)
  • Reduce caffeine, alcohol and fizzy drinks.
  • Insoluble fibre like oats, sterculia & ispaghula husk
    AVOID INSOLUBLE ONES.
42
Q

What is the drug treatment for IBS?

A

Antispasmodics & Antimuscarinics for abdo pain and G.I spasms.

Linaclotide for severe IBS associated with constipation - reduces pain bloating and constipation.

For constipation, increase fibre and use laxative but AVOID LACTULOSE (causes bloating).

For diarrhoea: Loperamide

For bloating: Peppermint oil

Tricyclic antidepressants (like amitriptyline) and SSRI (like fluoxetine), unlicensed. If patient doesn’t respond to laxative, antispasmodics or loperamide.

Gastro-intestinal System (6 decks)

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