IBD Flashcards
how does cyclosporin work
it is an immunosuppressant
it works by inhibiting calcineurin
it also has approximately 34982743928743987239 drug interactions as it is a p450 inhibitor
it is also nephrotoxic
which IBD is ciclosporin used for
ulcerative colitis
how does methotrexate work
antimetabolite - it inhibits dihydrofolate reductase - used in the synthesis of purines and pyrimidines
it is contra indicated in patients with renal and hepatic impairment
it should always be given with folic acid to reduce toxiticity
which IBD is methotrexate used in the treatment of
Crohn’s disease
used for the induction and remission of disease
2nd line to AZAs or 6MP
What must be measured before starting azathioprine
TPMT
How does azathioprine work?
metabolised to 6-mercaptopurine
has a steroid sparing effect
used in Crohn’s and UC
cytotoxic - important for women of childbearing age
how are corticosteroids used n IBD
to induce remission
NOT for maintenance
UC –> Beclometasone
CD –> Budesonide
what is important to illicit from a patient history before giving infliximab
previous history of TB - can reactivate
how do infliximab and adalimumab work and which IBDs are they used in
anti-TNF alpha
Inflix –> CD and UC
Adal –> CD only
Aminosalicylates are first line for which IBD
UC
inhibits synthesis of inflammatory mediators
how does lactulosee interact with ASAs
alters pH so will affect absorption
in which IBD is surgery curative
UC
what are the features of UC
symmetrical continous, non-interrupted inflammation of the mucosal layer of the colon
usually involving the recturm
what are the features of CD
asymmetrical transmural inflammation with skip lesions affecting anywhere along the GI tract leading to fibrosis and formation of fistulae/abscesses
in which ethnic group is UC and CD more prevalent
those of jewish descent
what effect does smoking have on IBD
protective UC
more likely to develop CD
which antibodies are found in the circulation of IBD patietns
PANCA - UC
ASCA - CD
what might be the endoscopic findings in UC
diffuse continuous erythematous pinpoint ulcerations almost always with rectal involvemnt
what might be the endoscopic findings in CD
large ulcerations, skip lesions, cobblestone appearance
rectum usually spared
what might be the histological findings on biopsy for UC
cryptitis and crypt abscesses
branching of crypts
atrophy of glands (goblet cells)
what might be the histological findings on biopsy for CD
transmural inflammation
granulomas
what might be the radiological findings for UC
loss of haustra shortening of the colon pinpoint ulcers collar button ulcers thumb printing pseudopolyps no fistulae
chronic:
halo sign - inflammation of fat around rectum
what might be the radiological findings for CD
deep ulcerations nodular or stenotic terminal ileum (string sign) comb sign (stranding of mesentery) inflammed pseudopolyps fistulae may be visible
what is the presentation of UC
tends to have relapsing course: frequent small stools (tenesmus from proctitis) lower ado cramping joint pain (HLA27) erythema nudism pyoderma gangrenosum
