Inflammatory Bowel Disease Flashcards
Inflammatory markers in blood
High ESR CRP High platelet count High WBC Low Hb Low albumin
Inflammatory markers in stool
Calprotectin - white cell only present in the colon
Extra-intestinal manifestations
Eye - Inflammation Joints - inflammation Renal - calculi in CD Liver - Fatty liver Biliary - Sclerosing cholangitis, gallstones Skin - erythema nodosum, vasculitis
Differential Diagnosis
Malabsorption
Ileo-caecal TB (looks like CD)
Infective / ischaemic colitis
When do guidelines say surveillance colonoscopy should be offered
In extensive colitis:
<20 years - every 3 years
30-40 - every 2 years
>40 - annually
What is the initial treatment for a person with IBD
5-ASA (or sulfasalazine pro-drug)
What is the 2nd add on treatment in IBD
Steroids - prednisolone or budenoside
3rd line of treatment in IBD
Thiopurines: AZA or 6-MP or MTX
- Azathiopurine
- 6-Mercaptopurine
- Methotrexate
4th line of treatment
Biologics
5th line of treatment
Surgery
- colectomy with ileostomy
- pouch surgery
Why, if a patient is started on a drug, do they have to stay on it for the long term
The patient can have bad side effects if switched
Why is 5-ASA inserted into the rectum
For distal and more extensive disease, inflammation is treated better if 5ASA is administered via rectum
What are the problems with steroids in IBD
Usually, steroids are given in short doses.
However, in IBD, higher doses over longer periods need to be given and this can cause worse side effects
What kind of treatment are thiopurines?
Immunosuppression
When they are metabolised, they become the same active component which treats inflammation in the body
Which thiopurine are patients usually started on but why can they be a problem
Azathiopurine but many cannot tolerate as can be toxic
