IBD

Question 1

what is IBD?

Answer 1

irritable bowel disease

chronic recurring inflammation of the GI tract

Question 2

what are examples of IBD

Answer 2

crohn’s disease

ulcerative colitis

Question 3

Describe crohns disease

Answer 3

• inflammation of ANY part of the GI tract
• involves ileum, caecum, colon
• effects regions in a DISCONTINOUS pattern - skip lesions

Question 4

what are the complications of CD

Answer 4

malignancy
anal lesions
abdominal mass

Question 5

What is ulcerative colitis

Answer 5

• confine to the colon
• effects region in a CONTINOUS pattern
• starts in the rectum and progresses upwards

Question 6

what are the complications of UC?

Answer 6

blood loss
electrolyte disturbances
blood in stool
mucus 
sometimes pain

Question 7

Does UC respond to antibiotics?

Answer 7

no but CD does

Question 8

Is there a possibility for UC to reoccur after surgery?

Answer 8

no but CD does

Question 9

Is fistulas present in UC or CD?

Answer 9

CD

Question 10

What are symptoms of IBD

Answer 10

bloody diarrhoea 
urgency to empty bowels 
malnutrition
fever
weight loss

Question 11

What is a ESR test? Describe the process.

Answer 11

measures severity of CD and UC

RBCs places in a tube sediment at a set rate, if inflamed they clump together and sediment faster
- indication of inflammation

Question 12

What are extra intestinal manifestations as a result of IBD/treatment?

Answer 12

dermatological
rheumatological
ocular
general - kidneys and live

Question 13

What are skin lesions and when are they most common?

Answer 13

erythema nodosum - tender red bumps

pyoderma gangrenosum - deep chronic ulcers - more common in UC

Question 14

What happens to the bine due to IBD?

Answer 14

30-60% of Pt with IBD have lower bone density - osteoporosis/ ostroperia
- prolong use of steroids, inflammation and Vit B deficiency may contribute

spinal arthritis causing inflammation and fusing of vertebra - rare

Question 15

describe ocular.

Answer 15

• commonly conjunctivitis, iritis, episderitis

Question 16

what are the symptoms of ocular?

Answer 16

ocular pain
photophobia
blurred vision
headache

Question 17

describe malignancy screening

Answer 17

pt with extensive colitis of more than 8-10 years are under surveillance programmes and undergo regular colonoscopy with multiple biopsies

Question 18

what are the risk factors of IBD

Answer 18

more common in CD
genes implicated - NOD2 and ATG16L1
immune response
luminal microbial antigens and adjuvants

environmental
smoking 
diet 
drugs 
stress
antibiotics 
lifestyle 
pollution 
geography

Question 19

What is the target for treating IBD

Answer 19

IBD - lifelong condition with no cure 
induction of remission 
maintenance of remission
improved quality of life 
prevent bowel complications/EIM
mucosal healing to decrease risk of cancer

Question 20

What are the drug treatments for IBD

Answer 20

Aminosalicylates - 1st line 
Corticosteroids 
immunosuppressants 
TMPT - thiopurine methyl tranferase 
methotrexate 
biologics 
antibiotics

Question 21

describe aminosalicylates

Answer 21

1st line therapy for induction of remission in UC and to decrease efficacy in CD

anti inflammatory effects - works locally not systemically
sulfasalizine-5ASA linked to sulfapyridine by diazo bond cleaved by colonic bacteria - 5ASA delivery

Question 22

what is the MOA of aminosalicylates

Answer 22

inhibition of leukocyte movement
decrease cytokine levels and TNF
inhibition of inflammatory mediators - prostaglandins, leukotriense and PAF

Question 23

what are the side effects of aminosalicylates

Answer 23

headaches
dizziness
fever

Question 24

describe corticosteroids and state examples

Answer 24

induce rapid remission in CD and UC - not used long term due to side effects

used in mild/moderate disease where aminosalicylates failed
may use in conjunction with 5-ASA

examples - prednisolone, hydrocortisone, methylprednisolone

Question 25

what are the long term adverse effects of corticosteroids?

Answer 25

``` HPT hyperglycaemia cataract osteoporosis osteonecrosis ```

Question 26

describe immunosuppressants

Answer 26

for failed 5-ASA and pt taking chronic corticosteroids for CD and UC - 3-6 months for effect - MAINTENANCE not remission

Question 27

what is the MOA of immunosuppressants

Answer 27

thiopurines - azothioprine is converted to 6-mercaptopurine to TIMP - purine analogue TIMP is unstable and disrupts DNA synthesis in lymphocytes cell and antibody mediated immune reactions are suppresssed screen for TMPT enzyme polymorphism - mutation

Question 28

What is TMPT?

Answer 28

Thiopurine methyl transferase - enzyme responsible for metabolism of azathioprine - individuals with no TMPT enzyme can become severely ill if treated with normal dose of thiopurine drugs - increase risk of marrow suppression and death

Question 29

What is methotrexate used for?

Answer 29

used as alternative of azathioprine

Question 30

what is the MOA of methotrexate

Answer 30

inhibits dihydrofolate reductase leading to suppression of inflammation and DNA synthesis. adenosine accumulation is anti inflammatory MXA is an anti-folate that blocks pyrimidine/purine pathway and B-cell proliferation

Question 31

describe biologics and give and example

Answer 31

- monoclonal antibody therapy - anti-TNF- alpha inhibitor - inhibits signalling and cytokine production - increase NFK beta inflammation example - infliximab

Question 32

describe antibiotics and give an example

Answer 32

- for mild/moderate CD treatment - maintenance | - when failed sulfasazine