IBD therapy Flashcards
Lifestyle advice?
Smoking aggravates crohns!
What do aminosalicylates do?
Reduce inflammation
Reduces risk of colon cancer
Maintenance treatment reduces risk relapse in patients
Side effects of aminosalicylates?
Diarrhea
What dictates the type of administration of drug?
Site of inflammation
Enemas and suppositries for rectal/ distal descending colon
Oral - delayed release due to PH dependent release/prodrugs
Where does sulphonamide take action and why?
The colon
5ASA that is bound to sulphonamide, cleaved in colonic bacteria
Which 5ASA affects the duodenum, jejunum, ileum and colon?
Pentasa
T/F
Pentasa should only be prescribed in Crohn’s cases
T
affects small intestine unec UC
What is an enema?
Liquid gas injected rectum
What is suppository?
Tablet insert rectum
Ads/ Pros various topical therapies?
- Suppositories coat <20cm
+ have better mucosal adherence than enemas - <10% enemas remain in the rectum
+ Reflex contraction aids proximal spread of enema material
T/F
steroids are the optimal maintenance therapy for IBD
F
should be used as “bridge” to maintenance therapy
high dose intially and reduce
T/F
Steroids are the main drugs used in acute ttacks
T
Some steroid side effects?
Metabolic: weight gain, diabetes, hypertension
Muscoloskeletal: osteoperosis
Acne, THIN SKIN
Azathioprine is an example of
an immunosupressant
What is infliximab?
monoclonal antibody that binds to TNFa, used to treat IBD
How does azathioprine work?
Metabolised to antimetabolite that inhibit DNA synthesis
Inhibits clonal proliferation in the induction phase of the immune response
Azathioprine has a ____ onset of action, approximately ____ weeks
slow
16
Azathioprine should not be prescribed with ____ because:
allopurional
is a purine metabolism inhibitor, stops Azathioprine from working
Side effects/risks Azathioprine
- leucopenia
pancreatitis
hepatitis
skin cancer
Anti TNFa therapy has a ____ onset of action
rapid
Effects of anti TNFa therapy
- rapid mucosal healing
- retreatment maintains remission
- reduces hospitalization
Infliximab is given ____ every ____
IV, 8 weeks
13% of patients experience _______ and there have been numerous reports of _____. 70 cases of ____ and ____ have also been reported
infusion reactions, infection, lymphoma, tumors
When to use Anti TNFa therapy?
Long term strategy inc.
- immune supression
- surgery (crohns)
- supportive therapy
Refractory/fistulating disease
When is surgery indicated in IBD?
- Failure medical therapy with acute or chronic symptoms
- Complications (toxic dilation, obstruction, fistulae. abscesses)
T/F
Surgery is curative in IBD
F
potentially curatvie in UC
T/F
Surgery is curative in IBD
F
potentially curatvie in UC NOT CROHNS
Crohns: What is resection + why is it carried out?
Removing bits of the bowel and anastomosing them together
Fistulae and obstruction
What is an ileostomy
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
What is stricturoplasty?
Widening strictures surgically - other option is resection if unable to do this
What is a seton and why is it used?
Surgical cord placed in perianal abcess
- allows drainage of pus while the fistulae heals
What are the surgical treatment options for UC?
- permanent ileostomy
- restorative proctocolectomy and pouch
- ileorectal anastamosis
suffix -stomy indicates
stoma making
suffix -omy indciates
removal
What is a J pouch?
proctolectomy then
small intestine to create a pouch attached to anus. Sphincters still intact so patient can control waste removal
Complications of pouches?
Immediate: Haemorrhage
Early: Wound infection, pelvic abscess, anastamotic leak
Late: Impotence, pouchitis
How to asess UC emergencies?
Truelove and Witt criteria
- Raised erythrocyte sedimentation rate
- Bloody stools
- Haemoglobin (anaemic)
- High heart rate
- High temp
What is the “first aid” operation for UC?
Subtotal colectomy (all of colon apart from rectum) with end ileostomy
T/F
IN UC emergencies, removal colon tends to settle rectal disease
T
No rush to deal with rectum, manage with meds if need be
T/F
Most crohn’s patients undergo surgery
T
Natural history goes to stricturing and penetrating disease
Duodenal or pyloric stenosis (crohns) indicates?
Gastrojejunostomy
T/F
Post operative fistulae usually close with conservative measures
T
active disease causes spontaneous fistulae
Principle for managing intra-abdominal fistulae?
Resect primary organ defect and close secondary organ
T/F
In crohns, if disease affects the entire colon and the rectum is minimally or not involved, a colectomy may be performed
T
Can be emergency, segmental, total colectomy
T/F
with perianal fistula the aim is to cure
F
control rather than cure - seton good option
