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Inflammatory bowel disease (Clinical presentation (GIT (Oral ulcers …

- - - - Moderate
        Under 10 bloody stools/d
        Mod PR bleed
        Mild fever
        HR 70-90
        Hb 105-110
        ESR<30
      - Severe
        Over 10 bloody stools/d
        Large PR bleed
        Pyrexia
        HR>90
        Hb<105 ESR>30
      - Mild
        Under 4 stools/d
        Min PR bleed
        Apyrexial
        HR<70 Hb>110
        ESR<30
    - - Mild
        Apyrexial
        normal HR
        ESR/CRP low
        Normal Alb
      - Severe
        Pyrexial
        tachycardic
        High CRP/ESR
        Low Alb
- - - - Conservative
        IV fluid resus
        NBM (if severe)
        Regular obs, stool chart, bloods
      - Medical
        
        Steroids
        E.g. PO prednisolone, IV hydrocortisone
        MOA: reduce inflammation
        
        Immunosuppressants
        E.g. 5-ASA, sulfasalazine, cyclosporine
    - - Medical
        
        Immunosuppressants
        E.g. 5-ASA, sulfasalazine, azathioprine,
        methotrexate, 6-MP, ciclosporin, tacrilimus
        
        Biologics
        Indication: refractory disease
        e.g. infliximab, adalimumab
        
        Steroids
        E.g. prednisolone
        Route: topical (enemas, suppositries)
      - Surgical
        Indication: failed medical, complication
        MOA: pan proctocolectomy and ileostomy;
        whole colon and rectum removed, curative
        OR colectomy and ileoanal anastomosis;
        terminal ileum forms pouch so continent
      - Conservative
        Colonoscopic surveillance 2-4y
  - - - Conservative
        IV fluid resus
      - Medical
        
        Immunosuppressants
        E.g. 5-ASA
        MOA: induction of remission by reducing inflamm
        SEs: SJS, renal impairment, acute panc
        
        Metronidazole
        Indication: steroid resistance, severe perianal disease
        
        Steroids
        E.g. PO prednisolone
        
        TNF-a inhibitors
        Indication: add on therapy
        E.g. infliximab, adalimumab
    - - Conservative
        Diet (elemental in children)
      - Medical
        
        Immunosuppressants
        E.g. azathioprine, 6-MP (1L), methotrexate (2L)
        SEs: BM suppression, pancreatitis
        
        TNF-a inhibitors
        Indication: add on therapy
        E.g. infliximab
      - Surgical
        Indications: medical fail, obstruction, perf, fistulae, abscess
        MOA: resect worst areas, but not curative
        SEs: short bowel syndrome, recurrence