301 Fundamentals on therapeutics: GIT Flashcards
Conditions affecting GIT
- Oral cavity conditions (mouth ulcers, oral thrush, gingivitis)
- Dyspepsia stomach acid (heartburn)
- Gastritis
- Malabsorption
- Pancreatitis
- Hepatitis
- Biliary colic
- IBD
- IBS
- Diverticulitis
- Appendicitis
Common symptoms of GI conditions
- Abdominal pain & discomfort
- N + V
- Diarrhoea
- Constipation
- Blood in stools, weight changes, bloating etc.
SOCRATES - abdominal pain questions
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating and relieving factors
Severity
What is IBS?
Functional bowel disorder (absence of abnormality)
Affects twice as many women and 10-20% of pop. in western world
Symptoms of IBS
Abdominal pain and discomfort - affecting LLQ - symptom relief on defecation
Altered bowel habits - diarrhoea/constipation
Bloating
IBS above 6 months of symptoms
Causes of IBS
No known cause - multifactorial
Motility dysfunction
Diet
Genetics
Psychological factors
RED flag symptoms in IBS
Blood in stools - suggestive in IBD
Fever
N + V
Severe abdominal pain
Children under 16 - rare
Patients 45+ - changes in bowel habits - refer - cancer
Steatorrhoea - malabsorption problems
IBS management
Diet - FODMAPS avoid fats
Lifestyle - reduce stress
Antispasmodics - ‘ine’ (mebeverine, alverine, hyoscine and peppermint oil) - take before food
Treat intermittent diarrhoea and constipation
Low dose TCAs (amitriptyline) - abdominal pain
SSRI (fluoxetine) for refractory pain
Herbal medicines and probiotics - effective (limited evidence)
When should you refer with suspected IBS?
Fever
Blood in stools
Weight loss
Why does IBS occur?
Gut wall becomes sensitive and excitable, occurring too quickly (less water absorbed: diarrhoea) or too slowly (more water absorbed: constipation)
IBS triggers
Stress and emotion
Infections like gastroenteritis
Medications (affecting how NS interacts with gut)
What is diarrhoea?
Passage of 3+ loose or liquid stools per day
How many cases of diarrhoea per year?
17 million
3 types of diarrhoea
Acute: lasting <14 days (bacteria or viral infection)
Persistent: lasting >14 days
Chronic: lasting >4 weeks (caused by IBD, coeliac disease and bowel cancer)
Causes of diarrhoea
Viruses (norovirus)
Bacteria (food poisoning)
Parasitic causes
Drugs
IBS
IBD
Coeliac disease
What drugs cause diarrhoea?
Laxatives
Magnesium containing antacids
Metformin
RED flag symptoms of diarrhoea
- Changes in bowel habits (long-term) over 50s
- Diarrhoea following travel
- > 2-3 day duration in children/elderly/patients unable to drink fluid
- Presence of blood/mucous in stool
- Severe abdominal pain
- Steatorrhoea
Why is diarrhoea following travel a RED flag?
Giardiasis (intestinal infection caused by parasite)
Why is diarrhoea a concern in children, the elderly and patients unable to drink fluid
Dehydration risk
Diarrhoea management
- Oral rehydration solution (ORS) (glucose)
- Rice based ORS
- Loperamide (not 1st line as diarrhoea is body’s response to something wrong)
What set of patients benefit from rice based ORS over ORS?
Diabetics as ORS contains glucose
What is coeliac disease?
Chronic immune-mediated systemic disorder in genetically pre-disposed people
Spectrum condition ranging from gluten insensitivity to coeliac
What is coeliac disease triggered by?
Response to dietary gluten
Gluten is main protein in wheat, barley and rye
What does coeliac disease do?
Gluten absorbed from dietary sources and induces auto-immune response of GI cells causing damage to small intestine, causes inflammation of SI villi, reducing vitamins and mineral absorption
What does coeliac usually result in?
B12 deficiency
Symptoms of coeliac disease
Bloating
Diarrhoea
Nausea
Flatulence
Constipation
Tiredness
Headaches
Sudden weight loss
Hair loss
Anaemia
Osteoporosis
Rash (dermatitis herpetiformis)
Neurological disorders
What is dermatitis herpetiformis?
Symptom of coeliac
Itchy bumps and blisters on skin due to gluten sensitivity
Coeliac disease management
Adherence to gluten-free diet
Treat with antihistamines for symptoms (as autoimmune and not GI pain)
