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Management of GI and Endocrine Conditions > Lecture 5 - Inflammatory Bowel Disease > Flashcards

Lecture 5 - Inflammatory Bowel Disease Flashcards

1
Q

What is inflammatory bowel disease?

A

Ulcerative colitis and crohn’s disease

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2
Q

What are ulcerative colitis and crohn’s characterised by?

A

inflammation, swelling and ulceration of the intestinal tissue

they are chronic with periods of remission

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3
Q

symptoms of IBD?

A

stomach pain, weight loss, diarrhoea (blood/mucus) and tiredness

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4
Q

What else can IBD cause?

A

Joint pain, inflamed eyes and rashes

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5
Q

Where does ulcerative colitis effect?

A

the large bowel

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6
Q

Where does Crohn’s affect?

A

any area of the GI system from mouth to anus and all layers of tissue can be inflamed

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7
Q

How to diagnose IBD?

A

symptoms presented
blood tests for anaemia, vit deficiencies and inflammatory markers

xray, CT and MRI scans

sigmoidoscopy and colonoscopy

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8
Q

How to diagnose crohn’s disease?

A

small bowel enema and small capsule endoscopy

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9
Q

what is a small capsule endoscopy?

A

A patient swallows a large capsule with a camera in it which sends images back to the computer, patient passes capsule and it is removed

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10
Q

What is a sigmoidoscopy?

A

small camera inserted into the rectum and moves to the lower part of the rectum

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11
Q

What causes IBD?

A

genetic links

autoimmune disease

environmental

previous infection

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12
Q

When is IBD most common to occur?

A

In late teens to early 20s, with most diagnosed by the time they are 30

most common in white ethnic groups

more common in women than men

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13
Q

How many people in the UK are affected?

A

one in every 350

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14
Q

What are the aims of IBD treatment?

A

induce and maintain remission

reduce symptoms and improve quality of life

reduce inflammation
reduce autoimmune response

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15
Q

what can be used to reduce inflammation?

A

Steroids, aminosalicylates, cytokine modulators

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16
Q

What can be used to reduce autoimmune response?

A

Immunosuppressant drugs

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17
Q

What should we consider when deciding treatment?

A

Clinical severity of the disease (e.g. how much of the colon is affected) and the patient preference

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18
Q

How are corticosteroids administered?

A

orally or rectally

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19
Q

Formulations of corticosteroids?

A

GR or MR formulations, enemas or foams

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20
Q

Examples of corticosteroids?

A

hydrocortisone

beclomethasone

budesonide

prednisolone

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21
Q

What is an enema?

A

A liquid that comes in a tube and is administered rectally

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22
Q

What is a foam?

A

aerosol that the patient can administer themselves, more palatable than the enema

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23
Q

What do corticoseroids do?

A

reduce inflammatory mediators directly and also have effects on expression of genes associated with inflammatory and anti-inflammatory proteins

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24
Q

Cautions of corticosteroids?

A

congestive heart failure, hypothryoidism, osteoporosis, untreated infection

25
Side effects of cortocosteroids?
insomnia, dyspepsia, Cushing's syndrome, impaired healing, adrenal suppression with long term use
26
Interactions of corticosteroids?
grapefruit juice increases plasma concentration or oral budesonide, corticosteroids antagonise diuretic effects
27
What is Cushing's syndrome?
when there is too much cortisol in the body from the cortisol in corticosteroids
28
Symptoms of Cushing's syndrome?
weight gain around chest and tummy area, disproportionate fat deposits in the back of the neck, red and puffy faces
29
How are aminosalicylates administered?
orally or rectally
30
Aminosalicylate formulations?
MR tabs/caps, granules, suspensions or foam, suppository, enemas
31
Examples of aminosalicylates?
balsalazide mesalazine olsalazine sulfasalazine
32
Rare side effects of aminosalicylates?
blood disorders
33
What do patients need to report when taking aminosalicylates?
unexplained bleeding, bruising, purpura, sore throat, fever or malaise
34
What needs to be checked when taking aminosalicylates?
Renal function should be checked before starting oral therapy, 3 months later then annually
35
What is a problem with aminosalicylates?
Salicylate sensitivity
36
Side effects of sulfasalazine?
colours urine and contact lenses orange - tear ducts and tears are eventually orange decreases concentration of digoxin and absorbs folates
37
What are cytokine modulators?
Monoclonal antibodies which inhibit pro-inflammatory cytokine, tumour necrosis factor alpha (specialist use)
38
How are cytokine modulators administered?
By subcutaneous administration
39
Examples of cytokine modulators?
Infliximab adalimumab golimumab vedolizumab
40
How do cytokine modulators work?
stop the expansion of activated T cells by interrupting the calmodulin-calcineurin cascade
41
What effects do immunosuppressants have?
T cell effects
42
How are immunosuppressants administered?
Orally or by injection
43
Examples of immunosuppressants?
azathioprine, ciclosporin, mercaptopurine, methotrexate
44
Why do immunosuppressants require regular monitoring?
Anti cancer drugs with blood toxicity and liver toxicity need monitoring of blood counts and organ function for safe use
45
How often is methotrexate taken?
weekly
46
What is taken alongside methotrexate?
folic acid to reduce the side effects
47
What tablets of methotrexate are used?
2.5mg
48
Side effects of methotrexate?
sore throat, bleeding, bruising, mouth ulcer need to be reported
49
What needs to be monitored when taking methotrexate?
full blood count, renal and liver function
50
What is methotrexate classes as in CMS?
high risk drug
51
What should patients carry when on methotrexate?
Patient safety card incase they are seen by paramedics or medical staff
52
How is mild disease of IBD treated?
mild disease in rectum and recto-sigmoid is treated locally with steroid or aminosalicylate
53
How is diffuse or unresponsive IBD treated?
Orally with steroid or aminosalicylate (alone or in combination with rectal therapy)
54
How is severe IBD treated?
Parenteral administration | steroid, immunosuppression and antibody therapy
55
Non drug treatment for IBD?
smoking cessation = smoking is the most modifiable risk factor attention to diet - low residue foods, trigger foods surgery - stoma and resection operations
56
What foods should people with IBD avoid?
stick to low residue foods (residue is what sticks in the bowel after digestion) avoid wholegrains, raw veg, dried fruit, seeds and nuts
57
What is a stoma operation?
part of the bowel is removed
58
What is resection surgery?
remove inflamed section and rejoin the bowel to bypass the problem

Management of GI and Endocrine Conditions (24 decks)

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