1 GI Flashcards

Question

Lactulose CI in:

Answer 1

MR-EC preparations (⬇️ stool ph) IBS Mesalazine

Answer 2

``` headache Nausea Watery diarrhoea Indigestion Skin rash - itch Fever Metallic taste Yellow body fluids Discoloured contact lens( harmless) ```

Answer 3

``` Diabetes Hypertension Fluid retention Upset stomach Weight gain Immunosuppressant Osteoporosis ``` CI kidney + liver problems

Answer 4

``` Allergy Flu symptoms Fever Chills N+V Fatigue Diarrhoea Muscle ache Hypotension (low BP) ```

Answer 5

``` Under 12 Pregnancy Active UC!!!!! Severe pain Bloody diarrhoea Liver failure Water retention Conditions with low gut mobility Antibiotics related colitis (clindamycin) 16mg max daily! ```

Answer 6

Heat Gastric acid

Answer 7

Loose stool Dark stool Sore skin

Answer 8

1 week More than 90% effective >90%

Answer 9

Asthma/COPD Motion sickness Dysmenorrhea Arrhythmias CI in ulcerative colitis

Answer 10

IBS MR /EC Mesalazine

Answer 11

Loperamide | Codeine

Answer 12

Ciclosporin

Answer 13

Tuberculosis TB Take sexual contraception until 18weeks AFER treatment with MAB

Answer 14

Pain in joints, eyes , skin, osteoporosis and arthritis

Answer 15

``` Antipsychotics (clozapine, quetiapine) Atropine. Benztropine. Biperiden. Chlorpheniramine. Certain SSRIs (Paroxetine) ``` But used as antispasmodic Dicyclomine propantheline Hyocine

Answer 16

reduce colonic motility by inhibiting parasympathetic stimulation of the myenteric and submucosal neural plexuses. They also inhibit gastric emptying. SE: Dry mouth with difficulty swallowing and thirst. dilation of the pupils with difficulty accommodating and sensitivity to light - i.e. blurred vision. increased intraocular pressure. hot and flushed skin. dry skin CANT: SEE,SPIT,PEE,POOP

Answer 17

UC occurs when the lining of your large intestine (also called the colon), rectum, or both becomes inflamed.

Answer 18

``` Bowel rest Only if: Infection present Or Immunosuppressed ``` Antibiotics IV- gram negative or aerobic

Answer 19

High fibre diet | Bulk forming laxatives—>methycellulose

Answer 20

``` 1. aminosalicylates Balsalazine Olsalazine Mesalazine Sulfalazine ``` ALTERNATIVELY: ORAL Prednisolone or rectal corticosteroids 2. ADD oral prednisone (after 4 weeks with aminosalicylate) ADD Tacrolimus if no response after 2-4 weeks CI: loperamide and codeine

Answer 21

ORAL 1. High dose aminosalicylates PLUS rectal Or oral beclometase Alternative: oral prednisone alone 2. ADD oral prednisone (after 4 weeks with aminosalicylate) ADD Tacrolimus if no response after 2-4 weeks CI: loperamide and codeine

Answer 22

Oral prednisone ``` Alternatively: Monoclonal antibodies (MAB) ``` adalimumab Infliximab No improvement? ``` 1. Stat hospital MEDICAL EMERGENCY IV Corticosteroids ( + assess need for surgery) ``` Alternatively: IV Ciclosporin OR surgery If IV ciclosporin CI give: infliximab 2. If no improvement within 72hrs of hospital admission IV Ciclosporin PLUS IV corticosteroids OR Surgery

Answer 23

Reals AS alone (more effective than with oral) Low dose oral AS Azathioprine / mercaptopurine But : if 2+ flare ups in 12months required IV corticosteroids After one severe flare up Remission not maintained after oral AS —-> continue MAB if effective/Tolerated in acute flare up

Answer 24

1+ acute flare up in 12 months or first presentation: 1. CORTICOSTEROIDS Prednisolone Methyl Prednisolone IV hydrocortisone Alternatively in patients with: right sided colonic disease: budesonide or AS 2+ acute flare ups in 12 months (maintaining remission of CD) Azathioprine or mercaptopurine Alternatively: methotrexate Alternatively: MAB After surgery: Azathioprine OR mercaptopurine OR AS

Answer 25

Not suitable Vits: A, E, D, K; zinc, selenium, magnesium, essential fatty acids

Answer 26

Increased frequency or volume or both Acute 14 days or less Chronic 14+ Red flag: weight loss, rectal bleeds, travel, antibiotics, recent hospital visit

Answer 27

Food poisoning: Salmonella Campylobacter E-coli

Answer 28

``` Qt prolonged Cardiac arrest Dizziness, Headache, Doesn’t cross BBB ```

Answer 29

``` Upper abdominal pain Fullness Early satiety Bloating Belching Nausea ```

Answer 30

A L A R M Aneamia Loss of weight Anorexia Recently changed, unexplainable dyspepsia in 55+, not responding to tx Melena (blood in stool)

Answer 31

1. Antacid 2. PPI for 4wks 3. H.pylori test if no improvement

Answer 32

1. H.pylori test if Positive (eradication therapy) | 2. PPI or H2 antagonist for 4wks (if test negative)

Answer 33

Constipation Rebound acid secretion hypocalcemia Alkalosis Milk alkali syndrome (Hugh blood ca)

Answer 34

``` high urine output. headache and confusion. fatigue. nausea. pain in your abdomen ```

Answer 35

2 hours before and after medicines Especially: Tetracyclines Quinolones Bisphosphates

Answer 36

``` Esomeprazole Lansoprazole (30-60mints before food) Omeprazole ✅ pregnancy Pantoprazole Rabepazole ``` “Best in morning, swallow whole, don’t chew or crush” “2hrs before or after food”

Answer 37

``` Can mask gastric cancer Increased risk fractures (osteoporosis) Increased GI infections c.difficile Abdominal pain, nausea, constipation Subacute cle 1 year after taking PPI Low mg 3mths-1yr PPI + digoxin = toxicity ``` Take Ca + Vit D Or bisphosphate

Answer 38

Toxic Omeprazole decrease methotrexate clearance

Answer 39

Shortest duration and lowest dose

Answer 40

Resolves by it self usually | If not give steroids

Answer 41

1 house before food | & enteral feeds

Answer 42

ALWAYS rule out malignancy ESP in pts 55+ Cimetidine Ranitidine Famotidine Nizatidine ``` SE: Headaches Rashes Dizziness Diarrhoea Confusion + psychological reactions Depression Hallucinations in elderly + very ill ```

Answer 43

Tachycardia Cardiac disease Hypotension Anaphylaxis CAN CAUSE DEATH

Answer 44

Tetrogenic in pregnancy Avoid MG in antacid

Answer 45

1. Withdrawal NSAIDs if possible | 2. PPIs or H2A or misoprostol

Answer 46

Age 65+ History of peptic ulcers Other GI complications Co-morbidities: Diabetes Cardiovascular disease Hepatic/renal impairment Taking other meds: Bisphosphate Corticosteroids SSRI’s

Answer 47

``` Continue PPI (after healing) Or H2A or misoprostol ``` ADD cox2 selective NSAIDs

Answer 48

Heart burn and bring up acid

Answer 49

Mild: Antacids + alginates PPI - H2A Severe PPI for 4-6wks Maintain remission with low PPI/H2A Pregnancy Antacids or alginate Omeprazole Children Resolves after 12-18 months Thicker feeds or alginates

Answer 50

Symptoms: Vomiting, rashes, anaphylactic shock, colic, diarrhoea Causes: Egg, fish,milk,nuts Tx: Sodium cromogilcate Chlorphenamine Adrenaline (epipen)

Answer 51

Cystic fibrosis Chronic pancreatitis Zollinger-Ellison syndrome Coeliac disease How to take: Distribute food intake increase frequency and decrease quality Avoid: difficulty to digest food: lentils,beans,avoid reduced fat foods Starch, fat, protein Take with food If mixed with food or drink have it within 1 hr ME/EC = increase pancreatin doses

Answer 52

Increased or decreased Uric acid (Severe joint pain, AKI) NV, abdominal pain, skin around mouth irritation/buccal mucosa (perioral skin)

Answer 53

With increased doses of pancreatin At risk male, severe CF, laxative use Nutrizym 22 Pancrease HL contra indicated in kids 15 and under Pts stat report SE abdominal pain

Answer 54

MR/EC Not suitable Avoid sorbitol (laxatives) (Take K+ supplement (liquid = better) (digoxin?) Split daily doses Avoid laxatives Can have bulk forming Increased doses codeine /loperamide can be used