Management of IBD

Question 1

IBD characteristics

Answer 1

Ulcerative colitis + Crohn’s disease

Inflammation, swelling, intestinal ulceration

Question 2

IBD symptoms

Answer 2

Stomach pain
Weight loss
Diarrhoea (mucus/blood)
Tiredness

Join pain, Inflamed eyes, rashes

Question 3

Ulcerative colitis

Answer 3

Affects large bowel
Inflammation on inner lining

Question 4

Crohn’s disease

Answer 4

Affects any area of GI system
Inflammation in all tissues

Question 5

IBD diagnosis

Answer 5

Blood test: anaemia, vitamin deficiencies, inflammatory markers
X-ray examination
CT + MRI scan
Sigmoidoscopy and colonoscopy

CD: enema, endoscopy

Question 6

IBD causes

Answer 6

Genetic link
Autoimmune disease

Question 7

IBD prevalence

Answer 7

Late teens/early 20s
White ethnic groups
Women > men

Question 8

IBS Treatment

Answer 8

Inflammation
-Steroids
-Aminosalicylates
-Cytokine modulators

Autoimmune response
-Immunosuppressant drugs

Question 9

Corticosteroids

Answer 9

Orally/rectally

Hydrocortisone
Beclomethasone
Budenoside
Prednisolone

Question 10

Corticosteroids cautions

Answer 10

Congestive heart failure
Hypothyroidism
Osteoporosis

Question 11

Corticosteroids side effects

Answer 11

Insomnia
Dyspepsia
Cushing’s syndrome
Impaired hearing
Adrenal suppression (long term use)

Question 12

Corticosteroids interactions

Answer 12

Sntagonise diuretic effect

Budesonide - Grapefruit juice

Question 13

Aminosalicylates

Answer 13

Orally/rectally

Balsalazide
Mesalazine
Olsalazine
Sulfasalazine

Question 14

Aminosalicylates side effects

Answer 14

Blood disorders
Bruising
Sore throat]
Fever

Check renal function

Question 15

Sulfasalazine

Answer 15

Orange urine and contact lenses
Decreases concentration of digoxin
Decreases absorption of folates

Question 16

Cytokine modulators

Answer 16

Subcutaneous

Infliximab
Adalimumab
Golimumab
Vedolizumab

Question 17

Cytokine modulators MOA

Answer 17

Stop expansion of activated T cells - interacting with calcineurin cascade

Question 18

Immunosuppressants

Answer 18

Orally/injections

Azathioprine
Ciclosporin
Mercaptopurine

Methotrexate

Question 19

Immunosuppressants caurions

Answer 19

Anticancer drugs with blood toxcity and liver toxicity

Question 20

Methotrexate

Answer 20

Weekly dose 2.5mg tablets
Follow up with folic acid

Question 21

Methotrexate side effects

Answer 21

Sore throat
Bleeding
Bruising
Mouth ulcers

Question 22

Methotrexate cautions

Answer 22

FBC, renal and liver monitoring

Question 23

Treatment use

Answer 23

Mild in rectum - local steroid/aminosalicylate

Diffuse/unresponsive IBD - orally

Severe - parental administration, steroid, immunosuppressant and antibody therapy

Question 24

Non-drug treatment

Answer 24

Smoking cessation
Attention to diet
Stoma operations
Resection operations