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Gastroenteritis > IBD Therapy > Flashcards

IBD Therapy Flashcards

1
Q

What are the aims of IBD therapy?

A

control inflammation + heal mucosa, restore normal bowel habit, improve quality of life

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2
Q

What are the therapeutic strategies?

A

Lifestyle advice, drugs, surgery

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3
Q

What therapy options are there for UC?

A

5ASA (mesalazine)
Steroids
Immunosuppresants
Anti-TNF therapy

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4
Q

What are the therapy options for CD?

A

Steroids,
Immunosuppresants
ANti-TNF therapy

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5
Q

What is the preferred action for 5ASA?

A

topical effect, anti-inflammatory properties, reduces risk of colon cancer, side effects are diarrhoea, idiosyncratic nephritis

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6
Q

5-Aminosalicylic acid (5-ASA)

A

Oral - prodrugs, pH dependant release, delayed release.

Topical - suppositories and enemas

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7
Q

What types of 5ASA are there?

A

Sulphasalazine, Balsalazide, Mazavant, mesalazine, pH release (asacol), delayed release (pentasa)

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8
Q

What 5ASA gets only released in the Colon?

A

Salazopyrin

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9
Q

What 5ASA gets released in the colon and the Ilium?

A

Balsalazide

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10
Q

What 5ASA gets released in the colon, the Ilium and the jejunum?

A

Asacol Salofalk

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11
Q

What 5ASA gets released in the colon, the Ilium, the jejunum and the duodenum?

A

Pentasa

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12
Q

Give two examples of Corticosteroids

A

Prednisolone (oral) and Budesonide (topical)

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13
Q

What is the purpose of Corticosteroids

A

To induce remission

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14
Q

Should corticosteroids be stopped immediately?

A

No, reduced over a period of 6-8 weeks

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15
Q

How many CD patients become steroid-dependant?

A

28% at one year

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16
Q

Name some musculoskeletal steroid side effects

A

Avascular necrosis

osteoporosis

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17
Q

Name some Metabolic side effects of Steroids?

A

Weight gain
Diabetes
Hypertension

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18
Q

Name some other steroid side effects

A

Acne
Thinning of skin
Cataracts
Growth failure

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19
Q

What immunosuppressant’s are used for IBD?

A

Azathioprine
Mercaptopurine
Methotrexate

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20
Q

What is the main metabolism of Azathioprine?

A

AZA –> 6-MP –> 6-TGN (active)

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21
Q

What are side products of Azathioprine metabolism?

A

imidazole, 6-MMP (via TPMT) and 6-TU (via Xanthine Oxidase)

22
Q

Describe the effects of Azathioprine

A 
Slow onset (16w)
TPMT activity contributes to toxicity 
Avoid co-prescription of allopurinol (XO inhibitor) and regular blood monitoring required
23
Q

What are Azathioprine side effects?

A

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer

24
Q

What is Anti-TNF?

A

Tumour Necrosis Factor a = proinflammatory cytokine.
Chimeric (infliximab; IV infusion
Humanised (adalimumab, S/C injection)
Promotes apoptosis of activated T-lymphocytes
Rapid onset of action

25
Q

Remision rates of Infliximab

A

30-40%

26
Q

Deescribe Anti-TNF

A

Rapid mucosal healing in responders

remission duration 8-12 weeks

27
Q

Safety of Anti-TNFa

A

Infusion reactions - 13% HACA +ve
Infection - numerous
Cancer - Lymphoma and solid tumours
TB

28
Q

When use Anti-TNFa?

A

Long term strategy, supportive etc.
refractory/fistulating disease
and exclude TB

29
Q

Explain the 2 types of IBD surgery

A

Emergency - failure to respond to medical therapy, small bowel obstruction, abscess and fistulae
Elective - Failure to respind to medical therapy, Dysplasia of colon mucosa

30
Q

Describe surgery for CD

A

Minimise amount of bowel resected, non curative, try not to induce short gut syndrome

31
Q

Describe surgery for UC

A

Curative, option of permanent ileostomy or restorative protocoloectomy and pouch

32
Q

What are the elective surgeries for CD?

A

Resection
Stricturoplasty
Fistulas
Anal disease

33
Q

What are the elective surgeries for UC?

A

Proctocolectomy with end ileostomy
Proctocolectomy with ileorectal anastomosis
With a pouch

34
Q

What are the emergency surgeries for IBD?

A

Sub total colectomy for UC
Resection for CD
Diagnostic laparoscopy
Rectal/anal disease

35
Q

Why may you do elective surgery in UC?

A 
Medically unresponsive disease
Intolerability 
Dysplasia/malignancy 
growth retardation in children 
Attempted resolution of extra-intestinal disease
36
Q

Difference between colostomy and ileostomy?

A

colostomy - left, flush, stool

ileostomy - right, spouted, effluent

37
Q

Problems with a pouch?

A 
Average 6 bowel movements a day
leakage
incontinence 
nocturnal incontinence 
failure and reversed to ileostomy
38
Q

Complications of a pouch?

A

Immediate - haemorrhage and enterotomy - Anaphylaxis
Early - urinary dysfunction, wound infection, pelvic abscess, anastomotic leak - Artelectasis, Ileus and portal vein thrombosis
Late - Impotence, Infertility, Pouchitis - DVT/PE, small bowel obstruction

39
Q

How do you assess acute attack severity?

A 
ESR
haemoglobin 
bloody stools
temperature
heart rate
40
Q

How should you treat a rectal flare up?

A

With predfoam enemas etc. DO NOT ENTER

41
Q

What is the cancer risk with IBD?

A

4% = CRC with UC

by 30 yrs, up to 18%

42
Q

Signs of toxic megacolon

A 
Sepsis
Distension
Pain
Requires decompression
may perforate and be fatal
43
Q

What is Rigler’s sign?

A

Gas on outside of bowel wall

44
Q

Considerations for CD surgery

A

DVT
steroids/immunosupp
nutritional status
Electrolytes

45
Q

What are indications for CD surgery?

A 
Stenosis causing obstruction
Enterocutaneous fistulas
Intra-abdominal fistulas 
Abscesses
Bleeding
Free perforation
46
Q

Surgical treatment for Multisite disease

A

Stricturoplasty of lesions
Heineke-Mikulicz
Balloon dilatation

47
Q

What are concerns for abscesses and fistulas?

A

SNAP - sepsis, nutrition, anatomy and plan.

Intra-abdominal and enterocutaneous

48
Q

What are the types of CD colonic surgeries?

A

Emergency, segmental, total, panproctocolectomy, pouches

49
Q

Types of perianal disease?

A

Primary lesions - fissure/ulcer
Secondary lesions - abscess, tages, fistula
Incidental lesions - pilesm hidradenititis

50
Q

What is good treatment for Fistulas?

A

Seton.

Surgery is also good (lay open, stoma if bad enough)

Gastroenteritis (5 decks)

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