Inflammatory bowel disease Treatment

Question 1

What are the three therapeutic strategies to control IBD?

Answer 1

Lifestyle advice
Drugs
Surgery

Question 2

What lifestyle advice is given to a patient with Crohn’s?

Answer 2

stop smoking

Alter diets

Question 3

In what way can a change in diet affect an IBD patient?

Answer 3

Influences symptoms but has no effect on pathogenesis

Question 4

What effects do all drugs have?

Answer 4

anti-inflammaory effects

Question 5

What are the therapy options for ulcerative colitis?

Answer 5

5ASA mesalazine
Steroids
Immunosuppressants
Anti-TNF therapy

Question 6

What are the therapy options for Crohn’s disease?

Answer 6

Steroids
Immunosuppressants
Anti-TNF therapy

Question 7

What are the side effects of mesalazine?

Answer 7

diarrhoea or idiosyncratic nephritis

Question 8

what is idiosyncratic nephritis?

Answer 8

Inflammation of the kidneys

Question 9

Give examples of 5-ASA drugs currently in use

Answer 9

Sulphasalazine
Balaxalazide
Mezavant

Question 10

which part of the GI tract is salazopyrin released?

Answer 10

Colon

Question 11

which part of the GI tract is balsalazide released?

Answer 11

colon

Question 12

which part of the GI tract is asacol salofalk released?

Answer 12

Ileum and colon

Question 13

which part of the GI tract is Pentasa released?

Answer 13

Duodenum, Jejunum, Ileum and colon

Question 14

Which has better mucosal adherance - suppositories or enemas?

Answer 14

suppositories

Question 15

How do enemas spread?

Answer 15

foam or liquid enemas spread by reflex contraction proximally

Question 16

How should corticosteroids be given?

Answer 16

Prednisolone should be given in a short course of an initially high dose over 8 weeks

Question 17

What are the side effects for steroid use?

Answer 17

Avascular necrosis
Osteoporosis
Acne
Thinning of skin
Weight gain
Diabetes
Hypertension
Cataracts

Question 18

why are immunosuppressants used in ulcerative colitis?

Answer 18

act as steroid sparing agents

Question 19

what are immunosuppressants used in Crohn’s disease?

Answer 19

as maintenance therapy

Question 20

What is tumour necrosis factor a?

Answer 20

pro-inflammatory cytokine

Question 21

what are the two antibodies to TNF?

Answer 21

Infliximab

Adalimumab

Question 22

What does anti-TNF therapy do?

Answer 22

promotes apoptosis of activated T-lymphocytes

Question 23

what is the duration of remission with anti-TNF therapy?

Answer 23

8-12 weeks

Question 24

What are the dangers when using anti-TNF?

Answer 24

Can have infusion reactions
Can get infections - reactivation of TB
Cause cancer - lymphomas and solid tumours

Question 25

when should anti-TNF alpha be used?

Answer 25

As part of long term treatment | Refractory/fistulising disease

Question 26

what are the main reasons anti-TNF alphas shouldn't be used?

Answer 26

If the patient has been exposed to TB - potential to activate it

Question 27

when is emergency surgery used in IBD?

Answer 27

Failure to respond to medication Small bowel obstruction Abscess Fistulae

Question 28

When is elective surgery used in IBD?

Answer 28

Failure to respond to medical therapy | Dysplasia of colon mucosa

Question 29

Is the surgery for Crohn's curative?

Answer 29

No

Question 30

If the patient develops short gut syndrome, what interventions will need to be done?

Answer 30

Lifelong total parenteral nutrition

Question 31

Is surgery for ulcerative colitis curative?

Answer 31

Yes

Question 32

What does azathioprine do to DNA?

Answer 32

Interferes with DNA synthesis of rapidly dividing cells

Question 33

what is azathioprine converted and broken down to in the liver?

Answer 33

Converted to 6-MP and then broken down to 6-TGN

Question 34

What are the indications for surgery in ulcerative colitis?

Answer 34

``` Failure of medical therapy Toxic megacolon Poor quality of life Intolerance of medication even if it is working Dysplasia or carcinoma Massive haemorrhage ```

Question 35

what will a barium enema show in ulcerative colitis?

Answer 35

featureless colon

Question 36

What are the surgical options in ulcerative colitis? (3)

Answer 36

Subtotal colectomy Panproctocolectomy Panproctocolectomy with pouch formation

Question 37

what is a subtotal colectomy?

Answer 37

When a bit of the colon is left and the rectum is preserved to hold stool

Question 38

what is a Panproctocolectomy?

Answer 38

the whole of the large bowel is removed including the rectum

Question 39

What are the indications for surgery in Crohn's disease?

Answer 39

Symptomatic obstruction/ Fistulae/ stricture Haemorrhage Dysplasia or carcinoma Symptomatic peri-anal disease

Question 40

What is a common finding in a barium swallow in ulcerative colitis?

Answer 40

Stricture causing pain

Question 41

what are the surgical options in Crohn's disease?

Answer 41

``` Right hemicollectomy Stricturoplasty Resection Ileocaecal resection Colectomy with ileostomy ```

Question 42

What causes an intestinal fistula?

Answer 42

inflammatory process in the inflamed bowel

Question 43

Would a fistula be visible on a barium swallow?

Answer 43

yes

Question 44

How is peri-anal disease treated?

Answer 44

the fistulas are drained

Question 45

what is the most common operation for terminal ileal disease?

Answer 45

Right hemicollectomy

Question 46

what is stricturoplasty?

Answer 46

when the bowel is widened

Question 47

what does resection involve?

Answer 47

the surgeon removes the damaged and diseased part of the gut, and then staples together the ends of the remaining healthy sections

Question 48

what is a Colectomy with ileostomy?

Answer 48

when all of the colon is removed and a stoma bag is positioned where the small intestine has been attached to the surface