1. Chronic bowel disease

Question 1

Coeliac disease

Answer 1

An allergy to gluten causing inflammation in the small intestine. This leads to malabsorption.

Question 1

Coeliac disease symptoms

Answer 1

• Diarrhoea
• Abdominal pain
• Bloating
• Malnutrition
• Lactose intolerance

Question 2

Coeliac disease treatment

Answer 2

• Gluten free diet
• Diet supported with vitamin supplements

Question 3

Diverticula disease

Answer 3

Diverticula (small sacs) form on the mucosal lining of the colon. Usually do not cause symptoms for most patients unless they become infected.
This is when diverticulitis occure

Question 4

Diverticulitis symptoms

Answer 4

General malaise
Lower abdominal pain
Fever

Question 5

Diverticulitis treatment

Answer 5

- Painkillers like paracetamol

- Bulk-forming drug laxatives

- Antispasmodics

Question 6

Diverticula uncomplicated cases

Answer 6

Can be managed with simple analgesics
e.g paracetamol

Question 7

Inflammatory bowel disease

Answer 7

• Ulcerative colitis (continous inflammation in the colon and rectum)
• Crohn’s disease - patches of inflammation and can affect any part of the gastrointestinal tract, from the mouth to the anus

Question 8

Inflammatory bowel disease symptoms

Answer 8

• Bloody diarrhoea
• Abdominal pain
• Weight loss fatigue
• Mouth ulcers

There are periods where there are severe symptoms e.g acute flare ups and there are periods where there are very mild-no symptoms, e.g remission

Question 9

Use of loperamide in inflammatory bowel disease

Answer 9

Loperamide and codeine can treat diarrhoea but are contraindicated when the colon is inflammed ‘colitis’

As anti-motility drugs may cause paralytic ileus, where movement of food through intenstines stops —> toxic megacolon –> the colon dilating and failing to expel waste and faeces

Question 10

Acute flare-ups treament:
Ulcerative colitis

Answer 10

For mild-moderate UC
1st line: Aminosalicylates (mesalazine, sulfasalazine)
Alternatively: corticosteroids (short-term)

Can give oral or rectal

Moderate-severe ulcerative colitis
1st line: Immune system drugs (azathioprine, methrotrexate)

Corticosteroids cannot be used long term, as long term use is associated with osteoperosis and diabetes

Question 11

Acute flare-ups treament:
Crohn’s diease

Answer 11

For one acute flare up in the last 12 months:
Corticosteroids (prednisolone)
Alternatively: aminosalicylates

For two+ episodes and remission:
Immune system drugs

Question 12

Drugs used in inflammatory bowel disease

Answer 12

Aminosalicylates
* Mesalazine
* Sulfasalazine

Corticosteroids
* Prednisolone

Drugs affecting immune system
* Azathioprine
* Methotrexate
* Mercaptopurine
* Monoclonal antibody

Question 13

Aminosalicylates side effects

Answer 13

side effects

• Blood disorders (low white blood cells and platelets)
  Patients must report signs of infection or blood disorders e.g sore throat, fever, mouth ulcers, bleeding or bruising

Conduct a full blood count if suspected and stop drug

• Nephrotoxicity
  Monitor renal function
• Salicylate hypersensitivity
  Sulfasalazine colours bodily fluid orange (includes tears, sweat urine)
  Can also stain soft contact lenses

Question 14

Aminosalicylates interactions

Answer 14

Enteric coated and modified-release mesalazine interacts with lactulose

Enteric coated and modified-release mesalazine are designed to be released in the higher PH of the stomach

Lactulose lowers the ph of the small intestine, preventing its release

Question 15

Irritable bowel syndrome

Answer 15

Irritable bowel syndrome is a common, life-long relapsing condition. It affects the digestive system

Question 16

Irritable bowel syndrome symptoms

Answer 16

• Lower abdominal colic (can be induced by stress)
• Bloating
• Alternating between Diarrhoea and constipation

Question 17

Irritable bowel syndrome treatment

Answer 17

GI spasms
Antispadmodics
* Alverine
* Mebeverine
* Peppermint oil

Constipation
Laxatives
* Any class (except lactulose which causes bloating)
* Linoclotide (unresponsive)

Diarrhoea
Anti-motility drug
1st line: Loperamide

Antimuscarinics
* Atropine
* hyoscine butylbromide

Question 18

Short-bowel syndrome

Answer 18

when the intestine fails to absorp a large amount of nutrients and fluid, as a big part of the intestine has undergone surgical resectioning

Question 19

Short-bowel syndrome symptoms

Answer 19

• Malnutrition - patients often deficient in essential fatty acids, vitamins
• Diarrhoea - as colon is shorter, not enough time to reabsorb water into stool to bulken it
• Poor drug absorption - patients may need higher doses of high risk drugs, e.g warfarin, digoxin

Question 20

Short-bowel syndrome treatment

Answer 20

Essentially managing symptoms

To treat malnutrition:
Supply vitamin and mineral supplements

To treat diarrhoea:
Loperamide

To manage poor drug absorption:
* Increase dose of high risk drugs.e .g warfarin, digoxin.
* Avoid enteric coated and modified-release preparations as they will be ineffective with a short bowel (less of it will be release)
INSTEAD
* Have uncoated, soluble tablets and liquid