Case 15 Flashcards
(25 cards)
Main Drug treatment of UC
5-aminosalicylic acid (mesalazine) , corticosteroids, immunosuppressive drugs (azathioprine), anti-TNF drugs, dietary therapy, antibiotics)
Main drug treatment of Crohn’s
Corticosteroids, Immunosuppressive drugs- azathioprine, anti-Tnf, dietary therapy, antibiotics
Drug therapy for active disease in UC
Mesalazine, corticosteroid, Anti-TNF
Maintenance of remission- UC
Mesalazine, azathioprine/6-mercaptopurine, anti-TNF, vedolizumab, tofacitinib
Crohn’s active disease drug therapy
Budesonide, dietary therapy (kids) , antibiotics (perianal disease), prednisolone (systemically active corticosteroid), anti-TNF
Maintenance of remission- Crohn’s
Azathioprine, methotrexate, Anti- TNF, vedolizumab, ustekinumab
What type of drug is vedolizumab?
Gut-specific Lymphocyte traffic inhibitor. Stops the lymphocyte from trafficking inside. Blocks integrin
Anti-TNF antibodies
Infliximab, certolizumab pegol, adalimumab
General characteristics of UC
Diffuse mucosal inflammation limited to colon, affects rectum, may involve all or part of rest of colon
General aspects of Crohn’s
Patchy transmural inflammation, may affect any part of the GI tract
Symptoms of UC
Rectal Bleeding, diarrhoea, urgency, abdo pain
Extraintestinal manifestations of IBD
Aphthous stomatitis, episcleritis and uveitis, arthritis, vascular complications, e.nodosum, p.gangrenosum
Clinical patterns of Crohn’s
Inflammation, fistulization, obstruction, microperforation
Early presentations of Crohn’s
LQ pain, tenderness, diarrhea, fever, anorexia, weight loss
Endoscopic spectrum of severity in UC
Normal colon- mucosa is shy, pale pink and retains a delicate, reticulate vascular pattern
Mild- mucosa becomes duller and redder, often with a granular or fine sandpaper- like texture and vascular patter is obscured
Moderate - gross pitting of the mucosa is seen - lining may crumble away and bleed at the lightest tough - friability
Severe- macroulceration with mucopurulent exudate and spontaeous haemorrhage
Most dangerous acute complication of UC
TOXIC MEGACOLON.
- Occurs when the ulcerating, inflammatory process dissects deeply through the wall of the colon
Radiologic sign- accumulation of gas over a long segment of colon
Maximal dilatation
representing a combination of pseudopolyps and submucosal edema.
Early warning sign of impending malignant transformation in UC
Cellular atypia or dysplasia
However, dysplasia has to be found independent of severe inflammation
Most common cutaneous manifestation in Crohn’s
Erythema nordosum
Most common cutaneous manifestation in Ulcerative colitis
Pyoderrna gangrenosum
Extra-intestinal complications unrelated to disease activity - central arthropathy
Ankylosing spondylitis (associated with HLAB27) Sacro-iliitis
Liver disease complicated of UC
- Primary sclerosing cholangitis
- Steatosis (fatty liver)
- Chronic hepatitis
- Cirrhosis
Two clinical patterns of Crohn’s disease
Stricturing (obstructive) or penetrating (fistulizing)
Signs and symptoms of Inflammatory Crohn’s
- Pain
- Tenderness
- Diarrhea
- Low-grade fever
- Weight loss (anorexia)
Signs and Symptoms of Obstructive Crohn’s
- Post-prandial cramps
- Distention
- Borborygmi
- Vomiting
- Weight loss (food avoidance)
