Inflammatory Bowel Disease (12/03/19) Flashcards
What 2 conditions are included in inflammatory bowel disease?
Crohn’s disease and Ulcerative colitis
What is the peak age of diagnosis for Inflammatory bowel disease?
10-25
What is IBD?
Inflammation of gastric mucosa.
- patient goes through cycles of having disease and and not
What is Crohn’s disease?
Crohn’s disease:
- whole of GI (Mouth to Anus) can be infected.
- Transmural (all layers of intestinal wall) ulceration
- Patchy
What is Ulcerative Colitis?
- Mucosa of colon and rectum infected
- diffuse (join up/ continous), inflammation and ulceration
- just top layers of mucosa infected
What are the signs and symptoms of Inflammatory Bowel Disease?
- 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
Signs and symptoms of Crohn’s disease?
Strictures: narrowed bowel segments, leads to blockages and acute dilatation.
Fisulas: Abnormal channels in tissue between intestine and skin/other parts of intestines
What would you test for to investigate Inflammatory bowel disease?
- 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
What would you test for to investigate Inflammatory bowel disease?
- 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
Signs of Severe Ulcertive colitis
- 6 or more bowel movements
- visible blood in stool
- pyrexia (body temp >37)
- HR >90bpm
- Anaemia
- Eryhthrocyte sedimentation >30mm/hour
What is the site of action and indication for suppository, foam and enemas?
Suppository: Rectum for Proctitis
Foam: Sigmoid colon for Procto-sigmoiditis
Enemas: Descending colon to distal colon for left sided (distal) colitis
What would you use to treat ‘flares’ or remission?
Corticosteroids
How do Corticosteroids work?
Reduce inflammation and modulate immune system
What level of disease are corticosteroids used for?
Mild, moderate and severe
What would you give treat mild to moderate flare?
PREDNISOLONE 40mg daily, then reduce to 5mg/week
What would you give to treat acute-severe disease?
HYDROCORTISONE IV 100mg QDS, then titrate down over time
What are the side effects of Corticosteroids?
- GI side effects
- Fluid imbalance
- Hypertesion
- Blood sugar change
- Mood and behaviour change
- infection risk
- osteoporosis
What would you give for flare ups and mainting a disease long term for Ulcerating colitis?
AMINOSALICYLATES
Can you give topical and oral aminosalicylates together?
Yes, topical is used to manage flare up while oral is for long term treatment.
Can you give topical and oral aminosalicylates together?
Yes, topical is used to manage flare up while oral is for long term treatment.
Aminosalicylates side effects?
- Arthralgia, abdominal pain
- blood dyscrasisas (unexplained bleeding and sore throat)
What would you monitor when using Aminosalicylates?
Renal function
blood dyscrasisas
What would you use for first line immunomodulators?
Thiopurines: AZATHIOPRINE (2-2.5mg/kg/day) and MERCAPTOPRINE (1-1.5 mg/kg/day)
What formulation are Thiopurines found in?
ORAL ONLY
