IBD therapy

Question 1

Crohn’s disease is treated with what type of drugs?

Answer 1

Anti-inflammatory drugs

Question 2

Drugs for Crohn’s ?

Answer 2

steroids (Prednisolone)
immunosuppressants
anti-TNF therapy

Question 3

Drugs for ulcerative colitis?

Answer 3

5 ASA (mesalazine)
steroids
immunosuppressants
Anti-TNF therapy

Question 4

5 ASA (mesalazine)?

Answer 4

anti-inflammatory drug, prescribed as tablets and enemas/ suppositories

Question 5

Corticosteroids prescribed for IBD?

Answer 5

Prednisolone
Budesonide (less systemic effects)

side effects: osteoporosis, thinning of skin, weight gain, hypertension, cataracts

Question 6

Immunosuppressants for IBD?

Answer 6

Azathioprine / Mercaptopurine
Methotrexate

-used as steroid-sparing agents, to avoid steroid dependence developing

Question 7

Side effects of Azathioprine?

Answer 7

pancreatitis
leucopaenia
hepatitis
risk of lymphoma, skin cancer

Question 8

Main molecular targets in IBD therapy?

Answer 8

TNF-alpha and Integrins (adhesion molecules)

Question 9

Anti-TNF drugs?

Answer 9

Infliximab
Adalimumab

Promote apoptosis of activated T-lymphocytes.

Question 10

Anti-TNFα risks?

Answer 10

• infection

- lymphoma

Question 11

Surgery for Crohn’s?

Answer 11

• resection
• proctocolectomy, Brooke ileostomy followed by an ileostomy bag insertion
• seton suture for fistula tracts/ abscesses

Question 12

Surgery for Ulcerative Colitis?

Answer 12

-It is curative!
Proctocolectomy followed by:
-Koch pouch ileostomy
-Restorative proctocolectomy (J-pouch)

Question 13

Injecions for patients with removed terminal ileum?

Answer 13

vitamine B12 - it is absorbed there

Question 14

Elective operations for Crohn’s disease?

Answer 14

resection
stricturoplasty
fistulas
perianal disease

Question 15

Elective operations for ulcerative colitis?

Answer 15

• proctocolectomy with end ileostomy

- proctocolectomy with ileorectal anastemosis

Question 16

Indications for surgery in UC?

Answer 16

• unresponsive to medication
• intolerability
• dysplasia/malignancy
• growth retardation

Question 17

W pouch, J pouch and S pouch (ileorectal anastemosis)?

Answer 17

• staple the ileum to the anal skin

- not great: infertility, haemorrhage, urinary dysfunciton, plevic abscess

Question 18

Truelove and Witt Criteria?

Answer 18

Assessment of UC severity:
bowel movements
blood in stool
temperature
Heart rate >90
anaemia
ESR (measure of inflammation)

Question 19

Toxic Megacolon?

Answer 19

• quite rare
• distension and pain
• loss of haustra patter on abdo X ray
• may perforate - has to be deflated

Question 20

Sign of perforation of AXR?

Answer 20

Visible OUTSIDE of the bowel wall (normally not seen, as there should be no air)

Question 21

Indications for surgery in Crohn’s disease?

Answer 21

• stenosis causing obstruction
• fistulas
• abscesses
• bleeding
• perforation

Question 22

Stricturoplasty and balloon dilatation?

Answer 22

Avoid the need for a resection

Question 23

Seton sutures?

Answer 23

Option of long-term management of a perianal fistula.