Lecture 5: Management of Inflammatory Bowel Disease Flashcards
What is inflammatory bowel disease?
ulcerative colitis and crohns disease
What are the symptoms of IBD?
stomach pain
weight loss
diarrhoea with blood/ mucus
tiredness
joint pain
inflamed eyes
rashes
What is the difference between ulcerative colitis and crohns disease?
Ulcerative Colitis only affects the large bowel and the inflammation is on the inner lining
Crohn’s Disease can affect any area of the GI system and all layers of tissue can be inflamed
How is IBD diagnosed?
- Symptoms
- Blood tests for anaemia, vitamin deficiencies and inflammatory markers
- X-ray examination, CT + MRI scans
- Sigmoidoscopy and colonoscopy
What causes IBD?
- Genetic links
- Autoimmune disease
- Environmental
- Previous infection
What are the cautions included with corticosteroids?
- congestive heart failure
- hypothyroidism
- osteoporosis
- untreated infection
What are the side effects of corticosteroids?
- Insomnia
- Dyspepsia
- Cushings syndrome
- Impaired healing
- Adrenal suppression with long term use
What drugs are used to treat IBD?
- steroids
- aminosalicylates: balsalazide, mesalazine, olsalazine, sulfasalazine
- cytokine modulators
- immunosuppressant drugs
What is the effect of sulfasalazine?
Colours urine and contact lenses orange, decreases concentration of digoxin and absorption of folates
What are cytokine modulators?
Monoclonal antibodies which inhibit pro-inflammatory cytokine, tumour necrosis factor alpha
Administered by subcutaneous administration
infliximab, adalimumab, golimumab, vedolizumab
Briefly - stop the expansion of activated T cells by interrupting the calmodulin-calcineurin cascade
Name immunosuppressants used in IBD
azathioprine, ciclosporin, mercaptopurine, methotrexate
How do you treat mild IBD in the rectum and recto sigmoid?
local steroid or aminosalicylate
How do you treat severe cases of IBD?
Parenteral administration - steroid, immunosuppression and antibody therapy
What is non drug treatment of IBD?
- Smoking cessation
- Attention to diet
- Surgery: stoma, resection operations
What is non drug treatment of IBD?
- Smoking cessation
- Attention to diet
- Surgery: stoma, resection operations
