Lower GI Disease Flashcards
How does UC present?
Mucosa of rectum + colon inflamed
What are the causes of UC?
Environmental + immunological
Most likely autoimmune condition triggered by colonic bacteria
What are the risk factors of UC?
Family history, oral contraceptives + non-smoking
How does CD present?
Inflammation of mucosa any where from mouth to anus
What are causes of CD?
Immune-mediated caused by environmental trigger in genetically susceptible people
What are the risk factors of CD?
Family history, smoking, drugs
What are UC + CD?
IBD
What is the first test that can be done for IBD?
FBC
FBC = first blood count
= anaemia due to blood loss, malabsorption, malnutrition
= increased platelet count
= suggest active inflammation
What is the 2nd test that can be done for IBD?
Inflammatory markers
CRP + ESR raised in active inflammation
What is the 3rd test that can be done for IBD?
U&Es
Assess electrolyte disturbance or dehydration
What is the 4th test that can be done for IBD?
LFT
May indicate protein-losing enteropathy = lead to malnutrition
What is the 5th test that can be done for IBD?
Vitamin B12 + Vitamin D
Nutritional deficiences
How do you control symptoms of diarrhoea?
Diet
Antibiotic colitis
Do NOT give anti-diarrhoeal = stops motility
How do you control symptoms of constipation?
Check for bowel obstruction
Obstruction unlikely = tackle diet, fibre + fluids
Bulk-forming laxative - eg. ispaghula
How do you control symptoms of abdominal pain?
Now obstruction = hospital
Paracetamol for relief
Why are opiates + NSAIDs NOT recommended for abdominal pain?
Opiates = constipating effect
NSAIDs = gastric problems
What are the clinical features of acute flare of UC?
5 stools a day plus
Temp increases
Tachycardia >90bpm
Anaemia
Blood in stool
What are the other clinical features of UC?
Bloody diarrhoea > 6 weeks
Rectal bleeding
Nocturnal defecation
Faecal urgency
Abdominal pain (left quadrant)
Pre-defecation pain
What are the treatment options for UC?
5-aminosalicylates
Steroids
Immunosuppressants
Ciclosporin
Biologics
Surgery
Describe 5-ASA use for UC
Short term = induce remission
Long term = maintenance
Oral or rectal
When is oral 5-ASA for UC used?
Higher up GI tract
When is rectal 5-ASA for UC used?
Low in GI tract
= local + systemic action
What side effect of 5-ASA?
Discolours tears or urine
Sensitivity to light
What is sometimes required for 5-ASA?
Require prescribing by brand
= narrow therapeutic window
= need to be kept on same brand
eg. mesalazine
Describe steroids use for UC
Short term = induce remission
Used with or instead of 5-ASA
Oral or rectal
With food
In morning
What is required for use of steroids if long term use?
Tapering
Why are steroids NOT used long term?
Osteoporosis
Diabetes
Hypertension
What are the side effects of steroids?
Ance
Weight gain
Increase appetite
Describe immunosuppressant use for UC
Relieve symptoms if steroids can’t
Tablet once a day BUT sometimes given as injections
Why are steroids taken in the morning?
Reduce disturbance to sleep
Why are immunosuppressants given as injections?
1x every few months
= improves adherence
What are the side effects of immunosuppressants?
Feeling + being sick
Increased risk of infection + liver problems
What are examples of immunosuppressants?
Azathioprine + mercaptopurine
What is ciclosporin?
More powerful immunosuppressant
Describe use of biologics for UC
Reduce inflammation
Moderate to severe UC
Given for 12 months
Infusions
What are side effects of UC?
Increased risk of infection
Vertigo
Describe use of surgery for UC
Removes colon
What is an ileostomy?
Small intestine diverted out of hole in abdomen
What is ileo-anal pouch?
Part of small intestine used to create internal pouch then connected to anus
What is problem with oral contraceptives with women who have IBD?
Less reliable
= malabsorption
= vomiting
Why can’t barrier methods (condoms) just be suitable alone for women?
Teratogenic drugs
eg. mercaptopurine
Does IBD affect fertility?
NO
BUT some drugs can
eg. teratogenic drugs stopped 3 months before trying to conceive
What are the clinical features of CD?
Unexplained persistent diarrhoea (4-6 weeks)
Abdominal pain
Weight loss
Mouth ulcers
Clubbing
Perianal pain
What are the treatments for CD?
NO cure
Steroids = episodic
Liquid diet
Immunosuppressants
Biological medicines
Sugery
Describe use of steroids for CD
May need couple of months
Long term effects
Describe liquid diet for CD
Drinks contain nutrients
Avoids risk of slower growth
What are side effects of liquid diet?
Nausea
Diarrhoea
Constipation
Describe use of surgery for CD
Relieve symptoms + help stop them coming back
BUT is it really viable if can happen throughout GI?
What does the main operations for CD involve?
Small cuts in abdomen = keyhole surgery
Removing small, inflamed sections of bowel
Stitching healthy parts together
What is the routine review for IBD?
Under care of consultant gastroenterologist
Check mental health
Compliance with meds
Contraceptive advice
Make aware need for colonscopic surveillance of colorectal cancer
