Irritable Bowel Disease Flashcards
What are the 2 types of IBD
Ulcerative colitis
Crohns syndrome
What causes IBD
Genetics and environmental factors- stress, smoking, air pollution, drugs, diet
How do environmental factors cause IBD
The body thinks they are foreign substances and produces antibodies causing inflammation
Crohns affects which parts of the body
Any part of the GI tract from the Mouth to the anus
Ulcerative colitis affects which part of the body
Only affects the colon
Whats the difference between ulcerative colitis and crohns
Crohns affects the anywhere in the GI tract from the mouth to the anus whereas ulcerative colitis only affects the colon
What are the symptoms of crohns
ADRFAW
Abdominal pain
Diarrhoea
Rectal bleeds
Fever
Anal fissures
Weight loss
Complications of crohns
Stricture
Perforations
Fistula
Cancer
Malnutrition
Osteoporosis
Anaemia
Delayed growth and puberty
Arthritis
Abnormalities of joints, eyes, liver and skin
A complication of crohns is stricture, what is this?
When the GI tract narrows meaning food cant go down and so goes back up causing vomiting
A complication of crohns is malnutrition, how is this caused and what does other complications does it result in?
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
What cancers can be caused by Crohn’s disease
Colorectal and bowel cancer
A complication of crohns is arthritis, how is this caused?
Antibodies produced causing inflammation, arthritis occurs due to inflamed joints
A complication of crohns is fistula, what is this?
Abnormal connection between two body parts such as vagina and anus
A complication of crohns is perforation, what is this?
Holes in the GI tract which could be life threatening such as in intestines- contents can leak causing infections and abscesses in abdomen
Non drug treatment of crohns
Diet change, stop smoking, stress management
Drug treatment in crohns
AAIBC
Aminosalicylates
Antibiotics
Immunosuppressants
Biological therapy
Corticosteroids
Diarrhoea and constipation meds
Which aminosalicylates are used in crohns and their MOA
Reduce inflammation in the GUT
Mesalazine
Sulphasalazine
Olsalazine
Balsalazide
Which aminosalicylate stains lenses orange/yellow
Sulphasalazine
Which immunosuppressants are used in crohns and their MOA
Reduced activity of immune system
Azathioprine
Methotrexate
Mercaptopurine
Which biological therapies/ monoclonal antibodies are used in crohns
Infliximab
Adalimumab
Golimumab
Which therapy in crohns is given under specialist supervision
Examples
Monoclonal antibodies/ biological therapy
Infliximab
Golimumab
Adalimumab
Which corticosteroids are used in crohns?
How long can they be used for?
MOA
Reduces inflammation
Oral prednisolone, methylprednisolone, budesonide, hydrocortisone
Only use short term when symptoms are severe- not for maintenance use
Example of antibiotics used in crohns
When are they used
Metronidazole
Ciprofloxacin
Fistulating crohns
Drugs used in IBD
ibd ACT BAD
Aminoglycosides
Corticosteroids usually 4-8 weeks
Thiopurine/mercaptopurine- immunosuppressants
Biological agents
Antibiotics
Diarrhoea- loperamide, cholestyramine, codeine+constipation drugs
Dont use diarrhoea drugs in UC or crohns?
Acute Ulcerative colitis
Whats proctitis
Inflammation of the lower end of the large intestine leading to anus
Proctitis treatment
examples
1st and 2nd line and 3rd line
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
Extensive UC treatment
Topical aminosalicylate and high dose oral aminosalicylate
Proctosigmoiditis and left UC treatment
Topical aminosalicylate
Acute severe UC treatment
IV corticosteroids and Infliximab (monoclonal antibody)
Maintaining remission in mild, moderate and severe UC meaning
Treatment?
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
Complications of ulcerative colitis
Colorectal cancer
Secondary osteoporosis
Venous thromboembolism
Toxic megacolon
Why do we avoid antidiarrhoeal drugs in acute UC
it can cause toxic megacolon
Whats toxic megacolon
Life threatening- when colon widens
Which aminosalicylate has the most SE. Which have fewer SE
Sulfasalazine - oldest aminosalicylate
Olsalazine, balsalazide, mesalazine are newer ones with fewer SE
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?
Unexplained bleeding, bruising purpura, sore throat, fever or malaise
A patient taking mesalazine presents with the symptoms unexplained bleeding, bruising purpura, sore throat, fever or malaise. What is this?
Bone marrow suppression
Refer
A patient with UC performs a FBC and is at suspicion of blood dyscrasia, what do you do?
Stop aminosalicylate immediately
Aminosalicylates change bodily fluids to what colour
Orange/ yellow
Monitoring requirements for aminosalicylates
Renal function before treatment, at 3 months and then annually
Dont give aminosalicylates to those sensitive to ……..
Aspirin
Do aminosalicylates affect the kidney?
May cause nephrotoxicity
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
Immunosuppressants- azathiopurine or mercaptopurine
