IBD 2

Question 1

What lab results are affected in IBD?

Answer 1

1. FBC - decreased Hb and increased platelets
2. LFT’s - decreased albumin - inflammation
3. Increased CRP and ESR
4. Decreased magnesium
5. U & E’s - decreased K
6. Vit B12 and folate decreased - decreased nutrient absorption
7. Faecal calprotectin increased - marker of inflammation
8. Stool culture - exclude infection
9. Coeliac screen

Question 2

What are the main symptoms of IBD?

Answer 2

1. Pain
2. Fatigue
3. Weight loss
4. Anaemia
5. Diarrhoea
6. Fever

Question 3

Why are nutrition and probiotics used?

Answer 3

Enteral nutrition may induce remission in young people with CD

Question 4

What is enteral nutrition?

Answer 4

Polymeric/elemental liquid feeds for 8 weeks as alternative to corticosteroids

• symptomatic relief after 10 days
• mucosal healing takes up to 8 weeks

Question 5

What supportive therapies would you give for IBD?

Answer 5

1. Anti-diarrhoeals
2. Laxatives
3. Analgesics
4. Anti-spasmodic
5. Vaccinations
6. Enoxaparin in hospital
7. Dietician review

Question 6

What antibiotics would you use in IBD?

Answer 6

Metronidazole and ciprofloxacin - specific uses in CD - abscess, fistula and secondary infection

Question 7

What are the risk factors for secondary osteoporosis due to IBD?

Answer 7

1. Malabsorption
2. High corticosteroid use
3. Reduced physical activity
4. Weight loss
5. Uncontrolled inflammation

Question 8

How is osteoporosis prevented in IBD?

Answer 8

1. Avoid steroids if possible
2. Encourage weight bearing exercise
3. Nutritious diet
4. Give Ca/vit D whilst on steroids and bisphosphonate if >70
5. Stop smoking
6. Avoid alcohol excess

Question 9

How would you induce remission in UC?

Answer 9

1. Topical and/or oral 5-ASA
2. And/or topical/oral steroid
3. If moderate-severe, prednisolone 40mg tapering over 8 weeks

Question 10

What do you need to monitor with aminosalicylates?

Answer 10

Renal function

Report any bleeding, bruising, purpura, sore throat, fever, malaise, nausea or breathing issues

Dose changes for induction/remission

Question 11

Corticosteroids…

Answer 11

1. Used in remission only
2. Starting dose
   - hydrocortisone 100mg qid IV
   - prednisolone 40mg mane po
3. Tapered reduction prednisolone - decrease by 5mg every 7 days
4. Ca and vit D tablets and PPI whilst on steroids - Ca and vit D reduce risk of secondary osteoporosis due to steroids and PPI to protect gastric mucosa - risk of stomach ulcers

Question 12

What are the temporary side effects of corticosteroids?

Answer 12

1. Increased appetite
2. Moon face
3. Acne
4. Increased blood sugar and salt retention
5. Mood changes
6. Increased infection risk
7. Stomach ulceration

Question 13

What are the long term side effects of corticosteroids?

Answer 13

1. Thinning of bones, muscle and skin
2. Bruising
3. Diabetes
4. Glaucoma or cataracts

Question 14

Remission in acute severe UC?

Answer 14

1. IV hydrocortisone 100mg 6 hourly
2. Consider holding ASA
3. Blood/fluid/electrolyte placement
4. Enoxaparin prophylaxis
5. No improvement after 72 hours add ciclosporin/infliximab
6. Assess for surgery daily

Question 15

How would you maintain remission?

Answer 15

1. Wean steroids
2. Thiopurine
3. Continue ciclosporin/infliximab if used
4. Restart ASA
5. Stop smoking

Question 16

Maintenance for UC…

Answer 16

5- ASA

Question 17

Immunosuppressants…

Answer 17

1. May act slowly
2. Sensitivity to sunlight
3. Susceptibility to infections
4. Contraception
5. Increased likelihood of some cancers
6. Report symptoms
7. Monitoring and TMPT test for thiopurines

Question 18

What pre monitoring is required for biologics?

Answer 18

1. Tb
2. Infection
3. Hepatitis
4. Labs
5. BP, temp, pulse