IBD Flashcards
What is IBD?
Inflammation of the gastric mucosa
What area does ulcerative colitis involve?
The mucosa of the rectum and colon
Which areas does Crohn’s disease effect?
Whole GIT from mouth to anus
What surgical procedure provides total cure of ulcerative colitis?
Total colectomy
Surgery for Crohn’s disease is curative. True or false?
False
Strictures and fistulas are common in what type of IBD?
Crohn’s disease
What are strictures and fistulas?
Strictures are narrowed segments of bowel which can lead to blockages, acute dilation and perforation
Fistulas are abnormal channels lined with granulation tissue
What are some possible causes of IBD?
smoking, genetics, environmental factors, gut microbes, diet, medication
What are some signs and symptoms of IBD?
Abdominal pain, bloating and distension, diarrhoea, tiredness, fatigue, fever, anemia, weight loss. Nausea and vomiting, urgency
What are some extra-intestinal manifestations of IBD?
Swollen joints, eye problems, erythema nodosum (swollen fat under skin causing redness, bumps), Pyoderma gangrenosum (skin ulceration)
What variables are assessed to calculate Crohn’s disease activity index?
- Number of liquid or soft stools
- Severity of abdominal pain
- general wellbeing
- presence of complications
- fever
- use of Loperamide
- presence of anaemia
- weight
- Abdominal mass absent or present
How is severe active Crohn’s disease defined?
very poor general health with one or more symptoms including: weight loss, fever, severe abdominal pain, increased frequency of soft stool
What does treatment of IBD depend on?
Type, location and extent of disease, severity
What are the primary aims of treatment?
Achieving and maintaining remission and improving quality of life
What are the secondary aims of treatment?
avoiding surgery, reducing long term steroid use, reduce risk of colorectal cancer, and development of complications
What is the general management of acute mild to moderate IBD?
Local application of corticosteroid or aminosalicylate
How is diffuse inflammatory disease not responding to local therapy managed?
Oral treatment with aminosalicylate or corticosteroid
How is severe inflammatory bowel disease managed?
Admission to hospital, IV corticosteroids and other immunsuppressive agents
What are the monitoring parameters for IBD?
Faecal calprotein Stool frequency Presence of blood and/or mucous in the stool Temperature CRP U&Es
Name 3 aminosalicylates that are only licensed for use in UC
Mesalazine, Balsalazide, Olsalazide
What causes side effects in sulphasalazine?
Sulphapyridine - carrier molecule - this is not present with new analogues of Aminosalicylates
Explain the pharmacological treatments available for IBD
corticosteroids, Aminosalicylates, Immunomodulating agents such as Thiopurines, biologics and others including methotrexate, Ciclosporin and Tacrolimus
Purpose and MoA of corticosteroids in IBD treatment
used to induce remission, work by reducing inflammation and modulating the immune system. Prednisolone binds to cellular glucocorticoid receptors, inhibiting inflammatory cells and suppressing expression of inflammatory mediators
Purpose and MoA of Aminosalicylates
to induce and maintain remission. Mechanism not fully understood but reduces inflammation in GI tract through variety of anti-inflammatory processes. It also decreases prostaglandin production in colon and inhibits pro-inflammatory cytokines
Purpose and MoA of Thiopurines
1st line immunomodulators for IBD, induce and maintain remission, mechanism not fully understood but acts as an immunomodulator and suppresses immune response and inflammation
What actions are taken if there is acute relapse of UC or Crohn’s?
Bed rest
Low residue diet
Monitoring
Corticosteroids - hydrocortisone IV or methylprednisolone
When are immunosuppressive agents used?
In patients where the disease is not responding to oral corticosteroids
Immunosuppressants work immediately. True or false?
false, may take 1 or 2 months to be effective
Name the immunosuppressants that are used for patients who do not respond to oral corticosteroids
Azathioprine, 6-mercaptopurine, Once weekly methotrexate, Ciclosporin - UC only
Which monoclonal antibodies are used in IBD and why?
Infliximab, Adalimumab, Golimumab, Vedolizumab. Used as they have a high afftinity to alpha-TNF and so inhibit its activity
Which IBD complications require immediate surgery?
bleeding, fistulas, perforation, abscess, intestinal blockage
Give examples of elective surgery procedures for IBD
bowel resection, strictureplasty, colectomy, fistula treatment, abscess drainage
