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Flashcards in Inflammatory Bowel Disorder Deck (9)
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Describe Crohn's Disease

-Chronic progressive patchy inflammation of the gut wall

-May occur anywhere along the GIT (more in ileum and colon)

-Transmural, chronic inflammation

-Hyperplasia and luminal invasion

-Patchy ulceration



-Perianal disease

-RLO masses occur


Describe Ulcerative Colitis

-Continuous progressive generalised epithelial ulceration

-Inflammation limited to colon

-Distal disease (rectum or sigmoid colon) our more extensive (L-sided colitis)

-Superficial continuous inflammation (mucosa only)

-Inflammation limited to colon and starting at anus

-Most limited to the left side

-No perianal disease (fistulae, fissures and perforation)


What are the key clinical differences between CD and UC?

*Acute or insidious onset of symptoms
*Abdominal pain
*Weight loss/anorexia
*Palpable tender mass (lower abdomen)
*Malabsorption, hypovitaminosis
*Frequently perianal disease

*Often abrupt onset with some chronic symptoms
*Left sided pain
*Lower abdominal cramps
*Pain on defecation


What are the main complications associated with IBD?


-Dietary restrictions

-Vitamin deficiencies






How should you manage UC?

*Inducing remission = oral 5-ASA and/or topical steroid e.g. prednisolone
*Maintenance = oral 5-ASA and oral azathioprine/mercaptopurine

*Inducing remission = oral 5-ASA and/or topical steroid e.g. prednisolone (tacrolimus if inadequate response to oral prednisolone)
*Maintenance = oral 5-ASA and oral azathioprine/mercaptopurine

*Inducing remission = IV corticosteroids (hydrocortisone) and IV cyclosporin or infliximab or surgery
*Maintenance = infliximab, adalimumab or golimumab and consider adding oral azathioprine or mercaptopurine


How should you manage CD?

*Inducing remission = oral steroids or budesonide/5-ASA if prednisolone not tolerated
*Maintenance = azathioprine/mercaptopurine or methotrexate

*Inducing remission = glucocorticosteroids and consider using infliximab
*Maintenance = infliximab potentially with azathioprine or methotrexate

-Fistulating disease:
*Inducing remission = antibiotics/drainage and consider infliximab
*Maintenance = infliximab potentially with azathioprine/mercaptopurine or methotrexate


Acute treatment vs Chronic treatment

-Acute treatment (fast onset):

-Chronic treatment (slow onset):
*2-3 months for onset of action


What should you consider when selecting treatment?

-Can you wait for the slow drugs to take effect?

-Is the drug cost effective

-Is treatment suitable for long-term treatment?
*Aim to wean off steroids once in remission
*Ciclosporin is not for long terms use


What are the associated co-morbidities?

-Heart failure:
*Steroids (fluid retention)
*Infliximab (worsens heart failure)

*Steroids (can affect glycemic control)

*Avoid repeated courses of steroids