IBD 2 Flashcards
What lab results are affected in IBD?
- FBC - decreased Hb and increased platelets
- LFT’s - decreased albumin - inflammation
- Increased CRP and ESR
- Decreased magnesium
- U & E’s - decreased K
- Vit B12 and folate decreased - decreased nutrient absorption
- Faecal calprotectin increased - marker of inflammation
- Stool culture - exclude infection
- Coeliac screen
What are the main symptoms of IBD?
- Pain
- Fatigue
- Weight loss
- Anaemia
- Diarrhoea
- Fever
Why are nutrition and probiotics used?
Enteral nutrition may induce remission in young people with CD
What is enteral nutrition?
Polymeric/elemental liquid feeds for 8 weeks as alternative to corticosteroids
- symptomatic relief after 10 days
- mucosal healing takes up to 8 weeks
What supportive therapies would you give for IBD?
- Anti-diarrhoeals
- Laxatives
- Analgesics
- Anti-spasmodic
- Vaccinations
- Enoxaparin in hospital
- Dietician review
What antibiotics would you use in IBD?
Metronidazole and ciprofloxacin - specific uses in CD - abscess, fistula and secondary infection
What are the risk factors for secondary osteoporosis due to IBD?
- Malabsorption
- High corticosteroid use
- Reduced physical activity
- Weight loss
- Uncontrolled inflammation
How is osteoporosis prevented in IBD?
- Avoid steroids if possible
- Encourage weight bearing exercise
- Nutritious diet
- Give Ca/vit D whilst on steroids and bisphosphonate if >70
- Stop smoking
- Avoid alcohol excess
How would you induce remission in UC?
- Topical and/or oral 5-ASA
- And/or topical/oral steroid
- If moderate-severe, prednisolone 40mg tapering over 8 weeks
What do you need to monitor with aminosalicylates?
Renal function
Report any bleeding, bruising, purpura, sore throat, fever, malaise, nausea or breathing issues
Dose changes for induction/remission
Corticosteroids…
- Used in remission only
- Starting dose
- hydrocortisone 100mg qid IV
- prednisolone 40mg mane po - Tapered reduction prednisolone - decrease by 5mg every 7 days
- Ca and vit D tablets and PPI whilst on steroids - Ca and vit D reduce risk of secondary osteoporosis due to steroids and PPI to protect gastric mucosa - risk of stomach ulcers
What are the temporary side effects of corticosteroids?
- Increased appetite
- Moon face
- Acne
- Increased blood sugar and salt retention
- Mood changes
- Increased infection risk
- Stomach ulceration
What are the long term side effects of corticosteroids?
- Thinning of bones, muscle and skin
- Bruising
- Diabetes
- Glaucoma or cataracts
Remission in acute severe UC?
- IV hydrocortisone 100mg 6 hourly
- Consider holding ASA
- Blood/fluid/electrolyte placement
- Enoxaparin prophylaxis
- No improvement after 72 hours add ciclosporin/infliximab
- Assess for surgery daily
How would you maintain remission?
- Wean steroids
- Thiopurine
- Continue ciclosporin/infliximab if used
- Restart ASA
- Stop smoking
