GI (IBD) Flashcards

all the hard diseases

1
Q

UC location and layers affected

A

colon, rectum

mucosa, submucosa

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2
Q

minor complications of UC

A

haemorrhoids, anal fissures, perirrectal abcesses

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3
Q

major complication of UC and symptoms

A

toxic megacolon

high fever, tachycardia, distended abdomen, elevated wbc, dilated colon

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4
Q

clinically, which is common in crohn’s vs uc?
1. fever, malaise
2. rectal bleeding
3. abdominal tenderness
4. abdominal mass

A
  1. crohn’s
  2. both
  3. crohn’s, but uc possible
  4. crohn’s
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5
Q

clinically, which is common in crohn’s vs uc?
1. abdo pain
2. abdo wall and internal fistula
3. distribution
4. aphthous or linear ulcers (mouth)

A

all crohn’s

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6
Q

what is most affected for crohn’s.

A

terminal ileum, but can occur in any part of GI tract.

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7
Q

crohn’s vs uc which is continuous

A

CD discontinuous uc continuous

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8
Q

mild, moderate UC and what is the marker of inflamx

A

mild - less than 4 stools, no systemic disturbance (ESR normal)
mod - 4-6 stools, minimal systemic disturbance

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9
Q

what are systemic manifestations of severe UC and ESR level?

A

fever, tachycardia, anemia. more than 6 stools a day

ESR > 30

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10
Q

ileufulminant UC? and symptoms

A

> 10 bowel movements a day

continuous bleeding, toxicity, abdominal tenderness, transfusion, colonic dilation

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11
Q

CD presentation

A

periods of remission and exacerbation

diarrhoea, abdominal pain, perirectal, perianal lesion

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12
Q

nonpharm for UC and CD

A
  • exclusion diets are not endorsed
  • enteral nutrition
  • probiotics (VSL3, e coli nissle 1917)
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13
Q

major classes of therapies in IBD

A
  • 5 ASA
  • corticosteroids
  • immunomodulators (azathioprine)
  • immunosuppressive (cyclosporine)
  • antimicrobials (metronidazole)
  • anti tnf), interlukin, jk inhibitors (tofactinib)
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14
Q

use of corticosteroids in IBD

A

40-60mg prednisone for refractory IBD or require more rapid control

or budesonide

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15
Q

cyclosporine benefit in UC vs CD

A

short term benefit in UC if patients fail corticosteroids

little benefit in CD

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16
Q

what is infliximab vs adalimumab and their role in therapy

A

anti TNF alpha antibody for both UC and CD

for both induction and maintenance therapy

adalimumab is used when infliximab has lost response

17
Q

first line for UC mild to moderate

A

TOP ASA > PO ASA > corticosteroids

18
Q

how does smoking affect UC and CD

A

UC: If suddenly stop smoking, can trigger a flare up
CD: if stop smoking, is beneficial for pt

19
Q

systemic complications of IBD

A

eye inflamx
lower bone density
growth failure rate in children
liver and bile duct inflammation
ASYMMETRICAL arthritis and join pains
skin lesions
kidney stones

20
Q

IBD patients are usually..

A

underweight, malnutrition

21
Q

what can be used for remission induction but not maintenance therapy

A

steroid, cyclosporine

22
Q

which has more side effects, sulfasalazine or mesalazine

A

sulfasalazine. due to the sulfapyridine side group

23
Q

dose related side effects of sulfasalazine (3)

A

GI. headache, mild hematologic toxicities

24
Q

side effects rendering immediate stop of sulfasalazine

A

agranulocytosis, aplastic anemia

25
Q

how to give budesonide. why dont need to taper

A

budesonide: 9mg per day for 8 weeks, stop without taper
- drug is localised into the intestines unlike pred

26
Q

when are thiopurines (immunosuppressants) started

A

during remission or when steroids are given. takes about 3-6 months to exert effect

27
Q

what are dose related side effects of thiopurine

A

bone marrow suppression,
hepatotoxicity

28
Q

what are idiosyncratic side effects of thiopurine

A

malignancy, infection

29
Q

medications to avoid

A

antimotility agents, opioids, anticholinergics
- can cause toxic megacolon

NSAIDs

30
Q

side effect of ciclosporin

A

electrolyte, nephrotoxicity, htn, neuro, infections

31
Q

when to check ciclosporin trough and for what

A

pre4th dose, aim 200-300 to prevent toxicity

32
Q

inflammation markers for uc/cd

A

stool calprotectin, CRP

33
Q
A