what is IBD
ulcerative colitis and crohns
both characterised by inflammation, swelling and ulceration of intestinal tissue
symptoms of IBD
stomach pain
weight loss
diarrhoea with blood/ mucous
tiredness
joint pain
rashes
inflamed eyes
what the difference between crohns and ulcerative colitis
crohns affect any area of the GIT and inflammation is on all layers of tissue
ulcerative collitis only affects the large bowel and inflammation is on inner lining
how to diagnose IBD
symptoms
blood tests for anaemia, vitamin deficiencies and inflammatory markers
x-ray, CT, MRI
sigmoidoscopy, colonoscopy
what causes IBD
genetic links
autoimmune disease
environmental
previous infection
aims of treatment for IBD
induce and maintain remission
reduce symptoms and improve quality of life
reduce inflammation
reduce autoimmune response
treatment drugs for IBD
corticosteroids
aminosalicylates
cytokine modulators
immunosuppresents
corticosteroids
administered orally or rectally
hydrocortisone, beclomethasone, budesonide, prednisolone
cautions and side effects and interactions of corticosteroids
cautions - congestive heart failure, hypothyroidism, osteoporosis
side effects - isnomnia, dyspepsia, cushings syndrome, impaired healing, adrenal suppression
interactions - grapefruit juice increases plasma concentration of oral busesonide
aminosalcylates
administered orally or rectally
balsalaside, mesalazine, olsalazine, sulfasalazine
side effects of aminosalyclates
blood disorders - patients need to report unexplained bruising, bleeding, sore throat, fever
renal function should be checked
sulfalazine can colour urine and contacts orange
sulfalazine decreases concentration of digoxin and absorption of folates
cytokine modulators
monoclonal antibodies which inhibit pro-inflammatory cytokines - TNF-a
administered subcutaneous
infliximab, adalimumab
stop the expansion of Tcell by interrupting the calmodulin- calcineurin cascade
immunosuppressants
t- cell effects
administered orally or by injection
azathioprine, methotrexate, ciclosporin
anticancer drugs with blood toxicity and liver toxicity so require monitoring for safe use
non drug treatment of IBD
smoking cessation
attention to diet
surgery - stoma/ resection
