chronic bowel disorder Flashcards
(7 cards)
coeliac disease management
autoimmune disease that causes an immune response in intestinal mucosa
associated with gluten, wheat, barley, rye
can cause malabsorption of nutrients
management:
symptoms - abdominal pain, bloating,
malnutrition - give vit D, calcium etc.
- gluten free diet to avoid complications such as osteoporosis, malnutrition, cancer
diverticular disease and diverticulitis
conditions that affect large intestine, bowel - cause abdominal pain
- caused by small pouches in wall of intestine called diverticula
diverticulosis - small pouches but asymptomatic
diverticular disease - small pouches and symptomatic - constipation, diarrhoea, abdominal pain, rectal bleed
treat with fibre, bulk forming laxatives, paracetamol, anti-spasmodics if needed
diverticulitis - when pouches become inflamed/infected
- usually no antibiotics
- uncomplicated - co-amox
- complicated - IV co-amox+metro or amox + gentamicin
complicated diverticulitis - abscess, fistula, perforation, obstruction, sepsis, haemorrhage
crohn’s disease management
CD - affects whole GIT, associated with thickened walls extending through all layers + deep ulceration
complications:
intestinal stricture or fistulae
anaemia and malnutrition
colorectal or small bowel cancer
acute:
1 flare up in 12 month period
- pred, methylpred or IV hydrocortisone
- if distal ileal or right sided - budesonide can be used if others dont work
aminosalicylates can be used - less S.E but less effective
2+ flares within 12 month period
- add on azathioprine/mercaptopurine
- methotrexate if aza/merc c/i
- severe: monoclonal antibodies
maintenance:
- smoking cessation
- monotherapy with azathioprine/mercaptopurine
- methotrextate
after surgery: azathioprine + metronidazole
when diarrhoea associated:
loperamide, codeine, colestyramine
- can use loperamide + codeine in CD not UC
fistulating CD:
- when fistula develops b/w intestine and perianal skin, bladder or vagina
- for symptoms - not fully heal - metronidazole +/- ciprofloxacin
- metro usually given for 1 month (no more than 3 months due to peripheral neuropathy)
- maintenance with azathioprine/mercaptopurine (infliximab if not responding)
- treatment must last at least 1 year
UC
UC - can affect rectum to whole of colon
- associated with bloody diarrhoea, defeaecation urgency, abdominal pain
- most common in 15-25 year olds
- complications such as colorectal cancer, secondary osteoporosis, VTE, toxic megacolon
types:
proctitis
proctosigmoiditis
distal/left sided
extensive colitis
pancolitis
UC follows a continuous pattern, whereas CD is patchy
UC acute treatment (mild to moderate)
proctitis - distal - topical preparations
extensive - systemic needed
diarrhoea - avoid loperamide + codeine - can cause toxic megacolon
proctitis:
1 - topical aminosalicylate
2- if no improvement in 4 weeks - add oral aminosalicylate
3 - still no improvement - topical or oral corticosteroids for 4-8 weeks
Pt can use oral aminosalicylate as 1st line if preferred (less effective)
proctosigmoiditis/left sided UC:
1 - topical aminosalicylate
2 - add high dose oral aminosalicylate if no improvement in 4 weeks OR high dose oral aminosalicyate + topical corticosteroids for 4-8 weeks
3 - stop topical - high dose oral aminosalicylate + oral corticosteroid for 4-8 weeks
extensive colitis:
1 - topical aminosalicyate + high dose oral aminosalicylate
2 - if no improvement in 4 weeks - stop topical - high dose oral amino + oral corticosteroid for 4-8 weeks
severe:
life-threatening, medical emergency
- IV hydrocortisone or methylpred - assess need for surgery
- if steroids c/i - IV ciclosporin, Infliximab
UC maintenance treatment
oral aminosalicylate recommended
- corticosteroid not suitable due to s.e
proctitis/proctosigmoiditis - topical +/- oral aminosal
left sided/extensive - low dose oral aminosal
2+ flare ups in 12 month period
- oral azathioprine or mercaptopurine
- monoclonal antibodies if no effect
imp points for aminosalicylates
sulfasalazine, mesalazine, olsalazine, balsalazide
nephrotoxic - monitor at initiation, at 3 months, then annually
hepatotoxic - monthly for first 3 months
blood disorders - monthly for first 3 months
c/i in salicylate hypersensitivity
sulfasalazine stains contact lenses orangey-yellow
