IBD Flashcards
Acute diarrhoea is not infectious. True or false?
False - usually infectious
Acute diarrhoea is usually self-limiting in 3 days. True or false?
True
How does loperamide work?
Increases salt and water reabsorption by decreasing motility of gut longitudinal and circular muscles
Loperamide is an OTC medicine that can be given to children. True or false?
False - OTC not for children
Loperamide is a synthetic opioid but has no opiate activity at therapeutic doses. True or false?
True
If symptoms of overdose of loperamide occur, what drug is given?
Naloxone
Other than loperamide and oral rehydration therapy, what is available for treatment of diarrhoea?
Antispasmodics
Loperamide and antispasmodics can be used for treatment of acute diarrhoea in young children. True or false?
False - neither can be used in young children
Acute diarrhoea that is infectious is caused by a virus. True or false?
True - e.g. norovirus, rotavirus
Traveller’s diarrhoea is usually caused by a virus. True or false?
False - usually by a bacteria e.g. E.coli, 10% of cases are viral
What drug is used adjunct to oral rehydration therapy in children aged 3 months and over?
Racecadotril
What does racecadotril do?
It is an enkephalinase inhibitor
It reduces hypersecretion of water and electrolytes into the intestinal lumen
Given orally
The rotavirus is a live vaccine given IV. True or false?
False - given orally
The rotavirus vaccine should be started in children over 15 weeks old, given in two divided doses. True or false?
False - should not be started in children over 15 weeks
What is the recommended schedule for rotavirus vaccine?
The first dose at 2 months of age (must be given between 6 weeks-15 weeks)
The second dose 3 months of age
What are the warning signs of diarrhoea for referral?
Symptoms for more than one week Babies/young children Signs of dehydration Diarrhoea accompanied by fever Stools are bloody or black Severe abdominal or rectal pain
What causes pseudomembranous colitis?
Overgrowth of C.diff and release of toxin
How is pseudomembranous colitis managed?
Stop antibiotics
Fluid and electrolyte replacement
Isolation strategies, environmental control and hand hygeine
How is C.diff treated?
Metronidazole or oral vancomycin
Alcohol gel kills C.diff spores. True or false?
False
Which drug classes should be avoided in the management of C.diff?
Quinolones
Cephalosporins
Clindamycin
What area does ulcerative colitis involve?
The mucosa of the rectum and colon
Which areas does Crohn’s disease effect?
Whole GIT from mouth to anus
What surgical procedure provides total cure of ulcerative colitis?
Total colectomy
Surgery for Crohn’s disease is curative. True or false?
False
What is the general management of acute mild to moderate IBD?
Local application of corticosteroid or aminosalicylate
How is diffuse inflammatory disease not responding to local therapy managed?
Oral treatment with aminosalicylate or corticosteroid
How is sever inflammatory bowel disease managed?
Admission to hospital, IV corticosteroids and other immunsuppressive agents
What are the monitoring parameters for IBD?
Faecal calprotein Stool frequency Presence of blood and/or mucous in the stool Temperature CRP U&Es
Name 3 aminosalicylates that are only licensed for use in UC
Mesalazine
Balsalazide
Olsalazine
What causes side effects in sulphasalazine?
Sulphapyridine - carrier molecule - this is not present with new analogues of aminosalicylates
What actions are taken if there is acute relapse of UC or Crohn’s?
Bed rest
Low residue diet
Monitoring
Corticosteroids - hydrocortisone IV or methylprednisolone
When are immunosuppressive agents used?
In patients where the disease is not responding to oral corticosteroids
Immunosuppressants work immediately. True or false?
False - may take 1 or 2 months to be effective
Name the immunosuppressants that are used for patients who do not respond to oral corticosteroids
Azathioprine
6-mercaptopurine
Once weekly methotrexate
Ciclosporin - UC only
Which monoclonal antibodies are used in IBD and why?
Infliximab Adalimumab Golimumab Vedolizumab Used as they have a high afftinity to alpha-TNF and so inhibit its activity
What is the dietary advice for someone who is constipated?
Increase fluid intake 2L/day and increase fibre
Name the 6 causes of constipation
Lifestyle Diet and fluid Mechanical - tumours, strictures etc. Systemic affecting motility - pregnancy, hypercalcaemia Neurological - paralysis Drugs - opiates, diuretics, CCBs
Type 1 and 2 of the bristol stool chart indicate diarrhoea. True or false?
False - indicate constipation
What are the treatment options for constipation?
Bulking agents e.g. dietary fibre, isphaghula, methyl cellulose
Stimulants e.g. senna, bisacodyl
How do bulking agents work in relieving constipation?
They increase faecal mass and so stimulate peristalsis
Laxatives should be offered to any patients starting on opiates. What are some other reasons for use of laxatives?
Post MI - to prevent strain Expulsion of parasites after anthelmintic treatment Prior to surgery Prior to certain X-ray procedures In liver failure
How do stimulants relieve constipation?
Increase intestinal motility - but should be avoided in intestinal obstruction
How do osmotic agents relieve constipation?
Increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with
Glycerol is a softening agent that is used orally to relieve constipation. True or false?
False - for rectal use only
Name a stimulant that is used for treatment of constipation
Senna
Name an osmotic agent that is used to treat constipation
Lactulose
Name a softening agent used to treat constipation
Glycerol
Docusate
Liquid paraffin
