Gastrointestinal Tract-IBD

Question 1

Inducing remission for Chron’s?

Answer 1

ACT BAD

Question 2

Complications of Chron’s?

Answer 2

Perforation, Stricture, Fistula, Malabsorption resulting in anaemia, Vit D and Calcium def (2ndary osteoporosis), Arthritis, Colorectal Cancer

Question 3

when are azathioprine and mercaptopurine contraindicated?

Answer 3

TPMT deficiency

Question 4

Ulcerative Colitis Classification Index

Answer 4

Truelove and Witts Scoring looks at: bowel movements, HR, ESR (inflamm marker) and presence of Malaena, Anaemia and Pyrexia.

Question 5

Proctitis? Proctosigmoiditis?

Answer 5

Proctitis: inflammation of rectum
Proctosigmoiditis; inflammation of rectum and sigmoid colon
Extensive UC: most severe

Question 6

Which drugs should be avoided at UC?

Answer 6

Anti-diarrhoeals-increased risk of toxic megacolon (diarrhoea management in UC is specialist area while in Chron’s anti-diarrhoeals e.g. Loperamide, Codeine or Colestyramine can be used)

Question 7

Treatment of acute mild-moderate proctitis (inducing remission)?

Answer 7

1st-Topical aminosalicylate (enema or suppos) for 4 weeks-if ineffective;

2nd- Oral aminosalicylate for 4 weeks-ineffective;

3rd- Add rectal/topical corticosteroid (e.g. prednisolone) for 4-8w to aminosalicylate

4th line- no response after 2-4 w-Tacrolimus or Budesonide Multimatrix (taken orally but has local action on colon can also be considered)

Question 8

treatment for acute mild-moderate proctosigmoiditis and left-sided UC to induce remission?

Answer 8

Topical aminosalicylate

Question 9

Treatment for acute mild-moderate extensive UC to induce remission?

Answer 9

Topical aminosalicylate + high dose oral aminosalicylate
No remission in 4 w–> Topical 5-ASA + Oral CCS

If decline topical or contraindicated to 5-ASA-oral prednisolone is sufficient.

Question 10

treatment of acute severe UC (life-threatening)?

Answer 10

1st-i/v CCS (methylprednisolone or i/v hydrocortisone)
2nd-if i/c CCS contraind/not tolerated- i/v ciclosporin

No improvement in 72 hrs- i/v CCS + i/v ciclosporin
(if ciclosporin contraind-use Infiliximab instead)

Question 11

Maintaining remission in all mild-moderate-severe UC?

Answer 11

1st line-topical or oral aminosalicylate monotherapy
2nd line- oral +topical ASA e.g. rectal and oral sulfasalazine

If 2 or more exacerbations in 12m–> use Azathioprine or Mercaptopurine to maintain remission

Question 12

Important S/E of aminosalicylates

Answer 12

Nephrotoxicity- monitor initially, at 3 m and annually

Bone marrow suppression (leucopenia and thrombocytopenia)-monitor FBC and patient report any signs of malaise, fever, bruising purpura, unexplained bruising and sore throat.

Salicylate hypersensitivity- leading to rash, fever and liver enzyme abnormalities-monitor LFTs.

Question 13

Which drug should be avoided with aminosalicylate hypersensitivity?

Answer 13

Aspirin

Question 14

Which drug discolours bodily fluids and soft contact lenses a yellow/orange colour?

Answer 14

aminosalicylates especially sulfasalazine (older generation, more S/E)