Inflammatory bowel disease Treatment Flashcards
What are the three therapeutic strategies to control IBD?
Lifestyle advice
Drugs
Surgery
What lifestyle advice is given to a patient with Crohn’s?
stop smoking
Alter diets
In what way can a change in diet affect an IBD patient?
Influences symptoms but has no effect on pathogenesis
What effects do all drugs have?
anti-inflammaory effects
What are the therapy options for ulcerative colitis?
5ASA mesalazine
Steroids
Immunosuppressants
Anti-TNF therapy
What are the therapy options for Crohn’s disease?
Steroids
Immunosuppressants
Anti-TNF therapy
What are the side effects of mesalazine?
diarrhoea or idiosyncratic nephritis
what is idiosyncratic nephritis?
Inflammation of the kidneys
Give examples of 5-ASA drugs currently in use
Sulphasalazine
Balaxalazide
Mezavant
which part of the GI tract is salazopyrin released?
Colon
which part of the GI tract is balsalazide released?
colon
which part of the GI tract is asacol salofalk released?
Ileum and colon
which part of the GI tract is Pentasa released?
Duodenum, Jejunum, Ileum and colon
Which has better mucosal adherance - suppositories or enemas?
suppositories
How do enemas spread?
foam or liquid enemas spread by reflex contraction proximally
How should corticosteroids be given?
Prednisolone should be given in a short course of an initially high dose over 8 weeks
What are the side effects for steroid use?
Avascular necrosis Osteoporosis Acne Thinning of skin Weight gain Diabetes Hypertension Cataracts
why are immunosuppressants used in ulcerative colitis?
act as steroid sparing agents
what are immunosuppressants used in Crohn’s disease?
as maintenance therapy
What is tumour necrosis factor a?
pro-inflammatory cytokine
what are the two antibodies to TNF?
Infliximab
Adalimumab
What does anti-TNF therapy do?
promotes apoptosis of activated T-lymphocytes
what is the duration of remission with anti-TNF therapy?
8-12 weeks
What are the dangers when using anti-TNF?
Can have infusion reactions
Can get infections - reactivation of TB
Cause cancer - lymphomas and solid tumours
when should anti-TNF alpha be used?
As part of long term treatment
Refractory/fistulising disease
what are the main reasons anti-TNF alphas shouldn’t be used?
If the patient has been exposed to TB - potential to activate it
when is emergency surgery used in IBD?
Failure to respond to medication
Small bowel obstruction
Abscess
Fistulae
When is elective surgery used in IBD?
Failure to respond to medical therapy
Dysplasia of colon mucosa
Is the surgery for Crohn’s curative?
No
If the patient develops short gut syndrome, what interventions will need to be done?
Lifelong total parenteral nutrition
Is surgery for ulcerative colitis curative?
Yes
What does azathioprine do to DNA?
Interferes with DNA synthesis of rapidly dividing cells
what is azathioprine converted and broken down to in the liver?
Converted to 6-MP and then broken down to 6-TGN
What are the indications for surgery in ulcerative colitis?
Failure of medical therapy Toxic megacolon Poor quality of life Intolerance of medication even if it is working Dysplasia or carcinoma Massive haemorrhage
what will a barium enema show in ulcerative colitis?
featureless colon
What are the surgical options in ulcerative colitis? (3)
Subtotal colectomy
Panproctocolectomy
Panproctocolectomy with pouch formation
what is a subtotal colectomy?
When a bit of the colon is left and the rectum is preserved to hold stool
what is a Panproctocolectomy?
the whole of the large bowel is removed including the rectum
What are the indications for surgery in Crohn’s disease?
Symptomatic obstruction/ Fistulae/ stricture
Haemorrhage
Dysplasia or carcinoma
Symptomatic peri-anal disease
What is a common finding in a barium swallow in ulcerative colitis?
Stricture causing pain
what are the surgical options in Crohn’s disease?
Right hemicollectomy Stricturoplasty Resection Ileocaecal resection Colectomy with ileostomy
What causes an intestinal fistula?
inflammatory process in the inflamed bowel
Would a fistula be visible on a barium swallow?
yes
How is peri-anal disease treated?
the fistulas are drained
what is the most common operation for terminal ileal disease?
Right hemicollectomy
what is stricturoplasty?
when the bowel is widened
what does resection involve?
the surgeon removes the damaged and
diseased part of the gut, and then staples together the ends of the remaining
healthy sections
what is a Colectomy with ileostomy?
when all of the colon is removed and a stoma bag is positioned where the small intestine has been attached to the surface
