Chapter 1 BNF (Chronic Bowel Disorders) Flashcards
What is coeliac disease? What are the symptoms and what is the treatment?
adverse reaction to gluten
Diarrhoea, abdominal pain, bloating
Life long gluten free diet
assess risk of osteoporosis
vitamins and suppliments
What is Diverticulitis, what are the symptoms and what are the treatments?
small bulges or pockets in the lining of the intestines (diverticula) and become inflammed.
lower abdominal pain, constipation, diarrhoea
High fibre diet
bulk forming drugs (evidence limited)
antibiotics
What drugs are containdicated in an acute flare up of ulcerative colitis?
codeine/loperamide (avoid antimotility and antispasmodics…risk of toxic megacolon
What is the best route of administration for treating:
Extensive colitis
Left sided colitis
proctosigmodoiditis
proctitis
Extensive: oral
left sided colitis: enema
proctosigmoditis: foam preparations
proctitis: suppositories
pancolitis (entire colon)
What is first line in acute mild-moderate ulcerative colitis (proctitis, proctosigmoditis)?
First Line: Aminosalicylate (rectal)
Alternative: rectal steroid or oral prednisolone
What is first line in acute mild-moderate ulcerative colitis (extensive colitis, left sided colitis)?
First Line: High Dose oral aminosalicylate
+ rectal aminosalicylate or oral beclometasone
alternative: oral prednisolone alone
What is first line in acute moderate-severe ulcerative colitis
oral prednisolne
alternative; monoclonal antibodies
Whats the next step if patient does not respond to aminosalicylate in ulcerative colitis?
if no response after 4 weeks
add oral prednisolone (discontinue any other steroid)
add tacrolimus
What should be used to treat very severe acute ulcerative colitis?
First line: IV Steroid or iv ciclosporin
second line (symptoms dont improve in 72hrs): iv ciclosporin (or infiximab) + iv steroid
What can be offered for maintainance of remission in ulcerative colitis?
Proctitis/Proctosigmoiditis - rectal ASA alone or with oral
extensive/left sided - low dose oral ASA
When can Azathioprine and mercaptopurine be used in ulcerative colitis?
2+ flare ups requiring steroids in 12 months
what lifestyle advice can be offered for Crohns Disease?
high fibre
smoking cessation
loperamide or codeine (not in UC)
Whats the treatment for 1 acute flare up in 12 months/ first presentation of Crohns Disease?
Prednisolone, methylprednisolone, IV hydrocortisone
budosenide
Whats the treatment for 2 acute flare ups in 12 months in crohns disease?
Azathioprine/ Mercaptopurine
Alternative: Methotrexate
Whats the treatment for maintance of remission in Crohns Disease?
Azathioprine or mercaptopurine
alternative: methotrexate
after surgery (ASA also an option)
