N116, inflammation 4, 2025

Inflammatory Bowel Disease (IBD)

• Definition: A group of chronic inflammatory conditions affecting the digestive tract.

  • Major types include Crohn's disease and ulcerative colitis.

• Risk Factors:

  • Family history.

  • Environmental triggers (dietary factors, stress).

  • Bacterial factors.

• Autoimmune Effect:

  • GI cells targeted by atypical immune response.

• Systemic Symptoms:

  • Fever, anemia, fatigue, weight loss, rash.

Crohn’s Disease vs. Ulcerative Colitis (UC)

• Crohn’s Disease:

  • Can affect any part of the GI tract.

  • Characterized by patchy inflammation and cobblestone appearance in the bowel.

• Ulcerative Colitis (UC):

  • Involves continuous inflammation, primarily in the large intestine.

  • Symptoms include the thickening of colon walls and ulceration.

Treatment Options for IBD

• Drug Classes:

  • Glucocorticoids: Reduce inflammation.

  • Aminosalicylates: Such as Sulfasalazine (Azulfidine); acts on colon.

  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs): E.g., Methotrexate.

  • Stem cell research.

Colonoscopy and Imaging for IBD

• Procedure:

  • Scope inserted into the lower GI tract for imaging.

• Findings:

  • Normal colon vs. Crohn's disease (cobblestoning, fat wrapping, fissures).

  • Normal findings in UC include loss of haustra and pseudo-polyps.

Asthma: Overview

• Definition: Chronic inflammatory airway disorder, not autoimmune.

• Incidence: Up to 10% in Canadians.

• Risk Factors:

  • Family history and atopy.

  • Exposure to noxious stimuli (allergens, irritants).

  • Chronic hypersensitivity and changes in airway structure.

Asthma Challenges

• Chronic bronchial inflammation leads to:

  • Increased risk of acute attacks due to sudden extreme inflammatory responses.

• Treatment Focus:

  • Stabilizing bronchial inflammation.

  • Minimizing attacks through trigger avoidance, maintenance drugs, correct inhalation techniques, and necessary immunizations.

Controller Medications for Asthma

• Anti-Inflammatory Drugs:

  • Inhaled glucocorticoids as first-line maintenance treatments.

  • Example Drugs: Pulmicort, Qvar, Flovent.

• Adjunctive Treatment:

  • Mast cell stabilizers (Cromolyn).

  • Leukotriene modifiers (Singulair).

Advanced Maintenance Treatments

• Biologics (antibodies):

  • E.g., Xolair (omalizumab); reduces inflammatory response in asthma.

Impaired Gas Exchange in Asthma

• Bronchioles narrow during asthma attacks, leading to gas trapping and impaired gas exchange:

  • Increased CO2 retention, decreased O2 intake resulting in hypoxemia.

Asthma Attack Symptoms and Pathophysiology

• Symptoms:

  • Wheezing, shortness of breath, tachycardia, anxiety, fatigue.

• Pathophysiology:

  • Limited inspiration and prolonged expiration lead to air trapping; can result in ventilation-perfusion mismatch.

Rescue Medications for Asthma Attacks

• Inhaled Beta 2 Adrenergic Agonists:

  • Fast-acting; e.g., Salbutamol (Ventolin), Albuterol.

• Anticholinergics:

  • E.g., Atrovent (Ipratropium); used for synergistic effects with beta-agonists.

Severe Asthma Attack and Emergency Treatment

• Life-threatening symptoms requiring immediate care:

  • Administer O2, beta-agonists (nebulized), calcium channel blockers (e.g., Magnesium sulfate IV).

Differences Between Asthma Attacks and Anaphylaxis

• Asthma Attack:

  • Airway/breathing focused; no associated allergic symptoms like hives or vomiting.

• Anaphylaxis:

  • Includes systemic symptoms like hives and swelling.

• If unsure, treat both conditions concurrently with epinephrine and albuterol.

Summary of Treatment Protocols

• Immediate treatment distinctions:

  • Asthma managed with bronchodilators; anaphylaxis with epinephrine.

• Medical attention is critical in both scenarios.