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year 3 exam 1 > IBD > Flashcards

IBD Flashcards

1
Q

which diseases make up IBD

A

Crohn’s and ulcerative colitis

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2
Q

IBD epidemiology

A
  • 10-40 y/o- 1/250 in UK - 40% CD smoke, 10% UC
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3
Q

IBD aetiology

A
  • mostly unknown - diet - smoking - infection - drugs - enteric microflora- appendectomy - stress - genetics
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4
Q

how does smoking affect IBD aetiology

A

may worsen clinical course but may have prevented onset - nicotine affecting smooth muscle

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5
Q

how does infection affect IBD aetiology

A
  • bacteria causing TB - UC can occur after infective diarrhoea - associated with measles and mumps
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6
Q

how do medications affect IBD aetiology

A
  • NSAIDs can exacerbate - contraceptive pill can increase CD risk - isotretinoin
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7
Q

how do genetics affect IBD aetiology

A
  • Mutations of CARD15/NOD2 on chromosome 16 - inappropriate response to immune system- Genes OCTNI on chromosome 5 and DLG5 on chromosome 10 have also been linked to Crohn’s - 70% of ulcerative colitis patients have anti-neutrophil cytoplasmic antibodies
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8
Q

pathophysiology of CD

A
  • discontinuous- deep ulcer, fissures and strictures can appear - TH1 associated - transmural inflammation - through all layers of bowels
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9
Q

pathophysiology of UC

A
  • continuous - starts at rectum and moves upwards - crypt abcesses and mucosal ulceration - TH2 associated - only mucosa and submucosa affected - inflammatory cells infiltrate lamina propria
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10
Q

which disease skips areas

A

CD

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11
Q

which disease has a cobblestone mucosa

A

CD

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12
Q

which disease has transmural movement

A

CD

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13
Q

which disease is rectal sparing

A

CD

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14
Q

which disease has perianal involvement

A

CD

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15
Q

which disease has fistulas, strictures and granulomas

A

CD

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16
Q

what are the 3 components that work together in the gut to maintain health

A

microbes epithelium immune cells

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17
Q

which immune cells are involved in maintaining gut health

A
  • payers patches - lymphatic - dendritic cells - sample antigens to lymphocytes - tolerogenic activation - Treg cells - once activated by dendritic cells move to laminar propria (IL10 to suppress immune response)
18
Q

how is inflammation caused by chemical, mechanical or pathogen invasion

A
  • epithelium activated - immune cell influx - tregs stop il10 secretion- dendritic cells secrete il6/12/23- recruitment of neutrophils
19
Q

symptoms present in all IBD

A

diarrhoea fever abdominal pain N&Vmalaise lethargy weight loss malabsorption

20
Q

symptoms present in CD

A

lower right quadrant pain anaemia palpable masses small bowel obstruction abscesses fistulas gut perforation

21
Q

symptoms present with UC

A

diarrhoea with blood/mucus abdominal pain with fever constipation

22
Q

diagnosis of IBD

A
  • clinical evaluation, history, symptoms - blood tests, abdominal radiography, sigmoidoscopy, colonoscopy, small bowel radiology, ultrasound and tomography
23
Q

how to manage risk of infections in IBD patients

A
  • assess at diagnosis - treat active HBV, TB, HCV, HIV - in acute severe disease - corticosteroids can remain
24
Q

corticosteroid issues

A
  • infection risk - osteoporosis - adrenal suppression - diabetes - weight gain - CVD
25
Q

monitoring requirements for steroids

A
  • fbc - hba1c - lipids - bp - eyes - mood- sleep - calcium! should be given 800-1000iu calcium and 800iu vit d daily
26
Q

risk factors of bone health in IBD

A
  • weight loss - steroids - inflammation - malabsorption - lack of exercise
27
Q

common malnutrition’s in IBD and how to treat them

A
  • magnesium : PO/IV - PO can worsen diarrhoea - iron : dietary improvements, IV in active IBD PO up to 100mg in inactive - monitor every 3 months for one year and then every 6-12 months after
28
Q

NSAIDs and IBD

A

may lead to an increase in disease activity - CD * Short term, low dose, in patients with controlled disease in remission - is potentially safe - not recommended

29
Q

risk of colorectal cancer with IBD

A
  • 8-10 years post diagnosis - UC extensive > distal > proctitis - reduce risk by managing inflammation, reviews, colonoscopies, dietary improvement
30
Q

other pharmaceutical care issues in patients with IBD

A

adherence stoma short gut syndrome mental health fatigue VTE prophylaxis

31
Q

what is the Montreal classification for

A

remission in UC S0 - no symptoms - remission S1 - mild S2- moderate S3 - severe

32
Q

how is remission induced in UC - mild/moderate proctitis

A

topical amino salicylates PLUS oral if remission not achieved within 4 weeks (+ steroids if C/I or further treatment required)

33
Q

how is remission induced in UC - mild/moderate proctosigmoiditis and left sided colitis

A

topical amino salicylates PLUS high dose oral if remission not achieved within 4 weeks (+ steroids if C/I or further treatment required)

34
Q

how is remission induced in UC - mild/moderate extensive colitis

A

topical AND oral amino salicylates, if remission not reached within 4 weeks stop topical and add steroids

35
Q

how is remission induced in UC - moderate to severe colitis

A

corticosteroids 4-60mg a day (side effects >40mg)

36
Q

how is remission induced in UC - moderate to severe active disease

A

biologics and JAK inhibitors - infliximab/adalimumab after conventional therapy failure - vedolizumab - inadequate/loss of response to others - including tnfa inhib- tofacitinib - if all else fails

37
Q

how to maintain remission in UC - Mild to moderate proctitis AND proctosigmoiditis

A
  • topical aminosalicylate (nightly or every 3 nights) - oral plus topical aminosalicylate - oral alone but not as effective - 2 + exacerbations in 12 months that require corticosteroids OR if remission is not maintained Azathioprine/mercaptopurine
38
Q

how to maintain remission in UC - Mild to moderate left sided and extensive colitis

A

low dose oral aminosalicylate - □ If 2 + exacerbations in 12 months that require corticosteroids OR if remission is not maintained Azathioprine/mercaptopurine

39
Q

how to induce remission in CD

A
  1. glucocorticoid monotherapy (if C/I - budesonide but less effective then aminosalicylate but less effective than both) 2. >2 exacerbations in 12 months, add- azathioprine/mercaptopurine - mtx if above c/i - tnf inhibitors - infliximab - il inhibitors - ustekinumab - lymphocyte inhibitors - vedolizumab
40
Q

how to maintain remission in CD

A
  • no treatment follow up plans actions if relapse how to access healthcare - treatmentazathioprine/mercaptopurine mtx - if above c/i
41
Q

when would you use budesonide in CD

A

to induce remission in patients who cannot have steroids with distal ileal, ileocecal and right sided colonic disease

42
Q

CD treatment after surgery

A

azathioprine with metronidazole (for up to 3 months post op)

year 3 exam 1 (44 decks)

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