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20300 > Inflammatory Bowel Disease (12/03/19) > Flashcards

Inflammatory Bowel Disease (12/03/19) Flashcards

1
Q

What 2 conditions are included in inflammatory bowel disease?

A

Crohn’s disease and Ulcerative colitis

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2
Q

What is the peak age of diagnosis for Inflammatory bowel disease?

A

10-25

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3
Q

What is IBD?

A

Inflammation of gastric mucosa.

  • patient goes through cycles of having disease and and not
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4
Q

What is Crohn’s disease?

A

Crohn’s disease:

  • whole of GI (Mouth to Anus) can be infected.
  • Transmural (all layers of intestinal wall) ulceration
  • Patchy
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5
Q

What is Ulcerative Colitis?

A
  • Mucosa of colon and rectum infected
  • diffuse (join up/ continous), inflammation and ulceration
  • just top layers of mucosa infected
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6
Q

What are the signs and symptoms of Inflammatory Bowel Disease?

A
  • Abdominal pain
  • Diarrhoea
  • Tiredness and fatigue
  • Weight loss
  • Anaemia
  • Fever
  • Nausea and vomiting
  • Abdominal bloating and distension

Extra-intestinal manifestation:

  • Swollen joints
  • Eye problems (iritus, uveitis, episcleritis)
  • erythema (swollen fat under skin)
  • Primary sclerosing cholangitis
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7
Q

Signs and symptoms of Crohn’s disease?

A

Strictures: narrowed bowel segments, leads to blockages and acute dilatation.

Fisulas: Abnormal channels in tissue between intestine and skin/other parts of intestines

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8
Q

What would you test for to investigate Inflammatory bowel disease?

A
  • Full history and clinical examination
  • Blood test:
    • Full blood count
    • inflammatory markers
    • urea and electrolytes
    • thyroid function test
    • liver function test
  • Stool culture (rule out c. diff.)
  • coeliac screen
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9
Q

What would you test for to investigate Inflammatory bowel disease?

A
  • Full history and clinical examination
  • Blood test:
    • Full blood count
    • inflammatory markers
    • urea and electrolytes
    • thyroid function test
    • liver function test
  • Stool culture (rule out c. diff.)
  • coeliac screen
  • Faecal calprotectin (inflammatory marker released when inflammation present)
  • Abdominal imaging
  • Endoscopy
  • Colonoscopy
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10
Q

Signs of Severe Ulcertive colitis

A
  • 6 or more bowel movements
  • visible blood in stool
  • pyrexia (body temp >37)
  • HR >90bpm
  • Anaemia
  • Eryhthrocyte sedimentation >30mm/hour
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11
Q

What is the site of action and indication for suppository, foam and enemas?

A

Suppository: Rectum for Proctitis

Foam: Sigmoid colon for Procto-sigmoiditis

Enemas: Descending colon to distal colon for left sided (distal) colitis

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12
Q

What would you use to treat ‘flares’ or remission?

A

Corticosteroids

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13
Q

How do Corticosteroids work?

A

Reduce inflammation and modulate immune system

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14
Q

What level of disease are corticosteroids used for?

A

Mild, moderate and severe

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15
Q

What would you give treat mild to moderate flare?

A

PREDNISOLONE 40mg daily, then reduce to 5mg/week

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16
Q

What would you give to treat acute-severe disease?

A

HYDROCORTISONE IV 100mg QDS, then titrate down over time

17
Q

What are the side effects of Corticosteroids?

A
  • GI side effects
  • Fluid imbalance
  • Hypertesion
  • Blood sugar change
  • Mood and behaviour change
  • infection risk
  • osteoporosis
18
Q

What would you give for flare ups and mainting a disease long term for Ulcerating colitis?

A

AMINOSALICYLATES

19
Q

Can you give topical and oral aminosalicylates together?

A

Yes, topical is used to manage flare up while oral is for long term treatment.

20
Q

Can you give topical and oral aminosalicylates together?

A

Yes, topical is used to manage flare up while oral is for long term treatment.

21
Q

Aminosalicylates side effects?

A
  • Arthralgia, abdominal pain

- blood dyscrasisas (unexplained bleeding and sore throat)

22
Q

What would you monitor when using Aminosalicylates?

A

Renal function

blood dyscrasisas

23
Q

What would you use for first line immunomodulators?

A

Thiopurines: AZATHIOPRINE (2-2.5mg/kg/day) and MERCAPTOPRINE (1-1.5 mg/kg/day)

24
Q

What formulation are Thiopurines found in?

A

ORAL ONLY

25
Q

What must be measured before mercaptopurine use?

A

TMPT (enzyme that converts mercaptopurine to Methylmercaptopurine which is hepatoxic) levels because this can cause side effects.

Also repeat after 1 month of use and if treatment not effective.

26
Q

Side effects of Thiopurines

A
  • Hypersensitive reaction (stop drug immediately if this is the case)
  • bone marrow suppresion
  • GI side effects (nausea, vomiting, diarrhoea)
  • Liver disorder
27
Q

What are other immunomodulators?

A

METHOTREXATE (I.M. once weekly) for maintenance in CD

TACROLIMUS (Oral) induce remission of mild to mederate CD

CICLOSPORIN(IV) for remision in severe UC

20300 (2 decks)

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