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21 Cards in this Set
- Front
- Back
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Where does inflammation occur in Crohn's disease? |
Can occur from any part of the intestinal tract (from mouth to anus) but usually confined to terminal portion of small intestine (ileum).
Inflammation can be patchy, penetrates deep, and forms ulcers and fistulas. |
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Complications of CD? (6)
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Dysphagia
Bowel obstructions Anemia Infections Malabsorption Side effects of drugs |
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What are fistulas? Where are they located? (4) |
They are transmural inflammation that can penetrate the serosa. Common sites are:
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What are the goals of therapy for CD? |
1. Relieve symptoms 2. Induce remission 3. Prevent recurrences 5. Improve quality of life 6. Treat extra-intestinal symptoms |
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What are the treatment options for mild crohn's disease?
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Colon: induce remission with SSZ/ 5-ASA (4-6 weeks)
Ileum: induce remission with oral budesonide (8-16 weeks) |
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What are treatment options for moderate crohn's disease? |
Induce remission with prednisone (10-16 weeks) or oral budeniside for ileal/ right side colonic disease only (8-16 weeks) |
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What are treatment options for severe crohn's disease? |
IV steroids (3-14 days) |
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What are common extra-intestinal symptoms? |
Arthritis Sarcolitis Ankylosing spondylitis (arthritis in spine joints) Osteoporosis Thromboembolic events Stomatitis |
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What is sulfazaline? |
It is a combination of 5-ASA and sulfapyridine which is split off by bacteria in gut.
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Why is sulfazaline rarely used? |
About 10-50% of patients have intolerances (=nausea, headache, vomiting, epigastric pain).
Also needs 4g/day, and patients treated previously with steroids fail to respond. |
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When using steroids to induce remission, how long does remission typically last? |
Less than 50% of patients will remain in remission after 1 year. 16-36% of patients will become steroid dependent. |
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What is the dosing regimen for azathioprine (immunomodulator) for maintenance therapy? |
Start at 50mg daily Increase dose by 25mg every 1-2 weeks until reach target dose of 2.5mg/kg |
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What is the dosing regimen for 6MP (immunomodulator) for maintenance therapy? |
Start at 50mg daily Increase dose by 25mg every 1-2 weeks until reach target dose of 1-1.5mg/kg |
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What are side effects of immunomodulators? (5) |
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How is methotrexate used? |
25mg IM weekly for induction 15mg IM weekly for remission
Side effect = nausea, vomitting, headaches, mouth ulcers
Also causes liver toxicity |
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What are contraindications to using methotrexate? |
Pregnancy Alcoholism Immunodeficiency Pre-existing blood dycrasias
It is also a potent inhibitor for folic acid, so must be used with supplement. |
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What are signs of liver failure? |
Jaundice Dark brown urine Pain on right side of stomach area Fever Extreme fatigue |
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What are side effects of using biological agents such as infliximab? |
Cases report TB reactivation if exposed Reduces immune response to infections Infusion related to side effects Development of cancers |
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When are antibiotics used? |
Given to patients with systemic signs of infection, such as if there is a fistula causing intestinal contents to drain into the bladder, the chance of infection is high.
Use metronidazole, ciprofloxacin |
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When the conditions are severe, what may patients resort to using? |
Medicinal marajuana, codeine, and morphine |
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Therapeutic choices for CD? (7) |
1. Supportive treatment (soft, low residue food, fluids, antidiarrheals PRN) 2. 5-ASA (may or may not be effective) 3. Oral corticosteroids (prednisone) 4. Immunosuppresive agent (azathioprine) 5. Methotrexate 15mg or 25mg with folic acid 6. Biological agent (infliximab) 7. Metronidazole or other antibiotic |
