Irritable Bowel Disease

Question 1

What are the 2 types of IBD

Answer 1

Ulcerative colitis
Crohns syndrome

Question 2

What causes IBD

Answer 2

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

Question 3

How do environmental factors cause IBD

Answer 3

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

Question 4

Crohns affects which parts of the body

Answer 4

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

Question 5

Ulcerative colitis affects which part of the body

Answer 5

Only affects the colon

Question 6

Whats the difference between ulcerative colitis and crohns

Answer 6

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

Question 7

What are the symptoms of crohns

Answer 7

ADRFAW

Abdominal pain
Diarrhoea
Rectal bleeds
Fever
Anal fissures
Weight loss

Question 8

Complications of crohns

Answer 8

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

Question 9

A complication of crohns is stricture, what is this?

Answer 9

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

Question 10

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

Answer 10

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

Question 11

What cancers can be caused by Crohn’s disease

Answer 11

Colorectal and bowel cancer

Question 12

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

Answer 12

Antibodies produced causing inflammation, arthritis occurs due to inflamed joints

Question 13

A complication of crohns is fistula, what is this?

Answer 13

Abnormal connection between two body parts such as vagina and anus

Question 14

A complication of crohns is perforation, what is this?

Answer 14

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

Question 15

Non drug treatment of crohns

Answer 15

Diet change, stop smoking, stress management

Question 16

Drug treatment in crohns

Answer 16

AAIBC

Aminosalicylates
Antibiotics
Immunosuppressants
Biological therapy
Corticosteroids

Diarrhoea and constipation meds

Question 17

Which aminosalicylates are used in crohns and their MOA

Answer 17

Reduce inflammation in the GUT

Mesalazine
Sulphasalazine
Olsalazine
Balsalazide

Question 18

Which aminosalicylate stains lenses orange/yellow

Answer 18

Sulphasalazine

Question 19

Which immunosuppressants are used in crohns and their MOA

Answer 19

Reduced activity of immune system

Azathioprine
Methotrexate
Mercaptopurine

Question 20

Which biological therapies/ monoclonal antibodies are used in crohns

Answer 20

Infliximab
Adalimumab
Golimumab

Question 21

Which therapy in crohns is given under specialist supervision

Examples

Answer 21

Monoclonal antibodies/ biological therapy

Infliximab
Golimumab
Adalimumab

Question 22

Which corticosteroids are used in crohns?

How long can they be used for?

MOA

Answer 22

Reduces inflammation

Oral prednisolone, methylprednisolone, budesonide, hydrocortisone

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

Question 23

Example of antibiotics used in crohns

When are they used

Answer 23

Metronidazole
Ciprofloxacin

Fistulating crohns

Question 24

Drugs used in IBD

Answer 24

ibd ACT BAD

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

Question 25

Dont use diarrhoea drugs in UC or crohns?

Answer 25

Acute Ulcerative colitis

Question 26

Whats proctitis

Answer 26

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

Question 27

Proctitis treatment examples 1st and 2nd line and 3rd line

Answer 27

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

Question 28

Extensive UC treatment

Answer 28

Topical aminosalicylate and high dose oral aminosalicylate

Question 29

Proctosigmoiditis and left UC treatment

Answer 29

Topical aminosalicylate

Question 30

Acute severe UC treatment

Answer 30

IV corticosteroids and Infliximab (monoclonal antibody)

Question 31

Maintaining remission in mild, moderate and severe UC meaning Treatment?

Answer 31

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

Question 32

Complications of ulcerative colitis

Answer 32

Colorectal cancer Secondary osteoporosis Venous thromboembolism Toxic megacolon

Question 33

Why do we avoid antidiarrhoeal drugs in acute UC

Answer 33

it can cause toxic megacolon

Question 34

Whats toxic megacolon

Answer 34

Life threatening- when colon widens

Question 35

Which aminosalicylate has the most SE. Which have fewer SE

Answer 35

Sulfasalazine - oldest aminosalicylate Olsalazine, balsalazide, mesalazine are newer ones with fewer SE

Question 36

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?

Answer 36

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

Question 37

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

Answer 37

Bone marrow suppression Refer

Question 38

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

Answer 38

Stop aminosalicylate immediately

Question 39

Aminosalicylates change bodily fluids to what colour

Answer 39

Orange/ yellow

Question 40

Monitoring requirements for aminosalicylates

Answer 40

Renal function before treatment, at 3 months and then annually

Question 41

Dont give aminosalicylates to those sensitive to ……..

Answer 41

Aspirin

Question 42

Do aminosalicylates affect the kidney?

Answer 42

May cause nephrotoxicity

Question 43

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

Answer 43

Immunosuppressants- azathiopurine or mercaptopurine