Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GSS 2 > IBD and peptic ulcers > Flashcards

IBD and peptic ulcers Flashcards

1
Q

What are the two types of peptic ulcer disease?

What are the differences?

A
  1. Gastric - deep penetrating lesion extending beyond the mucosa (less common). Less symtpomatic, is aggravated by food and associated with weight loss. Burning epigastric pain
  2. Duodenal - usually multiple lesions occurring near pylorus (more common)
    Relieved by food as there is a dull ache on empty stomach. Associated with weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of peptic ulcer disease?

A 
Crohn's
H.pylori
Chronic illness (CKD)
NSAID use
Zollinger- Ellison syndrom
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are alarm signals of dyspepsia that would initiate a referral?

A 
GI bleed
Weight loss
Coffee ground vomit
Abdo swelling
Difficulty swallowing
OTC meds don't work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the NICE guidelines for unvestigated dyspepsia?

A
  • H.pylori testing
  • If no response to lifestyle, full dose PPI for 1 month
  • If no response to PPI, h2 receptor antagonist for 1 month or prokinetic (domperidone)

1st choice PPI = omeprazole 20mg OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is H.pylori?

A
  • Gram -ve, rod shaped
  • Unipolar flagella gives it motility
  • Resides between gastric epithelium and mucous gel layer of stomach
  • Found in most patients with PUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you test for H.pylori?

A

13C-urea test as h.pylori breaks down urea and release carbon dioxide after ingestion of 13-C urea

Shouldn’t be performed within 4 weeks of anti-bacterial or within 2 weeks of anti-secretory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is 1st line for H.pylori?

A

7 day triple therapy:

PPI + 2 ABX

(amoxicillin/metronidazole/clarithromycin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is 2nd line for H.pylori?

A

Quadruple therapy for 2 weeks:

Tetracycline 500mg QDS
Metronidazole 400mg TDS
Full dose PPI

And another ABX that was different to the last course of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you reduce the risk of NSAID related GI bleeds?

A
  • PPI
  • Paracetamol as baseline analgesic
  • Use lower risk NSAID (ibuprofen)
  • Review need for NSAID
  • Switch to COX-2 selective inhibitor (long term risks such as cardio)
  • Lowest effective dose for shortest time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risks of PPIs?

A
  • C.difficile
  • Masks other symptoms
  • Fracture risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Crohn’s disease?

A
  • Affects any part of the GI tract
  • Patchy inflammation- cobble stone/granular appearance
  • Defined by local pattern
  • Inflammatory, fistulating structures
  • CARD gene
  • Has a small bowel obstruction risk
  • Life expectancy is reduced
  • Redness and oedema in mucosal lining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is ulcerative colitis?

A
  • Mucosal inflammation
  • Limied to the colon
  • Distal (rectum) or extensive disease
  • Not associated with fistulae
  • HCA gene
  • Severe diarrhoea with blood and mucous (fluid/electrolyte imbalance risk)
  • Anaemia
  • Better outcome with surgery than CD
  • Most cases are left sides

Found that smoking is protective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

IBD patients and their pharmacology

A
  • Enhanced production of cytokines and chemokines IL-12 IL-18 and TNFa
  • Have activated and acquired T and B cells and loss of tolerance to commensal bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Surgery can be used to help with CD. What procedures are they?

A
  • Using balloon to open up the tract

- Can cut open the narrowing part of the tract and sew it the other way

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are fistulae?

A

Abnormal pathways to organs

Can be enterenteric (between the colon) which is not a massive problem, however it can be from colon to vagina resulting in an infection

  • Can also have extra passages from colon to anus which are painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the respective disease activity scores for CD and UC?

A

CD - Harvey Bradshaw Index

UC - Simple colitis activity index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What investigations are needed for UC and CD?

A
  • Disease activity score
  • BP, temperature, abdo tenderness
  • Stools to rule out cultures such as C.difficile
  • History (FH, travel, medication)
  • Electrolytes, iron, FBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What extraintestinal diseases can cause IBD?

A
  • Osteoporosis

- Anklyosing Spondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the treatment for mild-moderate CD to induce remission?

A
  1. Oral steroids
    (prednisolone)
  2. Budesonide/5-ASA if
    prednisolone not tolerated
May need add on therapy:
1. Azathioprine/
Mercaptopurine
2. Methotrexate
If>2 exacerbations in 12
months OR steroids
cannot be weaned
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment for severe CD to induce remission?

A
  1. Glucocorticosteroids
    (PO/IV)
  2. Infliximab Adalimumab
  3. Vedolizumab

(Biologicals can take 1-2 weeks to work)

May need add on therapy:

  1. Azathioprine/
    Mercaptopurine
  2. Methotrexate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment for fistulating disease to induce remission?

A
  1. Antibiotics/ drainage
  2. Infliximab

May need add on therapy:

  1. Azathioprine/6MP
  2. Infliximab
22
Q

What is 1st and 2nd line maintenance therapy for all stages of CD?

A
  1. Azathiopurine/mercaptopurine

2. Metotrexate

23
Q

Other than 1st and 2nd line therapy, what can be used as maintenance therapy for CD?

A

-Infliximab for severe and fistulating disease

Vedolizumab can also be used in severe CD

24
Q

What is the treatment for mild UC to induce remission?

A 
1. Oral mesalazine (topical 5-
ASA either alone or in
combination if L-sided
disease).
Up to 4.8grams per day
  1. Oral steroids if 5-ASA
    ineffective (Prednisolone or
    beclomethasone)
  2. Immunosuppressants (AZA,
    6-MP) add-on if steroid
    therapy often required
  3. Tacrolimus
25
Q

What is the treatment for moderate UC to induce remission?

A
  1. Oral/ Intravenous steroids (5 days)
  2. ciclosporin
  3. IFX, Adalimumab,
    Golimumab, Vedolizumab
26
Q

What is the treatment for fulimant in UC?

A

Life threatening and needs surgery as it impacts entire colon and causes very severe pain

27
Q

What is the maintenance therapy in mild UC?

A 
1. Oral or topical 5-ASA
Minimum or daily dose:
mesalazine 2.4grams
sulphasalazine 2000mg
olsalazine 1000mg
  1. Azathioprine,Mercaptopurine
  2. Tacrolimus
28
Q

What is the maintenance therapy in moderate severe UC?

A
  1. Azathioprine, 6MP,
  2. Infliximab, Golimumab,
    Adalimumab,
    Vedolizumab
29
Q

What is the role of corticosteroids in IBD?

A
  • Used only to induce remission in acute flares
  • Has no role in maintenance
  • ADRs if used for more than 12 weeks
  • Reduce dose over 8 weeks to avoid relapse
30
Q

When would you escalate therapy of IBD and consider immunsuppressant therapy?

A
  • No response to steroids
  • > 2 steroid courses in 12 months
  • Relapse if corticosteroid has been weaned (especially within 12 months)
31
Q

What is budesonide?

A
  • Used mainly in CD
  • Alternative to prednisolone
  • Extensive 1st pass metabolism
32
Q

What are aminosalicylates (5-ASA)?

A
  • Usually topically acting rather than systemically which for UC that is a disease in colon and rectum. Foams, enemas, suppositories
  • Mesalazine
  • Sulphasalazine (5-ASA + sulphapyridine linked by azo bond)

-

33
Q

What are the s/e of 5-ASA?

A
  • Headaches
  • Dry skin
  • Many are dose related and dose just needs reducing

REVERSIBLE MALE INFERTILITY WITH SULPHASALAZINE

34
Q

What is azathioprine and 6-mercaptopurine?

A
  • Immunosuppressant therapy used in steroid dependent/resistant patients
  • Has a slow onset so use steroids for 8-12 weeks as well so cannot be used for monotherapy in active disease
  • Can lead to mucosal healing
  • Inhibits ribonucleotide synthesis
  • Metabolised to active thioguanine molecules
  • Azathiopurine is a prodrug of mercaptopurine as the presence of imidazole ring increases bioavailiability
35
Q

What is important when deciding a dose for azathioprine and 6-mercaptopurine?

A

TMPT levels (Thiopurine methyltransferase) which helps to metabolise these drugs

36
Q

What are adverse effects of immunosuppressants?

A
  • Flu-like symptoms
  • Fatique, nausea
  • Bone marrow suppression
  • Monitor FBC, LFT
  • Liver toxicity
37
Q

What is the role of methotrexate in IBD therapy?

A
  • Once a week
  • Folic acid to counteract ADRs
  • Remission is 25mg/week
  • Maintenance is 15mg/week
  • Important to measure methotrexate polyglutamate levels as it takes 8 weeks to reach steady state
  • Monitor FBC, LFTs and lung function
38
Q

What are the side effects of methotrexate?

A
  • Mouth ulcers
  • Bone marrow suppression
  • Teratogenic
39
Q

What is ciclosporin?

A
  • Only used in UC
  • Immunosuppressant
  • Given as IV infusion inititially, then oral
  • Minitor BP, FBC, LFT
40
Q

What is tacrolimus?

A
  • Moderate-severe UC
  • Oral
  • Immunosuppressant
  • Not well tolerated so is a hospital medication only
  • Nephrotoxicity risk
41
Q

What is infliximab?

A
  • Genetically engineered murine-human chimeric monocloncal antibody
  • Review after 2nd or 3rd dose
  • Infusion over 2 hours , given every 8 weeks
  • Escalate doses if no response or switch to adalimumab
  • Anti-TNFa activity
  • expensive
  • Eventually, patient will develop antibodies for it
  • Reactivation of latent infections
42
Q

What is adalimumab?

A
  • Fully humanised anti-TNF monoclonal antibody so has less s/e and less risk of developing antibodies
  • Can be self-administered at home (s/c injection)
  • Weekly
  • Immunsuppressive therapy should be given as well if possible
43
Q

How often is vedolizumab?

A

8 weekly infusion

44
Q

Biologics are c/i when?

A
  • Active infections
  • Heart failure
  • Known hypersensitivity to drug

Pre-screening is needed (TB, blood counts) .

Reassess patient every 12 months

45
Q

How often is golimumab?

A
  • 4 weekly s/c injection

Only for UC

46
Q

What ABX are used in IBD?

A
  • Metronidazole to prevent relapse after surgery. It isn’t used regularly due to peripheral neuropathy
  • Rifampicin
47
Q

What adjunctive treatment is used in IBD?

A

 Smoking cessation - CD

 Diet (elemental, low FODMAP)

 Antimotility and antispasmodic drugs eg. codeine, loperamide – limited use (short-term symptomatic use in nmild exacerbations), may induce toxic megacolon in UC

 Diarrhoea - cholestyramine if due to bile salt
malabsorption, esp after small bowel surgery

 Iron and vitamins

 Stress management

48
Q

What are the indications for surgery in IBD?

A

UC:

  • unresponsive to medical therapy
  • toxic megacolon
  • colorectal cancer

CD:

  • unresponsive to medical therapy
  • Disease is treatable by surgery
  • severe perianal infection, cancer, obstruction, fistula, abscess, strictures
49
Q

What are the risks of IBD surgery?

A 
- faecal incontinence, -
 prolapse
- anastomotic stricture/leak, -
- stoma
- short bowel syndrome
50
Q

What are the surgery options in UC?

A

UC:

 Colectomy (total or partial)
 Ileal pouch-anal anastomosis as
an alternative to a stoma (to allow patients to have some anal function)

 UC is a surgically curable
disease if the entire colorectal mucosa is removed

However, risk of infection (pouchitis)

GSS 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions