part 9

Question 1

• more effective for ulcerative colitis
• first line for mild-mod Crohn’s
• helps achieve remission and prevent flare-ups of IBD
• decreases inflammation by suppressing cytokines

Answer 1

5-ASA
5-aminosalicyclic acid
-the higher the dose the more likely to put IBD in remission, but a high dose causes N/V, headaches, and fatigue

Question 2

• used to achieve remission in IBD
• decreases inflammation
• helpful in acute flare-ups

Answer 2

corticosteroids

Question 3

• med requires regular CBC monitoring (can lead to inflammation of pancreas and liver)
• suppresses immune response
• maintains remission after corticosteroid induction therapy

Answer 3

immunosuppressants

Question 4

prevent or treat secondary infection with IBD

Answer 4

antimicrobials

Question 5

• inhibit the cytokine tumor necrosis factor

- prevent migration of leukocytes from bloodstream to inflamed tissue

Answer 5

biologic and targeted therapy (immunomodulators)

Question 6

Why might a pt with IBD need surgery?

Answer 6

• drainage of abd abscess
• failure to respond to therapy
• fistulas
• inability to decrease corticosteroids
• hemorrhage
• perforation
• severe anorectal disease
• intestinal obstruction

Question 7

What is a curative surgery for ulcerative colitis?

Answer 7

total proctocolectomy with ileal pouch/anal anastomosis (IPAA)

Question 8

• most common for ulcerative colitis
• diverting ileostomy
• ileal pouch is created and anastomosed directly to anus
• 2 procedures 8-12 weeks apart
• pt resume control at anal sphincter
• major complication sis acute or chronic pouchitis

Answer 8

IPAA: total proctocolectomy with ileal pouch/anal anastomosis

Question 9

• one stage surgery
• removal of colon, rectum, and anus with closure
• continence is not possible (stoma is usually placed below the belt line)

Answer 9

total protocolectomy with permanent ileostomy

Question 10

Why are surgical procedures commonly performed for Crohn’s disease?

Answer 10

-commonly performed for complications: 
strictures
obstructions
bleeding 
fistula 
disease will often reoccur at anastomosis sight

Question 11

With Crohn’s disease repeated removal of the small intestine can lead to what?

Answer 11

short bowel syndrome

Question 12

What are the risks with short bowel syndrome?

Answer 12

• too little small intestine surface area to maintain normal nutrition and hydration
• lifetime fluid boluses and parenteral nutrition may be needed