IBD Flashcards
In which of IBD types the risk of cancer is higher?
the risk of cancer is much higher in long-standing UC than in CD
a barium enema is contraindicated in both types if
if the patient is having an acute exacerbation of
UC or CD.
The main drugs used to treat IBD include
sulfasaluzine, 5-aminosalicylate preparations, olsalazine, prednisone, metronidazole, and azathioprine and its metabolite, 6-mercaptopurine. Methotrexate, cyclosporine, and monoclonal antibodies to TNF-a also available.
the active component of sulfasalazine
mesalamine
which drug is ineffective for CD of the small bowel?
sulfasalazine
what is Sulfapyridine and what is its side effects?
Sulfapyridine is a highly reactive sulfa moiety, which is responsible for most of the side effects of sulfasalazine, such as reversible infertility in men, leukopenia, and headache.
what drug is beneficial for perianal abscesses and fistulas in CD?
Metronidazole
maintenance therapy for CD
Metronidazole + 5-ASA
Mesalamine
(5-aminosalicylic acid, 5-ASA)
Long-term use of Metronidazole
neuropathy
How much does it take for 6-mercaptopurine and azathioprine (which metabolizes to 6MP) to show an effect?
3–4 months
adverse effects of 6-mercaptopurine and azathioprine….what should you do for that?
these 2 drugs have bone marrow suppressive effects, monitor CBC monthly. There is no report of increased malignancy with long-term use of either drug
The drugs that decrease the relapse rate in CD and UC?
The drugs that decrease the relapse rate in CD are azathioprine, 6mercaptopurine. and mesalarnine. while all the standard drugs decrease the relapse rate in UC!
drugs to Use in pregnancy for IBD
FDA risk category B: Metronidazole, prednisone, and sulfasalazine (and probably its derivatives 5-ASA and olsalazine but these have not been given an FDA risk category yet).
p-ANCA and ASCA association with
p-ANCA:UC
ASCA:CD
the cause of diarrhea in Crohn patients when < 100 cm of distal ileum is resected & treatment
Bile acid-induced diarrhea
Treat with bile acid scquestrants (e.g., cholestyramine), which bind and inactivate the bile acids.
the cause of diarrhea in Crohn patients when > 100 cm of distal ileum is resected & treatment
When > 100 em of distal ileum is resected, the patient gets steatorrhea from greatly decreased proximal gut concentration of bile salts (synthesis does not keep up with GI loss without the distal ileum resorption). Treat these patients with a low-fat diet.
in which type prednisolone is more effective?
UC
The main symptoms of UC
abdominal pain and bloody diarrhea
BUT
Tenesmus and constipation may be the major symptoms with ulcerative proctitis
Extraintestinal manifestations of UC include:
- skin lesions (E. nodosum and pyoderma gangrenosum),
- RF-negative arthritis,
- iritis/episcleritis/uveitis,
- venous thrombosis,
- ankylosing spondylitis,
- pericholangitis, and
- primary sclerosing cholangitis
which Extraintestinal manifestation does correlate with UC disease activity?
Skin lesions
which complications tend not to improve with improvement or the colitis?
Primary sclerosing cholangitis is also associated with HLA-B8,
whereas ankylosing spondylitis and uveitis are associated with HLA-B27. The complications associated with HLA antigens tend not to improve with improvement of the colitis, whereas the other problems mentioned here usually do get better !
what do you think of if a patient with UC develops jaundice?
PSC
when to workup for sclerosing cholangitis in UC?
Check LFTs, especially alkaline phosphatase, initially and periodically. If the value becomes 2 x nl and persists, conduct a workup for sclerosing cholangitis
risk of cancer in UC
Risk is increased with duration and extent of UC-paneolitis has the highest risk, whereas ulcerative proctitis has no increased risk
surgery in UC
UC is cured with surgery! But it is a rough surgery, so reserve it for findings of cancer or dysplasia!
