IBD Flashcards
UC stools can be?
• blood & mucous in stool
CD stool?
dark colour - bleed in proximal bowel
Cramping before stool in CD?
abdominal pain
abdominal mass
UC: Cramping pain before passing stool.
No abdominal mass.
Severe UC symptoms
- tachycardia >90bpm
* temp >37.8ºC
Site of UC
- Colon
- continuos mucosal inflammation/ surface
- rectum
- extends promiximally
Site of CD
- GIT mouth to anus
- commonly illeocaecal/ terminal ileum & proximal colon
- transmural - through gut wall
- fibrosis
- strictures causing obstruction & fistulae
IBD tests
- Hb - less, GI inflammation
- WBC - high, infection
- Platelets - high
- Ferritin -
- CRP or ESR - high, GI inflammation
- Albumin - less, GI inflammation, malabsorption
IBD other tests
- K - less, diarrhoea
- Na+ - less, diarrhoea
- Cr raised - dehydration
- Urea - high, dehydration
- Mg - low, diarrhoea
- LFT - high, sepsis
- VitB12 - less,
- VitD - less, poor bone health/recurrent corticosteroid
IBD tender, red patches on both shin
- Erythema nodosum
- can be w. joint pain/swelling and fever
- IBD complication.
Extraintestinal complication of UC
- Joints – ankylosing spondylitis, arthritis
- Skin – pyoderma gangrenosum
- Eye – uveitis
- Bone – osteoporosis
- Liver and biliary tree
- Malnutrition – kg loss, anaemia, vitamins (all more common in CD as it involves small intestine)
- Thromboembolic risk – needs VTE prophylaxis
reduced vitamin C, Ca, Mg
scurvy
Malnutrition - reduced Zinc =
taste impaired
Malnutrition - reduced VitB12 =
anaemia
Malnutrition - reduced Folate =
anaemia
Malnutrition - reduced Fe =
anaemia
reduced VitK =
bruises, less clotting factor.
Severe UC treatment NICE
- IV hydrocortisone 100mg TDS/QDS
- OR methylprednisolone 60mg OD
- for 5 days
- expect results by day 3
- convert to oral 40mg OD & reduce over 4-6wks.
- tailor to pt severity & tolerance
- consider ciclosporin/surgery if no improvement in 72 hrs.
- Infliximab if CI
Factors affect choice & route of UC therapy
- site
- extent
- treatment history
- compliance
- preparations
- pt choice
- risk factors
- cost
- allergies
proctisis give?
- suppositories.
* Topical mesalazine
Topical mesalazine administration in UC
- water based lubricant
- bedtime to reduce leakage & increase contact time
- try not to go toilet
- if it comes out by 10min, insert another
- stay in position
Aminosalicylate therapy formulation of methasalazine tablet - UC
- coated with pH dependent acrylic resin
- Octasa - Eudragit S, pH>7 dissolves, ileum/colon
- Solfalk - Eudragit L, pH>6, jejunum & ileum to colon
Formulation of mesalazine granules - UC
• ethylcellulose coated
Maintenance therapy for UC on top of mesalazine
- azathioprine 2-2.5mg/kg/OD
* mercaptopurine 1-1.5mg/kg/OD
Mercaptopurine metabolism ?
- TUA/ thiouric acid
- xanthine oxidase
- excreted
- MeMP/ methylmercaptopurine
- methylation by TPMT/ thiopurine S-methyltransferase
- TIMP/ thioinosine monophosphate
- catalysis by HPRT/ hypoxanthine phosphoribosyltransferase
From TIMP then? in mercaptopurine metabolism
- TGMP/ thioguanine monophosphate
- metabolised by IMPDH
- kinases convert TGMP into TGM/ thioguanine nucleotides
UC tests when presented
- stool culture
- bloods - FBC, U&E, LFTs, C reactive protein
- Endoscopy
- Colonoscopy
UC symptoms
- Tenesmus
- kg loss less common than CD
- mucus in stools
- fever
- urgency
- abdominal pain & cramps
- bloody diarrhoea
- malnutrition less common than CD
UC red flags
- Venous thromboembolism
- Toxic megacolon - risk of perforation = surgical emergency
- secondary osteoporosis - assess fracture risk
- colorectal cancer risk
Oral mesalazine coated in?
Eudragit S to reach colon
UC first line?
5-ASA
Aminosalicylates mono therapy oral eg
Mesalazine, sulfasalazine
