Flashcards in Crohn's Disease and Ulcerative Colitis Deck (36):
What is the anatomy of the colon of the gastro intestinal tract?
1. Ascending right colon
2. Transverse colon
3. Descending left colon
4. Sigmoid colon
7. Caecum and appendix
What is inflammatory bowel disease, what are the two main forms called and common symptoms?
1. The name of a group of disorders that cause the intestine to become inflamed
2. 2 main forms:
- Crohn's disease
- Ulcerative Colitis
3. Peak occurrence: 15 to 40 years agent
4. Common symptoms: abdominal cramps, pain, diarrhoea and weight loss
What are though to be the causes of inflammatory bowel disease?
1. Both seen as autoimmune disorders- trigger to cause inflammation
2. Genetic factors
How do you diagnose inflammatory disease?
Blood tests to see general signs of inflammation and anaemia, vitamin and mineral deficiencies
Stool test to rule out infections and diarrhoea
Examination of the bowel: endoscope
Biopsies taken during endoscopy; microscopy to confirm diagnosis
X rays, CT, MRI scans: location and extent of inflammation
Describe what Crohn's disease is?
Chronic inflammatory disease of the GI tract that is relapsing and remitting
Inflammation which extends all the way through he intestinal wall from mucosa to serosa
Affects four layers of GI tract: deep to superficial are mucosa, submucosa, muscularis and serosa
What are the two factors that are likely to play a role in developing Crohn's disease?
2. Genetic deposition
What does surgical resection mean and what does it do to Crohn's disease?
1. Surgical removal
2. May temporarily arrest symptoms, subsequent inflammation is likely to occur
3. Does not cure Crohn's disease unlike ulcerative colitis
What are the symptoms of Crohn's disease?
1. Patients with diarrhoea and insidious abdominal pain
2. Pain is exacerbated after feeding
3. Diarrhoea is non bloody
4. Patients have fever and weight loss
5. Non intestinal manifestations include:
- mouth ulcers (immune response)
- Erythemia nodosum (inflammation of fat cells under skin)
What are the complications of Crohn's Disease?
Strictures and perforations and fistulae
What are strictures?
1. Inflammation causes narrowing: food cannot pass
2. Severe cramping abdominal pain, nausea, vomiting and constipation (treated surgically)
What are perforations?
1. Contents of the bowel leaking through the hole forms an abscess
2. Causes pain and fever
3. Abscess may develop into a fistula
How are fistulae formed, what is it and how are they treated?
1. Forms due to inflammation in Crohn's spreads through the whole thickness of the bowel wall
2. Inflammation of tunnels through the layers of other tissues
3. Tunnels or passageways can connect bowel to other loops of bowel: bladder, vagina, outside skin, including skin around anus
4. Fistulas can be treated medically (diet, analgesics or with surgery)
Give examples of the causative agents, modifying factors and luminal factors in the pathogenesis of Crohn's disease?
1. Causative agents- bacteria, virus, dietary
2. Modifying factors- environment, genetic
3. Luminal factors- luminal bacteria, digestive enzymes, bile acids
Describe the pathway of pathogenesis in Crohn's disease?
1. Causative agent, modifying factors, luminal factors: Macrophage released
2. Immune response (T Cell)
3. Inflammation (amplification)- activated T Cell
4. Tissue Injury- TH1 response, TH2 response
Where does Crohn's disease mainly affect?
2. Colon alone
3. Small intestine
4. Distal ileum
5. Right colon
Where does ulcerative colitis normally affect? and the major types?
1. Descending left colon
Major types: (total colitis)
1. Transverse colon
2. Ascending right colon
3. Descending left colon (distal colitis)
4. Rectum (proctitis)
What does ulcerative colitis normally cause?
1. Causes inflammation and ulceration of the inner lining of rectum and colon
2. Small ulcers develop on surface of intestinal lining that may bleed and make pus
3. Surface of intestines become inflamed
4. Sometimes known as a chronic condition, long periods of good health (remission) but has relapses or flare ups
What are the causes of Ulcerative colitis?
2. Genetic- abnormal reaction of immune system to certain bacterias in stomach
3. Bacterial may play a role(
What are the symptoms of ulcerative colitis?
1. Diarrhoea: with blood, mucus and pus
2. Cramping pains in abdomen, very severe and often occurs before passing stool
3. Tiredness and fatigue- illness induced (anaemia, lack of sleep at night due to pain or diarrhoea)
4. Loss of appetite and loss of weight
5. Generally feeling unwell, fever
6. Anameia- loss of blood and poor diet
What are the pharmacological interventions for IBD from the least aggressive to most aggressive?
5. Cyclosporine (ciclosporine)
7. Experimental Therapies
What are the management options for IBD?
1. Drug therapy
2. Attention to nutrition
3. Smoking cessation for Crohn's disease
4. Severe or chronic active disease surgery
Describe what an anti-inflammatory drugs of 5-ASAs (aminosalicylates) is, how it works and give derivative examples?
1. Chemically related to aspirin work by dampening down inflammatory response (topical application)
2. Inhibit the function of lymphocytes, monocytes and plasma cell production of immunoglobulins
- Mesalamine, mesalazine and sulphasalazine - anti inflammatory actions for connective tissue: oral
- Inhibits production of oxygen reactive species (scavenge of free radicals)
What are the side effects of Aminosalicylates (5-ASA) and Sulphasalazine?
1. Common: Nausea, vomiting, watery diarrhoea, headache, indigestion, mild allergic reactions with rash, itchiness and fever
2. Less common: problems with kidneys, liver, lungs and pancreas
3. Sulphasalazine: cause male infertility by reducing sperm count
4. Sulphasalazine: reduces absorption of folates (blood cell formation), supplementation may be helpful
Describe the problems antibiotics may have in treating IBD?
1. Complications of Crohn's disease like abscesses and fistulas
2. Two most used:
metronidazole (avoid alcohol) and ciprofloxacin
3. Based on theory: abnormal reaction of immune system to intestinal bacteria
4. Not as effective for treatment of flare ups or maintenance treatment (helpful for treating Crohn's colitis- crohn's in colon) after surgery
Describe the problems Corticosteroids may have in treating IBD?
Less serious side effects: puffy face, excessive facial hair, night sweats, insomnia, hyperactivity
More serious side effects: high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and increased risk o infections
In children can lead to stunted growth
What are the main immunosuppressant drugs are used?
1. Azathioprine and mercaptopurine (main one)
3. Mycophenolate mofetil
When are Azathioprine and Mercaptopurine used and what are the issues with them?
1. Used when 5-ASAs and steroid have failed to produce results
2. Can take several months to work
3. Patients sensitive to sunlight
4. Susceptible to more diseases
5. May need extra vaccination against infectious diseases like measles, chicken pox or shingles
What are the side effects of Azathioprine and Mercaptopurine?
1. Nausea, flu like illness with fever and general aches and pains
2. Sudden worsening of diarrhoea
3. Less common:
- Inflammation of liver and/or pancreatitis
- Suppression of bone marrow function (lead to anaemia)
- Slight increased risk of lymphoma development (type of cancer affecting lymph glands)
Give an example of biologicals used- its role and examples that are medicines?
1. Anti tumour necrosis factor alpha (anti TNF alpha) drugs
2. Humanised monoclonal antibodies
3. TNF alpha important pro-inflammatory molecule
4. Infliximab (remicade) and Adalimumab (Humira)
Describe when Infliximab is used, how its used and side effects?
1. Given intravenously
2. Given when there is no response to steroids or immunosuppressants
3. Side effects:
- Reactions to infusion
- Greater susceptibility to infections
- Worsening of pre-existing heart condition
- Skin rashes
- Joint inflammation
Give example of antidiarrhoeals are used? (symptomatic agent)
1. Codeine phospate
2. Loperamide (imodium)
What are bile salt binders? (symptomatic agent)
1. Balts salts are naturally released from the river to help with digestion
2. Cholestyramine, colestipol and colesevalam combine with bile salts- prevent them reaching colon (reduces diarrhoea)
3. Patient has surgery to remove ileum, higher levels of balt salts can drain into colon and cause diarrhoea
What are bulking agents?
1. Contains a water absorbent plant fibre which includes Isogel, Fybogel
2. Swells up inside the bowel and thickens liquid or softens hard stools
3. Should not be used if stricture has been diagnosied
List all the symptomatic drugs that can be used in ulcerative colitis?
1. Antidiarrhoeal drugs
2. Bile salt binders
3. Bulking agents
6. Analgesics- paracetamol
When is surgery done in IBD and describe the effect on Crohn's and ulcerative colitis?
1. Last resort when all drug therapies have failed
2. Surgery on inflamed area
3. Crohn's disease: cannot be cured, develop anywhere in gut
4. Ulcerative colitis is cured by surgery
5. Relieves pain, urgency, diarrhoea. Able to stop taking drug and better standard of living.