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Gastrointestinal Block > IBD therapy > Flashcards

IBD therapy Flashcards

1
Q

Lifestyle advice?

A

Smoking aggravates crohns!

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2
Q

What do aminosalicylates do?

A

Reduce inflammation
Reduces risk of colon cancer
Maintenance treatment reduces risk relapse in patients

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3
Q

Side effects of aminosalicylates?

A

Diarrhea

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4
Q

What dictates the type of administration of drug?

A

Site of inflammation
Enemas and suppositries for rectal/ distal descending colon

Oral - delayed release due to PH dependent release/prodrugs

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5
Q

Where does sulphonamide take action and why?

A

The colon

5ASA that is bound to sulphonamide, cleaved in colonic bacteria

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6
Q

Which 5ASA affects the duodenum, jejunum, ileum and colon?

A

Pentasa

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7
Q

T/F

Pentasa should only be prescribed in Crohn’s cases

A

T

affects small intestine unec UC

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8
Q

What is an enema?

A

Liquid gas injected rectum

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9
Q

What is suppository?

A

Tablet insert rectum

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10
Q

Ads/ Pros various topical therapies?

A
  • Suppositories coat <20cm
    + have better mucosal adherence than enemas
  • <10% enemas remain in the rectum
    + Reflex contraction aids proximal spread of enema material
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11
Q

T/F

steroids are the optimal maintenance therapy for IBD

A

F
should be used as “bridge” to maintenance therapy
high dose intially and reduce

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12
Q

T/F

Steroids are the main drugs used in acute ttacks

A

T

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13
Q

Some steroid side effects?

A

Metabolic: weight gain, diabetes, hypertension
Muscoloskeletal: osteoperosis
Acne, THIN SKIN

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14
Q

Azathioprine is an example of

A

an immunosupressant

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15
Q

What is infliximab?

A

monoclonal antibody that binds to TNFa, used to treat IBD

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16
Q

How does azathioprine work?

A

Metabolised to antimetabolite that inhibit DNA synthesis

Inhibits clonal proliferation in the induction phase of the immune response

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17
Q

Azathioprine has a ____ onset of action, approximately ____ weeks

A

slow

16

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18
Q

Azathioprine should not be prescribed with ____ because:

A

allopurional

is a purine metabolism inhibitor, stops Azathioprine from working

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19
Q

Side effects/risks Azathioprine

A
  • leucopenia
    pancreatitis
    hepatitis
    skin cancer
20
Q

Anti TNFa therapy has a ____ onset of action

A

rapid

21
Q

Effects of anti TNFa therapy

A
  • rapid mucosal healing
  • retreatment maintains remission
  • reduces hospitalization
22
Q

Infliximab is given ____ every ____

A

IV, 8 weeks

23
Q

13% of patients experience _______ and there have been numerous reports of _____. 70 cases of ____ and ____ have also been reported

A

infusion reactions, infection, lymphoma, tumors

24
Q

When to use Anti TNFa therapy?

A

Long term strategy inc.

  • immune supression
  • surgery (crohns)
  • supportive therapy

Refractory/fistulating disease

25
Q

When is surgery indicated in IBD?

A
  • Failure medical therapy with acute or chronic symptoms

- Complications (toxic dilation, obstruction, fistulae. abscesses)

26
Q

T/F

Surgery is curative in IBD

A

F

potentially curatvie in UC

27
Q

T/F

Surgery is curative in IBD

A

F

potentially curatvie in UC NOT CROHNS

28
Q

Crohns: What is resection + why is it carried out?

A

Removing bits of the bowel and anastomosing them together

Fistulae and obstruction

29
Q

What is an ileostomy

A

part of the ileum brought out to the surface of the skin (
creates artificial opening or stoma
permanent or temporary - allows distal sites to heal
looks like a closed rosebud

30
Q

What is stricturoplasty?

A

Widening strictures surgically - other option is resection if unable to do this

31
Q

What is a seton and why is it used?

A

Surgical cord placed in perianal abcess

- allows drainage of pus while the fistulae heals

32
Q

What are the surgical treatment options for UC?

A
  • permanent ileostomy
  • restorative proctocolectomy and pouch
  • ileorectal anastamosis
33
Q

suffix -stomy indicates

A

stoma making

34
Q

suffix -omy indciates

A

removal

35
Q

What is a J pouch?

A

proctolectomy then

small intestine to create a pouch attached to anus. Sphincters still intact so patient can control waste removal

36
Q

Complications of pouches?

A

Immediate: Haemorrhage

Early: Wound infection, pelvic abscess, anastamotic leak

Late: Impotence, pouchitis

37
Q

How to asess UC emergencies?

A

Truelove and Witt criteria

  • Raised erythrocyte sedimentation rate
  • Bloody stools
  • Haemoglobin (anaemic)
  • High heart rate
  • High temp
38
Q

What is the “first aid” operation for UC?

A

Subtotal colectomy (all of colon apart from rectum) with end ileostomy

39
Q

T/F

IN UC emergencies, removal colon tends to settle rectal disease

A

T

No rush to deal with rectum, manage with meds if need be

40
Q

T/F

Most crohn’s patients undergo surgery

A

T

Natural history goes to stricturing and penetrating disease

41
Q

Duodenal or pyloric stenosis (crohns) indicates?

A

Gastrojejunostomy

42
Q

T/F

Post operative fistulae usually close with conservative measures

A

T

active disease causes spontaneous fistulae

43
Q

Principle for managing intra-abdominal fistulae?

A

Resect primary organ defect and close secondary organ

44
Q

T/F

In crohns, if disease affects the entire colon and the rectum is minimally or not involved, a colectomy may be performed

A

T

Can be emergency, segmental, total colectomy

45
Q

T/F

with perianal fistula the aim is to cure

A

F

control rather than cure - seton good option

Gastrointestinal Block (13 decks)

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