Flashcards in Inflammatory Bowel Disorder Deck (9)
Loading flashcards...
1
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
-Strictures
-Fistulae
-Perianal disease
-RLO masses occur
2
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)
3
What are the key clinical differences between CD and UC?
-CD:
*Acute or insidious onset of symptoms
*Abdominal pain
*Weight loss/anorexia
*Palpable tender mass (lower abdomen)
*Malabsorption, hypovitaminosis
*Frequently perianal disease
-UC:
*Often abrupt onset with some chronic symptoms
*Left sided pain
*Anaemia
*Dehydration
*Lower abdominal cramps
*Pain on defecation
4
What are the main complications associated with IBD?
-Strictures
-Dietary restrictions
-Vitamin deficiencies
-Anaemia
-Fistulae
-Dehydration
-Surgery
5
How should you manage UC?
-Mild:
*Inducing remission = oral 5-ASA and/or topical steroid e.g. prednisolone
*Maintenance = oral 5-ASA and oral azathioprine/mercaptopurine
-Moderate:
*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
-Severe:
*Inducing remission = IV corticosteroids (hydrocortisone) and IV cyclosporin or infliximab or surgery
*Maintenance = infliximab, adalimumab or golimumab and consider adding oral azathioprine or mercaptopurine
6
How should you manage CD?
-Mild:
*Inducing remission = oral steroids or budesonide/5-ASA if prednisolone not tolerated
*Maintenance = azathioprine/mercaptopurine or methotrexate
-Moderate:
*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
7
Acute treatment vs Chronic treatment
-Acute treatment (fast onset):
*Steroids
*5-ASA
*Anti-TNFs
*Ciclosporin
-Chronic treatment (slow onset):
*Azathioprine/mercaptopurine/methotrexate
*2-3 months for onset of action
8
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
9
