Gi Systems - Chronic bowel Disorders Flashcards
Coeliac disease is disorder of what?
Occurs where?
Intolerance to Gluten
Occurs in small intestine
Gluten causes what symptom specifically?
Bloating
Diverticulosis?
Asymptomatic small pouches
Diverticular?
Symptomatic Small pouches
Symptoms: Diarrhoea, Constipation, Abdominal pain, Rectal bleeding
Acute Diverticulitis?
Inflamed/infected pouches
Severe abdominal pains, fever, bleeding
Complicated acute Diverticulitis?
Abscess, Perforation, Fistula, Obstruction, Sepsis, Haemorrhage
Treating Diverticular?
Paracetamol, Bulk forming laxative - Fibre increase
Crohn’s disease how it looks?
Affects Whole Gi tract but patchy deep ulcerations/thickened walls etc
Why does Crohn’s disease lead to malnutrition?
Less surface area to absorb due to the ulcers
Acute treatment for Crohn’s?
Monotherapy:
Prednisolone, Methylprednisolone or IV Hydrocortisone
Disteal ileal, ileocaecal or right sided disease treatment?
If monotherapy w/ prednisolone, Methylprednisolone or IV Hydrocortisone
Use Budesonide if doesn’t work ^
2nd line for acute crohns?
Sulfasalazine or Mesalazine
Less side effects but less effective
What is classed as acute crohns?
First flare up in 12 months
If pt has 2+ flare ups in 12 months?
Add Azathioprine or Mercutopurine
If contraindicated: use Methotrexate
Severe: Monoclonal Antibodies
Maintenance treatment of Crohn’s
Encourage Stop smoking
Monotherapy: Azathioprine or Mercatopurine
Methotrexate if monotherapy contraindicated or used as acute treatment
Post surgery in crohns disease?
Azathioprine + Metronidazole
If metronidazole not tolerated:
Azathioprine alone
Diarrhoea caused in Crohn’s treatment?
Loperamide
Codeine
Colestyramine
What to avoid in ulcerative colitis?
Loperamide
Codeine
Colestyramine
Fistulating Crohn’s disease if Asymptomatic?
Leave alone
Symptomatic Fistulating Crohn’s disease
Metronidazole +/- Ciprofloxacin for 1month
Not 3 months due to peripheral neuropathy
Maintenance of Fistulating Crohn’s disease?
Azathioprine or Mercartopurine
If not responding:
Monoclonal antibody infliximab
(Atleast 1 year of treatment)
Ulcerative Collitis symptoms?
Bloody diarrhoea
Abdominal pain
Defecation urgency
What complications can ulcerative colitis lead to?
Colerectal cancer
Secondary Osteoporosis
Venous thromboembolism
Toxic Megacolon
5 different types of ulcerative colitis?
(Progressive as you go)
1) Proctitis
2) Proctosigmliditis
3) Distal/left sided
4) Extensive colitis
5) Pancolitis
First three stages of Ulcerative Collitis acute treatment?
Think -> close to rectum still
So use suppositories
Foam prep if or difficult retaining liquid
Why avoid loperamide or codeine in ulcerative colitis?
Can cause TOXIC MEGACOLON
Which is a Big infection as they slow down gastric emptying and it builds in colon
Proctitis or the “Tip” of colon treatment?
Topical aminosalicylates
If no improve after 4wks: oral aminosalicylates
Still no improvement: Corticosteroids
(4-8wks)
If aminosalicylates contraindicated?
Topical/ oral corticosteroids for 4-8wks
Proctosigmoiditis and left sided ulcerative colitis treatment?
Topical Aminosalicylates
High dose oral aminosalicylate
If not topical/oral corticosteroids
*Ensure to stop topical treatment when offering oral corticosteroid upgrade
Extensive ulcerative colitis treatment?
Way too high up for just topical
Therefore both Topical aminosalicylate and High dose oral aminosalicylate
If no change STOP topical aminosalicylate and do:
High dose aminosalicylate + oral corticosteroids for 4-8wks
(2 ORALS!)
Severe ulcerative colitis treatment?
Life threatening -> Emergency
As soon as pt arrived in hospital:
- IV Hydrocortisone or Methylprednisolone
In severe ulcerative colitis, if IV steroids in hospital is contraindicated?
Use IV Ciclosporins or surgery
If symptoms haven’t helped within 72hrs of hospital emission for severe ulcerative colitis?
IV Steroid + IV Ciclosporin + Surgery
If Ciclosporin contraindicated:
- Infliximab
Severe Ulcerative Colitis maintenance treatment?
Oral Aminosalicylate OD (once daily is most effective but risk of toxicity)
*Don’t use steroids due to side effects
Severe proctitis or proctosigmoiditis?
Rectal and/or Oral aminosalicylate
Severe left sided or extensive Ulcerative Colitis?
Low dose oral aminosalicylates
Aminosalicylates monitoring needed?
Nephrotoxic - before, 3months, annual
Hepatotoxic - monthly for first 3 months
Blood disorder - monthly for first 3m
Perform Blood count
IF SIGNS OF BLOOD DYSCRASIA: STOP!
Aminosalicylates are contraindicated in what?
Salicylate Hypersensitivity
Sulfasalazine colour contact lens what colour?
Orangey-Yellow
