IBD

Question 1

Exacerpations of IBD

Answer 1

Diarrhea 
Deficiency fluid volume 
imbalanced nutrition 
decreased activity tolerance 
Anxiety & impaired skin

Question 2

Adverse effects of corticosteroidsteroids

Answer 2

1) Adrenal insuf.
2) Osteoporosis
3) Infection
4) Gluose intolerance
5) Myopathy
6) Fluid and electrolyte disturbance
7) Growth delay
8) Psychological disturbance
10) Cataracts & glaucoma
11) PUD
12) Iatrogenic bushings

Question 3

why adrenal insufficiency

Answer 3

b/c suppressed production

Question 4

why osteoporosis

Answer 4

because suppression of bone formation & accelerated reabsorption by hostel class & calcium absorb contributes to increased parathyroid mobilization from bone

Question 5

why infection

Answer 5

b/c host defines (immune response & phagocytic acitivty of neutrophils & macrophages) has decreased

Question 6

why glucose intolerance

Answer 6

b/c increased glucose levels –> hyperglycaemia & glycosuria

Question 7

why fluid & lyse disturbance

Answer 7

b/c sodium & h20 retention with K+ loss can lead to 3rd spacing & arrhythmias

Question 8

Growth Delay

Answer 8

b/c supreessiong of dNA synthesis

Question 9

PUD

Answer 9

because inhibition of prostaglandin synthesis, augmented, pepsin & inhibition cytoplrotective mcusu & reduction fo gastric mucosal blood flow

Question 10

Tapering steroids

Answer 10

Adenals can slowly start to produce again
1) Tape dosage & physiological range over 7 days
2) switch from multiple doses to each more
3) taper to 50% of physiological values over next month
4) Monitor production of endogenous cortisol when basal levels have tenure duo normal
Cease normal glucocortiodd but give for stress

Question 11

ways to minimize steroid harm

Answer 11

1) Short time
2) Large dose with gradual decrease
3) increased risk if longer than 7-10 days
4) Give with food
5) Alternate day dosing
6) Local if possible
7) 5+ day tapper 1/2 dose
8) 10 + day taper 1/4 dose
9) Give during daytime

Question 12

Surgery for IBD?

Answer 12

Intractable disease
POOR QOL
Complications

Question 13

how to GC do antiinflamation

Answer 13

1) Inhibition synthesis of chemical mediators (PG, leukotrienes, histamine) which decrease swelling
2) Suppres proliferation of lymphocytes
3) Suppress infiltration of phagocytes so damage from lysosomal enzymes is averted