Inflammatory bowel disease Treatment Flashcards Preview

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Flashcards in Inflammatory bowel disease Treatment Deck (48):
1

What are the three therapeutic strategies to control IBD?

Lifestyle advice
Drugs
Surgery

2

What lifestyle advice is given to a patient with Crohn's?

stop smoking
Alter diets

3

In what way can a change in diet affect an IBD patient?

Influences symptoms but has no effect on pathogenesis

4

What effects do all drugs have?

anti-inflammaory effects

5

What are the therapy options for ulcerative colitis?

5ASA mesalazine
Steroids
Immunosuppressants
Anti-TNF therapy

6

What are the therapy options for Crohn's disease?

Steroids
Immunosuppressants
Anti-TNF therapy

7

What are the side effects of mesalazine?

diarrhoea or idiosyncratic nephritis

8

what is idiosyncratic nephritis?

Inflammation of the kidneys

9

Give examples of 5-ASA drugs currently in use

Sulphasalazine
Balaxalazide
Mezavant

10

which part of the GI tract is salazopyrin released?

Colon

11

which part of the GI tract is balsalazide released?

colon

12

which part of the GI tract is asacol salofalk released?

Ileum and colon

13

which part of the GI tract is Pentasa released?

Duodenum, Jejunum, Ileum and colon

14

Which has better mucosal adherance - suppositories or enemas?

suppositories

15

How do enemas spread?

foam or liquid enemas spread by reflex contraction proximally

16

How should corticosteroids be given?

Prednisolone should be given in a short course of an initially high dose over 8 weeks

17

What are the side effects for steroid use?

Avascular necrosis
Osteoporosis
Acne
Thinning of skin
Weight gain
Diabetes
Hypertension
Cataracts

18

why are immunosuppressants used in ulcerative colitis?

act as steroid sparing agents

19

what are immunosuppressants used in Crohn's disease?

as maintenance therapy

20

What is tumour necrosis factor a?

pro-inflammatory cytokine

21

what are the two antibodies to TNF?

Infliximab
Adalimumab

22

What does anti-TNF therapy do?

promotes apoptosis of activated T-lymphocytes

23

what is the duration of remission with anti-TNF therapy?

8-12 weeks

24

What are the dangers when using anti-TNF?

Can have infusion reactions
Can get infections - reactivation of TB
Cause cancer - lymphomas and solid tumours

25

when should anti-TNF alpha be used?

As part of long term treatment
Refractory/fistulising disease

26

what are the main reasons anti-TNF alphas shouldn't be used?

If the patient has been exposed to TB - potential to activate it

27

when is emergency surgery used in IBD?

Failure to respond to medication
Small bowel obstruction
Abscess
Fistulae

28

When is elective surgery used in IBD?

Failure to respond to medical therapy
Dysplasia of colon mucosa

29

Is the surgery for Crohn's curative?

No

30

If the patient develops short gut syndrome, what interventions will need to be done?

Lifelong total parenteral nutrition

31

Is surgery for ulcerative colitis curative?

Yes

32

What does azathioprine do to DNA?

Interferes with DNA synthesis of rapidly dividing cells

33

what is azathioprine converted and broken down to in the liver?

Converted to 6-MP and then broken down to 6-TGN

34

What are the indications for surgery in ulcerative colitis?

Failure of medical therapy
Toxic megacolon
Poor quality of life
Intolerance of medication even if it is working
Dysplasia or carcinoma
Massive haemorrhage

35

what will a barium enema show in ulcerative colitis?

featureless colon

36

What are the surgical options in ulcerative colitis? (3)

Subtotal colectomy
Panproctocolectomy
Panproctocolectomy with pouch formation

37

what is a subtotal colectomy?

When a bit of the colon is left and the rectum is preserved to hold stool

38

what is a Panproctocolectomy?

the whole of the large bowel is removed including the rectum

39

What are the indications for surgery in Crohn's disease?

Symptomatic obstruction/ Fistulae/ stricture
Haemorrhage
Dysplasia or carcinoma
Symptomatic peri-anal disease

40

What is a common finding in a barium swallow in ulcerative colitis?

Stricture causing pain

41

what are the surgical options in Crohn's disease?

Right hemicollectomy
Stricturoplasty
Resection
Ileocaecal resection
Colectomy with ileostomy

42

What causes an intestinal fistula?

inflammatory process in the inflamed bowel

43

Would a fistula be visible on a barium swallow?

yes

44

How is peri-anal disease treated?

the fistulas are drained

45

what is the most common operation for terminal ileal disease?

Right hemicollectomy

46

what is stricturoplasty?

when the bowel is widened

47

what does resection involve?

the surgeon removes the damaged and
diseased part of the gut, and then staples together the ends of the remaining
healthy sections

48

what is a Colectomy with ileostomy?

when all of the colon is removed and a stoma bag is positioned where the small intestine has been attached to the surface