Flashcards in Crohn's disease Deck (31):
What are the two types of Inflammatory bowel diseases?
What does Crohn's affect?
Any part of the GI tract
What type of inflammation is associated with crohn's?
The inflammation is deeper than Ulcerative colitis's inflammation
What effect does smoking have on crohn's disease?
What is the cytokine profile in Crohn's disease?
What is the immunopathology of Crohn's disease?
Mediated by T Help 2 cells
CD 4+ T cells
What is the pathology of Crohn'sdisease?
Focal and discontinuous inflammation
Formation of eroding fissures
Paneth cell function problem - problem with the signalling between commensal bacteria and Endothelial cells.
Results in autophagy and ER stress
What are the symptoms of Crohn's disease?
What is the genetic link of Crohn's?
What are complications of Crohn's disease?
Small bowel obstruction
What is used to treat a mild flare up of Crohn's ?
What is used to treat a severe flare up of Crohn's ?
Hydrocortisone - treats the rectal disease
Metronidazole - treats perianal disease
Infliximab - fistulising Crohn's
Adalimumab - fistulising Crohn's
What inflammatory cytokines are produced in Crohn's disease?
What can aggravates Crohn's?
Smoking - makes it a lot worse.
What effect does diet have on crown's?
No known the pathogenesis in Crohn's - though they diet can induce symptoms
What are the therapy options for Crohns?
How are steroids used for crohn's?
Used as a "bridge"
They are not that helpful
What immunosuppressive therapy is used in Crohn's?
azathioprine / mercaptopurine
If Azathioprine is prescribed what must be done?
Check white blood cell count
How is Azathioprine metabolised?
Meetbolised to 6 - MP
6- MP can be metabolised to 6-MMP by TPMT (which reduces omsk of the reactive constituents)
6- MP can also be metabolised to 6- TU by xanthine oxidase
6- MP can be metabolised by HPRT to 6-TGN (this is the active form)
What are the side effects of azathioprine?
Small risk of lymphoma, skin cancer
What are the prescribing methods for azathioprine?
TPMT activity contributes to toxicity
Avoid co-prescription of allopurinol (XO inhibitor)
Regular blood monitoring required
What is TNF alpha?
What anti-tnf therapy can be used and what is its effect?
Infliximab (Once every 2 months)
Adaliumumab (Can be injected from home)
How do anti-TNF therapy work?
Promote apoptosis of activated T lymphocytes
8-12 weeks of remission
Reduces hospitalisation needed for surgery
What are the problems associated with anti-TNF alpha treatment?
Cancer - lymphoma
What medical emergencies can occur in IBD?
Small bowel obstruction
How is perianal abscess in crohn's disease treated?
Insertion of a Seton thread through the abscess
What is the therapy pyramid for Crohn's?
What levels in the blood must be done to see if imunosupressive therapy is appropriate?