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Flashcards in Inflammatory Bowel Disorder Deck (9)
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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

What are the associated co-morbidities?

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

-Diabetes:
*Steroids (can affect glycemic control)

-Osteoporosis:
*Avoid repeated courses of steroids

-Pregnancy:
*Azathioprine/mercaptopurine/methotrexate
*Infliximab/adalimumab