Inflammatory Bowel Disease Flashcards
Inflammatory Bowel Diseases Outline
Group of conditions in which intestines become inflammed. 2 diseases: Crohn’s and Ulcerative Colitis
Crohn’s Disease Outline
Causes are unclear but involve genetic, environmental and immunological factors. Severe inflammation throughout GIT (mouth to anus). No cure (symptoms can only be treated)
Chron’s Disease Identifying Factors
Deep ulceration, mucosa fissuring and granulomas (white blood cell build up) with skip lesions (unaffected areas between affected). Effects transmucosally.
Chron’s Disease Signs and Symptoms of active disease
Diahorrea, fever, fatigue, abdominal pain and cramps, blood in stool, mouth sores, reduced appetite, weight loss and pain/drainage around anus. Different areas have specific regions
Ulcerative Colitis Outline
Causes unclear: genetic, environmental and immunological factors. Chronic diffuse mucosal inflammation of colon and proximal tissues. Relapsing-remitting pattern (life long condition)
Ulcerative Colitis Signs and Symptoms
Diahorrea (containing blood and pus), rectal bleeding (small amountof blood in stool), rectal pain, inability to defecate despite urgent feelings, weight loss, fatigue and fever
4 types of Ulcerative Colitis
proctosigmoiditis (rectum and sigmoid colon), ulcerative proctitis (rectum only), pancolitis (entire colon) and left sided colitis (rectum, sigmoid colon and descending colon)
IBD Mechanisms
due to genetic susceptibility/diet/stress epithelial cells release an excess of cytoines, these cytokines stimulate immune cells which release their own proinflammatory cytokines
IBD Pathogenesis Study
Genetic susceptibility, environmental factors, dysbiosis, epithelial transport dysfunction and chronic mucosal immune activation
Common extra-epithelial symptoms of IBDs
Conjunctivitis, axial arthritis, altered pancreatic function, peripheral arthritis and thromboembolism
IBD Intestinal Complications
Hemorrhage, strictures, colon perforation, anal fistulas, pelvic abscesses, toxic megacolon and cholangiocarcinoma
IBD extraintestinal complications
osteoporosis, deep vein thrombosis, anemia, gall stones and arthritis
Fistula Def
A connection between 2 parts of the body that doesn’t exist in the average healthy person
Enterocutaneous Fistula
Connection between the intestines and the skin. Through connections contents of intestines can leak through skin
Enetroentric Fistula Outline
Connection between intestines and kidney
Strictures Def
Narrowing of the large intestine and colon. Limits amount of bolus that can pass
Symptoms that indicate an increase in severity
Blood in feces, abdominal pain, nausea, diahorrea (>2 weeks), unexplained weight loss and fever
Stepwise IBD Treatment
Mild -> severe. Aminosalicylates, corticosteroids, immunomodulators and biologics (to surgery). Used to induce remission IBDs are never fully cured
Aminosalicylates Outline
Mild to moderate IBDs. More effective in ulcerative colitis. Acts locally on colonic epithelium, multiple anti-inflammatory effects
Aminosalicylates Anti-inflammatory effects
Reduce leukotrine + prostaglandin production, inhibits TNF production (via PPR gamma activation) and antioxidant activity
Amino salicylates side effects
Headache, nausea, abdominal pain, dyspepsia, fatigue and rash
Osalazine Outline
Amino salicylate. Prodrug cleaved by enzymes in the colon. Increases net luminal secretion and increases rate of GI meal transit
Corticosteroids Outline
Moderate IBDs. Higher % sucess in ulcerative colitis the Chronn’s disease. Used to induce remission has anti-inflammatory properties. Admin route (oral and IV (severe)). Used with aminosalicylates if monotherapy is inadequate
Corticosteroids Mechanism of Action
Binds glucocorticoid receptor, inhibits protein transcription/synthesis and down tegulation of proinflammatory cytokines Eg IL1, IL6 and TNF
Corticosteroids Side Effects
Treatment can only be used for short time. May develop a dendency (~ Cushing’s Syndrome)
Immunomodulators Def
Used to maintain remission or treat severe IBDs. Slow onset (can’t treat flares). Anti-inflammatory and cytotoxic effects
Azathioprine Outline
Immunomodulator. Produces metabolites that damage RNA/DNA in epithelial and immune cells. Side effects: bone marrow immunosupression and opportunistic infections. Red flags: rash, unexplained bruising/bleeding and infections
Methotrexate Outline
Inhibits dihydrofolate reductase, inhibiting DNA synthesis. Inhibits AICAR enzyme resulting in supression of inflammatory response. Daily oral/IV admin. Red flags: sore throat and fever
Biologics Def
Medicines that are grown and purified from large-scale cell cultures of bacteria/yeast/plant/animal cells. Proteins are purified from biological systems/lood
3 examples of aminosalicytes
Sulfasalazine, olsalazine and mesalazine
Corticosteroid examples
Hydrocortisone (oral/IV), prednisolone (oral), buedesone (oral) and methylprednisone (IV)
Examples of anti-TNF-alpha biologics
Infliximab, adalimuamb and golimuamb
anti-TNF-alpha Biologics Mechanism of action
Apoptosis (infliximab and adalimuamb) of cells producing TNF-alpha (imunosupression). Need to screen for latent diseases eg TB beore administrating
Vendolizumab Mode of Action
Monoclonal antibody. Binds to alpha4-beta7 intigrin on white blood cells in gut. Reducing inflammation specifically in gut
Ustekunimab Mode of Action
Monoclonal antibody. Targets IL-12 and IL-23, reducing T cell stimulation, reducing inflammation from T cell cytokines
Mild ulcerative Colitis
<4 bowel movements daily, small amount blood in stool, no pyrexia, pulse <90 bpm, no anaemia, erythrocyte sedimentation < 30 mm/hr
Severe Ulcerative Colitis
6+, some indication of systemic problems, visible blood in stool, >37.8 degrees C, pulse > 90 bpm, anemia, erythrocyte sedimentation > 30 mm/hr
Mild to Moderate UC treatment
topical amino salicylates (4 weeks), add systemic amino salicylates if not in remission after 4 weeks. If required add course of topical/oral steroid
Crohn’s Treatment 1st line
Corticosteroid,/Budesenoid (if steroids aren’t tolerated, less effective)/aminosalicylate therapy (steroids not tolerated or contradicted)
Crohn’s Treatment Add Ons
Immunosuppressant drug
Non-pharmacological Treatments
Avoid smoking, balanced + low fat diet, avoid regylar NSAIDs, target average BMI, regular physical activity and mental health care
Emergency Surgery Reasoning
Bowel perforation, rectal hemorrhage or toxic megacolon
Proctocolometry Outline
Removal of large intestine and (colon and rectum). Results in stoma
Colostomy Def
Surgery where opening is made in colon and skin to form stoma
Ileostomy Def
Surgery where opening is made in small intestine and skin to form stoma
Urostomy Def
Surgery where opening is made in bladder and skin to form stoma
Stoma Def
Temporary/permanent surgical opening allow waste excretion from colon to bag
