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GI Disease, IBD (UC), Peptic Ulcer Disease - Coggle Diagram
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IBD (UC)
Classification
Flaring starts in the colon and gradually spreads up the GI tract. Colon - (Proctitis), Large intestine - (Distal colitis) and Whole intestine - (Pancolitis)
Signs and Symptoms
Diarrhoea is the main symptom, mainly bloody. Symptom of urgency as UC gets worse, Ab pain and discomfort due to constipation.
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Treatment
Initial induction: Melsalazine rectal + 5-ASA oral
Mild and Moderate: 5-ASA oral (as rectal form can't reach deeper intestines)
Ineffective with 5-ASA: Add Budesonide 2mg/applicator form rectal OR hydrocortisone 10% foam once/twice daily OR Prednisolone 20mg/100mL once/twice daily (first line) OR Predisolone 5mg supp once/twice daily.
Ineffective with 5-ASA and Steroids: Azathiopine 2-2.5 mg/kg or Mercaptopurine 1-1.5 mg/kg oral daily.
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Severe acute colitis: Hydrocortisone + fluid and electrolyte replacement.
Salvage therapy:: Cyclosporin or infliximab IV due to severe condition.
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Risks and ADRs
Vedolizumab: Risk of PML (small but present risk)
Azathioprine: dose related myelosuppression and additive supression with allopurinol or febuxostat
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Maintenance
Continue with 5-ASA oral, if rectal form worked then continue use. NOT PBS SUBBED
Frequency changed to 2-3 times weekly rather than daily.
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Refractory disease state: Inflix subcut or infusion 5mg/kg for adutls and children, or vedolizumab 300mg infusion every 8 weeks for adults
Peptic Ulcer Disease
Risk factors
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Alarming symptoms: Anaemia, dysphagia, odynophagia, vomiting, unexplained weight loss
Diagnosis
Presenting with upper GI symptoms like reflux, can be diagnosed with Acid suppression therapy (PPI use to rule out GORD), H. Pylori faecal antigen (stool sample), Urea breath test, Endoscopy
Treatment
Triple therapy: PPI (Esomeprazole) + Amoxycillin, + Clarithyromycin for 7 days (Nexium HP7)
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Treatment failure
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OR Quad therapy: PPI, Bismuth, tetracycline and metronidazole 7-14 days
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Confirmation
Stop Abx and bismuth for 4 weeks, and stop PPI for 2 weeks before testing eradication of H.Pylori