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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
Q

Side effects of cortocosteroids?

A

insomnia, dyspepsia, Cushing’s syndrome, impaired healing, adrenal suppression with long term use

26
Q

Interactions of corticosteroids?

A

grapefruit juice increases plasma concentration or oral budesonide, corticosteroids antagonise diuretic effects

27
Q

What is Cushing’s syndrome?

A

when there is too much cortisol in the body from the cortisol in corticosteroids

28
Q

Symptoms of Cushing’s syndrome?

A

weight gain around chest and tummy area, disproportionate fat deposits in the back of the neck, red and puffy faces

29
Q

How are aminosalicylates administered?

A

orally or rectally

30
Q

Aminosalicylate formulations?

A

MR tabs/caps, granules, suspensions or foam, suppository, enemas

31
Q

Examples of aminosalicylates?

A

balsalazide

mesalazine

olsalazine

sulfasalazine

32
Q

Rare side effects of aminosalicylates?

A

blood disorders

33
Q

What do patients need to report when taking aminosalicylates?

A

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

34
Q

What needs to be checked when taking aminosalicylates?

A

Renal function

should be checked before starting oral therapy, 3 months later then annually

35
Q

What is a problem with aminosalicylates?

A

Salicylate sensitivity

36
Q

Side effects of sulfasalazine?

A

colours urine and contact lenses orange - tear ducts and tears are eventually orange

decreases concentration of digoxin and absorbs folates

37
Q

What are cytokine modulators?

A

Monoclonal antibodies which inhibit pro-inflammatory cytokine, tumour necrosis factor alpha (specialist use)

38
Q

How are cytokine modulators administered?

A

By subcutaneous administration

39
Q

Examples of cytokine modulators?

A

Infliximab

adalimumab

golimumab

vedolizumab

40
Q

How do cytokine modulators work?

A

stop the expansion of activated T cells by interrupting the calmodulin-calcineurin cascade

41
Q

What effects do immunosuppressants have?

A

T cell effects

42
Q

How are immunosuppressants administered?

A

Orally or by injection

43
Q

Examples of immunosuppressants?

A

azathioprine, ciclosporin, mercaptopurine, methotrexate

44
Q

Why do immunosuppressants require regular monitoring?

A

Anti cancer drugs with blood toxicity and liver toxicity

need monitoring of blood counts and organ function for safe use

45
Q

How often is methotrexate taken?

A

weekly

46
Q

What is taken alongside methotrexate?

A

folic acid to reduce the side effects

47
Q

What tablets of methotrexate are used?

A

2.5mg

48
Q

Side effects of methotrexate?

A

sore throat, bleeding, bruising, mouth ulcer

need to be reported

49
Q

What needs to be monitored when taking methotrexate?

A

full blood count, renal and liver function

50
Q

What is methotrexate classes as in CMS?

A

high risk drug

51
Q

What should patients carry when on methotrexate?

A

Patient safety card incase they are seen by paramedics or medical staff

52
Q

How is mild disease of IBD treated?

A

mild disease in rectum and recto-sigmoid is treated locally with steroid or aminosalicylate

53
Q

How is diffuse or unresponsive IBD treated?

A

Orally with steroid or aminosalicylate (alone or in combination with rectal therapy)

54
Q

How is severe IBD treated?

A

Parenteral administration

steroid, immunosuppression and antibody therapy

55
Q

Non drug treatment for IBD?

A

smoking cessation = smoking is the most modifiable risk factor

attention to diet - low residue foods, trigger foods

surgery - stoma and resection operations

56
Q

What foods should people with IBD avoid?

A

stick to low residue foods (residue is what sticks in the bowel after digestion)

avoid wholegrains, raw veg, dried fruit, seeds and nuts

57
Q

What is a stoma operation?

A

part of the bowel is removed

58
Q

What is resection surgery?

A

remove inflamed section and rejoin the bowel to bypass the problem

Management of GI and Endocrine Conditions (24 decks)

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