Inflammatory bowel diseases Flashcards
What is the cardinal symptom of ulcerative colitis?
Bloody diarrhoea
Describe the symptoms associated with ulcerative colitis
Colicky abdominal pain, urgency, tenesmus
Constipation
May be rectal bleeding
Symptoms of systemic upset (fever, malaise, weight loss)
May mimic GI infection
Describe the signs associated with ulcerative colitis
Tachycardia, hypotension
Tenderness, distension and/or abdominal masses
Dehydration in more severe cases
Give some extra-intestinal signs of inflammatory bowel disease
Erythema nodosum Apthous ulcers Episcleritis Joint problems Cholangitis Low albumin Pyoderma gangrenosum
What should be tested in a blood test when investigating inflammatory bowel disease? Are these tests useful?
Blood tests can be useful but only show abnormalities during acute attacks Test for: - raised WBC count - raised platelets - iron deficiency anaemia - raised ESF - raised CRP - low albumin
What investigations should be done in patients presenting with symptoms of inflammatory bowel disease?
PR examination Blood tests Sigmoidoscopy Stool samples (exclude infection) Abdominal ultrasound, CT scan Colonoscopy
When is a colonoscopy contraindicated in patients with suspected inflammatory bowel disease?
Colonoscopy should not be performed during an acute attack
What are the potential complications of inflammatory bowel disease?
Perforation Bleeding Toxic megacolon Venous thrombosis Colon cancer
Describe the use of aminosalicylates in the management of IBD and give an example
“Step 1” in IBD management
E.g. Mesalazine
Acrylic resin is pH-dependant
Elthylcellulose microgranules - drug is released a bit in the small bowel and the throughout the large bowel
Can also be given in the form of prodrugs to ensure that they’re not released too early
Give three aminosalicyclates that are given in the form of prodrugs
Balasalazide
Olzalazine
Sulfasalazine
Describe the use of steroids in the management of IBD
Only used for short term control of the disease so can be used at any “step” of IBD management
Needs to be prolonged - a short course won’t work
Describe the use of thiopurine in the management of IBD? Give an example
“Step 2” in IBD management
E.g. azathioprine
Have significant side effects but mean that the patient doesn’t need steroids
Describe the use of methotrexate in the management of IBD
“Step 3” in IBD management
unlicensed use, last resort
can cause problems with the lungs
Give three immunosuppressants that can be used in “step 4” treatment of IBD
Ciclosporin - rescue therapy
Mycophenolate - rarely used
Tacrolimus - increasing anecdotal evidence
Describe the use of biologic drugs in the management of IBD
Biologics are antibodies that have been designed from a cell line to target specific cells of the immune system E.g. anti-TNF-alpha antibodies - infliximab - adulimumab E.g. alpha-4b7 integrin blockers - vedolizumab
Drug of choice in fistulating disease
