IBD therapy

Question 1

Lifestyle advice?

Answer 1

Smoking aggravates crohns!

Question 2

What do aminosalicylates do?

Answer 2

Reduce inflammation
Reduces risk of colon cancer
Maintenance treatment reduces risk relapse in patients

Question 3

Side effects of aminosalicylates?

Answer 3

Diarrhea

Question 4

What dictates the type of administration of drug?

Answer 4

Site of inflammation
Enemas and suppositries for rectal/ distal descending colon

Oral - delayed release due to PH dependent release/prodrugs

Question 5

Where does sulphonamide take action and why?

Answer 5

The colon

5ASA that is bound to sulphonamide, cleaved in colonic bacteria

Question 6

Which 5ASA affects the duodenum, jejunum, ileum and colon?

Answer 6

Pentasa

Question 7

T/F

Pentasa should only be prescribed in Crohn’s cases

Answer 7

T

affects small intestine unec UC

Question 8

What is an enema?

Answer 8

Liquid gas injected rectum

Question 9

What is suppository?

Answer 9

Tablet insert rectum

Question 10

Ads/ Pros various topical therapies?

Answer 10

• Suppositories coat <20cm
  + have better mucosal adherence than enemas
• <10% enemas remain in the rectum
  + Reflex contraction aids proximal spread of enema material

Question 11

T/F

steroids are the optimal maintenance therapy for IBD

Answer 11

F
should be used as “bridge” to maintenance therapy
high dose intially and reduce

Question 12

T/F

Steroids are the main drugs used in acute ttacks

Answer 12

T

Question 13

Some steroid side effects?

Answer 13

Metabolic: weight gain, diabetes, hypertension
Muscoloskeletal: osteoperosis
Acne, THIN SKIN

Question 14

Azathioprine is an example of

Answer 14

an immunosupressant

Question 15

What is infliximab?

Answer 15

monoclonal antibody that binds to TNFa, used to treat IBD

Question 16

How does azathioprine work?

Answer 16

Metabolised to antimetabolite that inhibit DNA synthesis

Inhibits clonal proliferation in the induction phase of the immune response

Question 17

Azathioprine has a ____ onset of action, approximately ____ weeks

Answer 17

slow

16

Question 18

Azathioprine should not be prescribed with ____ because:

Answer 18

allopurional

is a purine metabolism inhibitor, stops Azathioprine from working

Question 19

Side effects/risks Azathioprine

Answer 19

• leucopenia
  pancreatitis
  hepatitis
  skin cancer

Question 20

Anti TNFa therapy has a ____ onset of action

Answer 20

rapid

Question 21

Effects of anti TNFa therapy

Answer 21

• rapid mucosal healing
• retreatment maintains remission
• reduces hospitalization

Question 22

Infliximab is given ____ every ____

Answer 22

IV, 8 weeks

Question 23

13% of patients experience _______ and there have been numerous reports of _____. 70 cases of ____ and ____ have also been reported

Answer 23

infusion reactions, infection, lymphoma, tumors

Question 24

When to use Anti TNFa therapy?

Answer 24

Long term strategy inc.

• immune supression
• surgery (crohns)
• supportive therapy

Refractory/fistulating disease

Question 25

When is surgery indicated in IBD?

Answer 25

- Failure medical therapy with acute or chronic symptoms | - Complications (toxic dilation, obstruction, fistulae. abscesses)

Question 26

T/F | Surgery is curative in IBD

Answer 26

F | potentially curatvie in UC

Question 27

T/F | Surgery is curative in IBD

Answer 27

F | potentially curatvie in UC NOT CROHNS

Question 28

Crohns: What is resection + why is it carried out?

Answer 28

Removing bits of the bowel and anastomosing them together | Fistulae and obstruction

Question 29

What is an ileostomy

Answer 29

part of the ileum brought out to the surface of the skin ( creates artificial opening or stoma permanent or temporary - allows distal sites to heal looks like a closed rosebud

Question 30

What is stricturoplasty?

Answer 30

Widening strictures surgically - other option is resection if unable to do this

Question 31

What is a seton and why is it used?

Answer 31

Surgical cord placed in perianal abcess | - allows drainage of pus while the fistulae heals

Question 32

What are the surgical treatment options for UC?

Answer 32

- permanent ileostomy - restorative proctocolectomy and pouch - ileorectal anastamosis

Question 33

suffix -stomy indicates

Answer 33

stoma making

Question 34

suffix -omy indciates

Answer 34

removal

Question 35

What is a J pouch?

Answer 35

proctolectomy then | small intestine to create a pouch attached to anus. Sphincters still intact so patient can control waste removal

Question 36

Complications of pouches?

Answer 36

Immediate: Haemorrhage Early: Wound infection, pelvic abscess, anastamotic leak Late: Impotence, pouchitis

Question 37

How to asess UC emergencies?

Answer 37

Truelove and Witt criteria - Raised erythrocyte sedimentation rate - Bloody stools - Haemoglobin (anaemic) - High heart rate - High temp

Question 38

What is the "first aid" operation for UC?

Answer 38

Subtotal colectomy (all of colon apart from rectum) with end ileostomy

Question 39

T/F | IN UC emergencies, removal colon tends to settle rectal disease

Answer 39

T | No rush to deal with rectum, manage with meds if need be

Question 40

T/F | Most crohn's patients undergo surgery

Answer 40

T | Natural history goes to stricturing and penetrating disease

Question 41

Duodenal or pyloric stenosis (crohns) indicates?

Answer 41

Gastrojejunostomy

Question 42

T/F | Post operative fistulae usually close with conservative measures

Answer 42

T | active disease causes spontaneous fistulae

Question 43

Principle for managing intra-abdominal fistulae?

Answer 43

Resect primary organ defect and close secondary organ

Question 44

T/F | In crohns, if disease affects the entire colon and the rectum is minimally or not involved, a colectomy may be performed

Answer 44

T | Can be emergency, segmental, total colectomy

Question 45

T/F | with perianal fistula the aim is to cure

Answer 45

F | control rather than cure - seton good option