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Investigations and Treatment for IBD

Investigations and Treatment for IBD. Chris Kwan PBL 28. Investigative Findings. Crohn’s Disease Sample has narrowing of descending colon and irregular contours (ulcers). Ulcerative colitis Areas can appear smoother and/or dilated ( leadpipe appearance). Comparison of Treatments.

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Investigations and Treatment for IBD

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  1. Investigations and Treatment for IBD Chris Kwan PBL 28

  2. Investigative Findings

  3. Crohn’s Disease • Sample has narrowing of descending colon and irregular contours (ulcers)

  4. Ulcerative colitis • Areas can appear smoother and/or dilated (leadpipe appearance)

  5. Comparison of Treatments

  6. Corticosteroids • Budesonide: indicated only for ileocaecalCrohn’s Disease • The formulations available makes budesnoide get delivered primarily to ileocaecal areas • Prednisolone: interchangeable with prednisone (because prednisolone is a prodrug that is converted by liver into prednisone)

  7. Immunomodulators

  8. Salicylates • 5-ASA may interact with mercaptopurine (by enhancing bone marrow toxicity of mercaptopurine) • Avoid combination or monitor closely

  9. Methotrexate • Always supplement with some folic acid • Dose methotrexate once a week • Folic acid is dosed once a week too (but not on the same day as methotrexate) • This aims to reduce adverse effects (considering that Tx will be long-term)

  10. Antibodies • Very expensive • Measure patient’s FBC to check for leukopaenia • Both of these have similar efficacy • Make sure the patient does not have infection, including active or latent TB

  11. POP-QUIZ D=

  12. Question 1 • Mr Ingo Stein presented into your clinic. He complained about having diarrhoea with very smelly stools. On examination, there is tenderness on the flanks. The DRE revealed anal fissures but your glove has no blood or mucus. You then give Ingo a barium enema and then perform an X-ray, which showed this:

  13. Question 1 • What’s the provisional diagnosis for Ingo? Crohn’s Disease

  14. Question 2 • Mr Wayne King is your next patient and he’s complaining of bloody diarrhoea. There is mild tenderness throughout the abdomen. You perform the DRE and do not find anal fissures and fistulae, but you get blood and mucus on your glove. You decide to give him a barium enema and perform an X-ray:

  15. Question 2 • What’s the provisional diagnosis for Wayne? Ulcerative colitis

  16. Question 3 • Ms Catherine Elms presented with yet another severe bout of Crohn’s Disease. You immediately treat her with corticosteroids. After that, what would you recommend to help achieve remission? An immunomodulator (e.g. 6-mercaptopurine, azathioprine) OR Methotrexate + folic acid

  17. Question 4 • MrsLayla Chin is brought into the wards to be treated for ulcerative colitis. After treating this, you discharge her a script for sulfasalazine and azathioprine. What are some adverse effects that Layla should be aware of when taking these drugs? Sulfasalazine: nausea/vomiting, diarrhoea, rash, blood dyscrasias, photosensitivity etc Azathioprine: leukopaenia, thrombocytopaenia, anaemia, infection, diarrhoea, nausea/vomiting etc

  18. References • Harrison’s Internal Medicine • AMH • UptoDate

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