IBD Flashcards
What are the 2 main conditions of IBD
Crohn’s and Ulcerative Colitis
What are some predisposing factors for IBD
Genetics
GI infections
Immunosuppression
Diet
Smoking (Crohn’s)
What is ulcerative colitis
Continuous inflammation affecting either the entire or part (left side) of the colon with the rectum being involved in many patients
What are the 3 main types of UC
Proctitis (rectum only)
Distal (rectum and end of colon)
Extensive (entire colon)
What are the main differences between UC and Crohn’s
UC is continuous, Crohn’s is sections
UC only affect mucosal layer, Crohn’s penetrates deeper
Crohn’s has the presence of fistures
Crohn’s can affect the mouth and eye
Describe the pathogenesis of IBD
After acute inflammation, immunoregulation fails resulting in chronic inflammatory processes, further damaging the tissue
What are the primary symptoms of IBD
Constipation
Diarrhoea
Rectal bleeding
Abdominal pain
What are the secondary symptoms of IBD
Weight loss
Malnutrition
Psychological effects
What are some symptoms specific to Crohn’s
Mouth ulcers
Eye disturbances
Erythema nodosum
Liver and kidney impairment
Arthralgia
Fistulae
Short bowel syndrome
What are the 3 main aims of treating IBD
Induce remission
Maintain remission
Fewest side effects
Symptomatic treatment of IBD
Paracetamol for pain (not NSAID)
Bulk-forming laxatives
Loperamide for Crohn’s only
Nutritional supplements
Crohn’s 1st-line inducing remission
Oral glucocorticoid
IV hydrocortisone for severe cases
Crohn’s inducing remission 2nd line
Oral 5-ASA or budesonide
Crohn’s add on therapies
Immunomodulators
Biologics
UC 1st line inducing remission
Topical 5-ASA
Add on oral 5-ASA/steroid
Add on topical steroid
UC 2nd line inducing remission
Oral 5-ASA
Treatment of severe active UC
IV hydrocortisone
IV ciclosporin or surgery
UC inducing remission in extensive disease
Topical 5-ASA + high dose oral 5-ASA
Oral prednisolone
UC 1st line maintaining remission
Topical 5-ASA
Add oral 5-ASA
UC 2nd line maintaining remission
Oral 5-ASA alone
What are 4 treatment approaches in order for IBD
Aminosalicylates (5-ASA)
Glucocorticosteroids (prednisolone)
Immunomodulators
Biologics
(Surgery)
Examples of aminosalicylates
Mesalazine
Olsalazine
Balsalazine
Steroid examples
Prednisolone
Hydrocortisone (IV for severe)
What is steroid refractory
When the patient is unresponsive to steroids so requires immunomodulators
What is steroid dependency
When steroids have been used to induce remission but symptoms come back when attempting to withdraw
How does ciclosporin work
Inhibits cyclophilin in lymphocytes, inhibiting calcineurin, inhibits production of IL-2
What drug can be used to help steroid dependent patienrs
Azathioprine3
3 examples of immunomodulators
Ciclosporin
Azathioprine
Methotrexate
3 examples of biologic therapies
Adalimumab
Infliximab
Vedolizumab
What index is used to measure severity of UC
Truelove and Witts’ severity index
