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Gastroenterology (Own) > Inflammatory bowel disease Treatment > Flashcards

Inflammatory bowel disease Treatment Flashcards

1
Q

What are the three therapeutic strategies to control IBD?

A

Lifestyle advice
Drugs
Surgery

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2
Q

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

A

stop smoking

Alter diets

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3
Q

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

A

Influences symptoms but has no effect on pathogenesis

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4
Q

What effects do all drugs have?

A

anti-inflammaory effects

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5
Q

What are the therapy options for ulcerative colitis?

A

5ASA mesalazine
Steroids
Immunosuppressants
Anti-TNF therapy

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6
Q

What are the therapy options for Crohn’s disease?

A

Steroids
Immunosuppressants
Anti-TNF therapy

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7
Q

What are the side effects of mesalazine?

A

diarrhoea or idiosyncratic nephritis

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8
Q

what is idiosyncratic nephritis?

A

Inflammation of the kidneys

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9
Q

Give examples of 5-ASA drugs currently in use

A

Sulphasalazine
Balaxalazide
Mezavant

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10
Q

which part of the GI tract is salazopyrin released?

A

Colon

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11
Q

which part of the GI tract is balsalazide released?

A

colon

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12
Q

which part of the GI tract is asacol salofalk released?

A

Ileum and colon

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13
Q

which part of the GI tract is Pentasa released?

A

Duodenum, Jejunum, Ileum and colon

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14
Q

Which has better mucosal adherance - suppositories or enemas?

A

suppositories

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15
Q

How do enemas spread?

A

foam or liquid enemas spread by reflex contraction proximally

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16
Q

How should corticosteroids be given?

A

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

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17
Q

What are the side effects for steroid use?

A 
Avascular necrosis
Osteoporosis
Acne
Thinning of skin
Weight gain
Diabetes
Hypertension
Cataracts
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18
Q

why are immunosuppressants used in ulcerative colitis?

A

act as steroid sparing agents

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19
Q

what are immunosuppressants used in Crohn’s disease?

A

as maintenance therapy

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20
Q

What is tumour necrosis factor a?

A

pro-inflammatory cytokine

21
Q

what are the two antibodies to TNF?

A

Infliximab

Adalimumab

22
Q

What does anti-TNF therapy do?

A

promotes apoptosis of activated T-lymphocytes

23
Q

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

A

8-12 weeks

24
Q

What are the dangers when using anti-TNF?

A

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

25
Q

when should anti-TNF alpha be used?

A

As part of long term treatment

Refractory/fistulising disease

26
Q

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

A

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

27
Q

when is emergency surgery used in IBD?

A

Failure to respond to medication
Small bowel obstruction
Abscess
Fistulae

28
Q

When is elective surgery used in IBD?

A

Failure to respond to medical therapy

Dysplasia of colon mucosa

29
Q

Is the surgery for Crohn’s curative?

A

No

30
Q

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

A

Lifelong total parenteral nutrition

31
Q

Is surgery for ulcerative colitis curative?

A

Yes

32
Q

What does azathioprine do to DNA?

A

Interferes with DNA synthesis of rapidly dividing cells

33
Q

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

A

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

34
Q

What are the indications for surgery in ulcerative colitis?

A 
Failure of medical therapy
Toxic megacolon
Poor quality of life
Intolerance of medication even if it is working 
Dysplasia or carcinoma
Massive haemorrhage
35
Q

what will a barium enema show in ulcerative colitis?

A

featureless colon

36
Q

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

A

Subtotal colectomy
Panproctocolectomy
Panproctocolectomy with pouch formation

37
Q

what is a subtotal colectomy?

A

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

38
Q

what is a Panproctocolectomy?

A

the whole of the large bowel is removed including the rectum

39
Q

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

A

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

40
Q

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

A

Stricture causing pain

41
Q

what are the surgical options in Crohn’s disease?

A 
Right hemicollectomy 
Stricturoplasty 
Resection
Ileocaecal resection
Colectomy with ileostomy
42
Q

What causes an intestinal fistula?

A

inflammatory process in the inflamed bowel

43
Q

Would a fistula be visible on a barium swallow?

A

yes

44
Q

How is peri-anal disease treated?

A

the fistulas are drained

45
Q

what is the most common operation for terminal ileal disease?

A

Right hemicollectomy

46
Q

what is stricturoplasty?

A

when the bowel is widened

47
Q

what does resection involve?

A

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

48
Q

what is a Colectomy with ileostomy?

A

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

Gastroenterology (Own) (18 decks)

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