PAC3421 Study Guide - Final Guide: Infliximab, Ciclosporin, Methotrexate
23 Jun 2018
School
Department
Course
Professor
Clarissa – IBD (divided into Ulcerative Colitis and Crohn’s Disease)
Criteria to be considered as mild ulcerative colitis:
-Less than or equal to 4 bowel actions per day
-Blood in stool may be present
-No additional manifestations (i.e. fever, anaemia, raised ESR)
Extra-intestinal signs (i.e. not located in both small and large intestines) observed in IBD (i.e. both UC & CD):
-Eye problems: uveitis (i.e. inflammation of the iris), episcleritis
-Liver problem: primary sclerosing cholangitis
-Joint problem: arthritis, ankylosing spondylitis, arthralgia
-Skin problem: pyoderma gangrenosum, erythema nodosum (Note: Only 25% of IBD patients get these
signs)
The following pathology and imaging tests below should be indicated for an IBD-suspected patient:
Stool culture
To see if the patient has an infection (i.e. a differential diagnosis to IBD).
Vitamin B12 and Vitamin D
To determine if the patient has problems in absorption
CRP
To determine if the patient has active inflammation
Colonoscopy
Requires anaesthesia
Colonoscopy - allows your doctor to look at the inner lining of your large intestine (rectum and colon) to look
for cobblestone appearance (particularly in CD)
Abdominal Ultrasound
Does not require anaesthesia and can be done when the patient is awake, so better than
colonoscopy/gastroscopy
Calprotectin
Elevated faecal calprotectin indicates the migration of neutrophils to the intestinal mucosa, which occurs
during intestinal inflammation in IBD patients
The IBD management approach - “Step-up” or “Top-down” approach
The term 'step-up' refers to a sequential treatment strategy that often begins with a less effective, potentially less
toxic treatment strategy, such as aminosalicylates, antibiotics or budesonide, with escalation to the highly effective
but potentially more toxic treatment strategies, such as prednisolone, immunomodulators and biological therapy, in
patients who failed each line of therapy. In this strategy, one would avoid overtreating and unnecessary exposure to
the risk of developing adverse events. However, studies have shown that most patients treated with the conventional
step-up therapy go on to develop strictures or perforation.
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