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Gastrointestinal > Irritable Bowel Disease > Flashcards

Irritable Bowel Disease Flashcards

1
Q

What are the 2 types of IBD

A

Ulcerative colitis
Crohns syndrome

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2
Q

What causes IBD

A

Genetics and environmental factors- stress, smoking, air pollution, drugs, diet

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3
Q

How do environmental factors cause IBD

A

The body thinks they are foreign substances and produces antibodies causing inflammation

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4
Q

Crohns affects which parts of the body

A

Any part of the GI tract from the Mouth to the anus

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5
Q

Ulcerative colitis affects which part of the body

A

Only affects the colon

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6
Q

Whats the difference between ulcerative colitis and crohns

A

Crohns affects the anywhere in the GI tract from the mouth to the anus whereas ulcerative colitis only affects the colon

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7
Q

What are the symptoms of crohns

A

ADRFAW

Abdominal pain
Diarrhoea
Rectal bleeds
Fever
Anal fissures
Weight loss

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8
Q

Complications of crohns

A

Stricture
Perforations
Fistula
Cancer
Malnutrition
Osteoporosis
Anaemia
Delayed growth and puberty
Arthritis
Abnormalities of joints, eyes, liver and skin

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9
Q

A complication of crohns is stricture, what is this?

A

When the GI tract narrows meaning food cant go down and so goes back up causing vomiting

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10
Q

A complication of crohns is malnutrition, how is this caused and what does other complications does it result in?

A

Inflammation of the intestine causing malabsorption of the nutrients (calcium, vit d etc.)

It causes:
Osteoporosis- lack of calcium
Delayed puberty and growth - malnutrition
Anaemia

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11
Q

What cancers can be caused by Crohn’s disease

A

Colorectal and bowel cancer

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12
Q

A complication of crohns is arthritis, how is this caused?

A

Antibodies produced causing inflammation, arthritis occurs due to inflamed joints

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13
Q

A complication of crohns is fistula, what is this?

A

Abnormal connection between two body parts such as vagina and anus

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14
Q

A complication of crohns is perforation, what is this?

A

Holes in the GI tract which could be life threatening such as in intestines- contents can leak causing infections and abscesses in abdomen

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15
Q

Non drug treatment of crohns

A

Diet change, stop smoking, stress management

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16
Q

Drug treatment in crohns

A

AAIBC

Aminosalicylates
Antibiotics
Immunosuppressants
Biological therapy
Corticosteroids

Diarrhoea and constipation meds

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17
Q

Which aminosalicylates are used in crohns and their MOA

A

Reduce inflammation in the GUT

Mesalazine
Sulphasalazine
Olsalazine
Balsalazide

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18
Q

Which aminosalicylate stains lenses orange/yellow

A

Sulphasalazine

19
Q

Which immunosuppressants are used in crohns and their MOA

A

Reduced activity of immune system

Azathioprine
Methotrexate
Mercaptopurine

20
Q

Which biological therapies/ monoclonal antibodies are used in crohns

A

Infliximab
Adalimumab
Golimumab

21
Q

Which therapy in crohns is given under specialist supervision

Examples

A

Monoclonal antibodies/ biological therapy

Infliximab
Golimumab
Adalimumab

22
Q

Which corticosteroids are used in crohns?

How long can they be used for?

MOA

A

Reduces inflammation

Oral prednisolone, methylprednisolone, budesonide, hydrocortisone

Only use short term when symptoms are severe- not for maintenance use

23
Q

Example of antibiotics used in crohns

When are they used

A

Metronidazole
Ciprofloxacin

Fistulating crohns

24
Q

Drugs used in IBD

A

ibd ACT BAD

Aminoglycosides
Corticosteroids usually 4-8 weeks
Thiopurine/mercaptopurine- immunosuppressants
Biological agents
Antibiotics
Diarrhoea- loperamide, cholestyramine, codeine+constipation drugs

25
Q

Dont use diarrhoea drugs in UC or crohns?

A

Acute Ulcerative colitis

26
Q

Whats proctitis

A

Inflammation of the lower end of the large intestine leading to anus

27
Q

Proctitis treatment

examples

1st and 2nd line and 3rd line

A

Topical aminosalicylate (mesalazine, sulfasalazine, balsalazide, olsalazine)

If no improvement within 4 weeks add oral aminosalicylate

If no improvement add oral or topical corticosteroids (budesonide, hydrocortisone, prednisolone) for 4-8 weeks

28
Q

Extensive UC treatment

A

Topical aminosalicylate and high dose oral aminosalicylate

29
Q

Proctosigmoiditis and left UC treatment

A

Topical aminosalicylate

30
Q

Acute severe UC treatment

A

IV corticosteroids and Infliximab (monoclonal antibody)

31
Q

Maintaining remission in mild, moderate and severe UC meaning

Treatment?

A

Prevents flare ups

Long term aminosalicylate

Oral azathioprine or mercaptopurine when 2 or more inflammatory exacerbations in 12 months which required systemic steroid

Avoid steroids due to SE

32
Q

Complications of ulcerative colitis

A

Colorectal cancer
Secondary osteoporosis
Venous thromboembolism
Toxic megacolon

33
Q

Why do we avoid antidiarrhoeal drugs in acute UC

A

it can cause toxic megacolon

34
Q

Whats toxic megacolon

A

Life threatening- when colon widens

35
Q

Which aminosalicylate has the most SE. Which have fewer SE

A

Sulfasalazine - oldest aminosalicylate

Olsalazine, balsalazide, mesalazine are newer ones with fewer SE

36
Q

A patient suffering from UC, on balsalazide presents to you with symptoms and you refer him due to bone marrow suppression. What symptoms did he have?

A

Unexplained bleeding, bruising purpura, sore throat, fever or malaise

37
Q

A patient taking mesalazine presents with the symptoms unexplained bleeding, bruising purpura, sore throat, fever or malaise. What is this?

A

Bone marrow suppression
Refer

38
Q

A patient with UC performs a FBC and is at suspicion of blood dyscrasia, what do you do?

A

Stop aminosalicylate immediately

39
Q

Aminosalicylates change bodily fluids to what colour

A

Orange/ yellow

40
Q

Monitoring requirements for aminosalicylates

A

Renal function before treatment, at 3 months and then annually

41
Q

Dont give aminosalicylates to those sensitive to ……..

A

Aspirin

42
Q

Do aminosalicylates affect the kidney?

A

May cause nephrotoxicity

43
Q

A patient has had more than 2 inflammatory exacerbations in the past 12 months which required steroids, what would you give to prevent flare ups

A

Immunosuppressants- azathiopurine or mercaptopurine

Gastrointestinal (10 decks)

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