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Pre-reg > Chronic Bowel Disorders > Flashcards

Chronic Bowel Disorders Flashcards

1
Q

what is coeliac disease?

A

autoimmune condition associated with chronic inflammation of small intestine unable to absorb nutrients

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2
Q

what nutrients are at high risk of not being absorbed in coeliac disease?

A

calcium and vit d

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3
Q

what are the 3 parts to treatment of coeliac disease?

A

1 gluten free
2 - assss risk for osteoporosis and treat bone disease
3 - vitamin and mineral supplements

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4
Q

Diverticulitis is when pockets (diverticula) develop in the lining of the intestine and become inflammed/infected. What are the 3 parts to management?

A

1 - high fibre diet
2 - bulk forming drugs to help with diarrohea or constipation
3 - antibiotics for signs of infection

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5
Q

name 4 complications of ulcerative colitis

A
  1. colorectal cancer
  2. secondary osteoporosis (corticosteroid, dietary changes)
  3. VTE
  4. toxic megacolon (deeper spread of inflammation)
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6
Q

what drugs should NOT be given to patients during a flare of UC?

A

loperamide and codiene - avoid anti-motility drug/antispasmodics: paralytic ileus = increased risk of toxic megacolon)

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7
Q

when would oral therapy, suppositories, enemas, and foam preperations be most appropriate for treatment of UC?

A

Oral - extensive (proximal) colitis
Suppositories - inflammtion of rectum (proctitis)
Enemas - inflammation up to descending colon (left-sided colitis)
Foam - inflammation of rectum and sigmoid colon (proctosigmoiditis)

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8
Q

first line treatment in proctitis (inflammation of rectum) and proctosigmoiditis (inflammtion of rectum and sigmoid)?
What-s the alternative?

A

1st - rectal aminosalicylate (mesalasine, sulfasalasine)
2nd - rectal corticosteroid or PO pred

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9
Q

first line treatment in extensive and left-sided colitis (up descending colon)?
what’s second line?

A

1st = high dose oral aminosalicaylate + rectal aminosalicylate or oral beclometasone if necessary
2nd = oral prednisolone

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10
Q

what’s 1st line for moderate-severe UC and what’s 2nd?

A

1st = oral prednisolone
2nd = monoclonal antibodies

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11
Q

what’s 1st line in treatment failure in mild-moderate UC?
what do you add in if no response after 2 - 4 weeks?

A

add oral pred after 4 weeks with aminosalicyate
add oral tacrolimus if no response after 2 - 4 weeks

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12
Q

what’s 1st line for severe acute UC?
what’s 2nd line option (if symptoms don’t improve/worsen in 72 hours)?

A

1st line = IV corticosteroid and assess need for surgery, or could use IV ciclosporin or surgery

2nd line = IV ciclosporin + IV corticosteroids or steroids

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13
Q

what’s an alternative to ciclosporin for management of acute severe UC?

A

infliximab

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14
Q

what’s an alternative to ciclosporin for management of acute severe UC?

A

infliximab

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15
Q

what are the differences in maintaining remission in proctitis and proctosigmoiditis compared to extensive colitis and left sided colitis?

A

Proctitis + proctosigmoiditis = rectal aminosalicylate alone or with oral aminosalicylate

Extensive + left-sided colitis = low-dose oral aminosalicylate + oral azathioprine/mercaptopurine if 2+ flare ups in 12 months that require steroids or if remisison not maintained by aminosalicylates + MAbs continued if effective

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16
Q

when is oral azathioprine/mercaptopurine added into maintained remission in extensive/left-sided UC?

A

if 2+ flare ups in 12 months needign steroids or if remission not maintained by aminosalicylates

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17
Q

when is oral azathioprine/mercaptopurine added into maintained remission in extensive/left-sided UC?

A

if 2+ flare ups in 12 months needign steroids or if remission not maintained by aminosalicylates

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18
Q

where in the body does Chron’s affect?

A

GI tract (mouth to anus)

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19
Q

name some lifestyle adivce you could give to someone with chron’s

A
  • high fibre diet
  • smoking cessation reduces risk of relapse
  • loperamide or codeine treats diarrhoea - not in colitis
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20
Q

what’s the treatment for 1+ acute flare in 12 months/1st presentation of Chron’s?
what are the alternatives?

A

corticosteroids
alternatives = budesonide or aminosalicylate in patients with distal ileal, iliealcaecal or right sided disease

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21
Q

what’s the treatment for 2+ acute flare ups in 12 months? (or if corticosteroid dose cannot be reduced)

A

azathioprine or mercaptopurine
alternative = methotrexate
alternative = MAbs

22
Q

what’s the maintenace of remission in Chrons disease with and without srugery?

A

without = azathioprine or mercaptopurine
alternative = methotrexate

after surgery = azathioprine or mercaptopurine OR aminosalicylate

23
Q

what’s an interaction involving mesalazine you should counsel patients about?

A

lactulose - lactulose lowers stool pH in the intestines. This prevents sufficent release of the active ingredient EC or MR preperations

24
Q

what should be monitored with aminosalicylates?
what are some general counselling points?

A

renal function
itching and hives, can get yellow/orange bodily fluids with sulfasalasine (stain contact lenses)
blood dyscrasias (unexplained bleeding, bruising, sore throat, fever)

25
Q

what laxative isn’t recommended in IBS and why?

A

lactulose as it causes bloating

26
Q

what classes of antibiotics can be used as 2nd line therapy for abdominal pain in IBS?

A

tricyclic antidespressants, SSRIs

27
Q

what is linoclotide and when can it be used?

A

laxative to be used in IBS when unresponsive to other classes and have had constipation for 12 months

28
Q

what vitamins and minerals are patients oftne deficient in who have short bowel syndrome?

A

vitamin A, B12, D, E & K, essential fatty acids, zinc, selenium, hypomagnesaemia

29
Q

what formulations are unsuitable for patients with short bowel?

A

EC or MR

30
Q

why may you need to give higher doses of warfarin, oral contraceptives and digoxin (or give IV) in patients with short bowel?

A

due to incomplete drug absorption

31
Q

what is constipation defined as in NICE?
what are the red flag symptoms?

A

less than 3 times a week

red flags = new onset over 50 years, anaemia, abdominal pain, unexplained weight loss, overt ot occult blood

32
Q

what are the 1st, 2nd, and 3rd line laxatives?

A

1st = bulk forming
2nd = osmotic
3rd = stimulant

33
Q

what can excessive use of stimualnt laxatives lead to?

A

hypokalaemia, diarrhoea, lazy bowel

34
Q

what stimulant laxative is genotoxic and carcinogenic?
what patient group is it used in?

A

Dantron
used in terminally ill patients only

35
Q

what 2 laxativs can be considered if at least 2 laxatives from different classes have been treid at the highest tolerated recommended doses for at least 6 months and what classes are they?

A
  1. prucalopride (woman only) - selective 5HT-4 agonist
  2. lubiprostone (chloride channel agonist)
36
Q

what laxative should you avoid in opioid induced constipation?

A

bulk forming

37
Q

what’s the choice of osmotic laxative in chroninc constipation?

A

macrogol

38
Q

what’s the 1st line laxative in children?
What can you add in?

A

macrogol - with diet/behaviour intervention
add stimulant if inadequate response
add lactulose or faecal softner if hard

39
Q

what’s the 1st line laxative in pregnancy and breat feeding?

A

bulk forming - then osmotic if stools remain hard

40
Q

what are the red flags for diarrohea?

A

unexplained weight loss, rectal bleeding, persistent diarrhoea, systemic illness, recent hospital treatment or abx, recent travel

41
Q

what’s the adult dose for loperamide?
whats the max dose?

A

initially 4mg, then 2mg for up to 5 days, take a dose after each loose stool
max dose = 16mg

42
Q

what can be given if loperamide overdose occurs?

A

naloxone

43
Q

what is the MHRA warning surrounding loperamide?

A

serious cardiac adverse reactions with high doses (QT prolongation, torasde de pointes)

44
Q

what 3 types of interaction do you need to bear in mind when giving antacids?

A
  1. impaired absorption of drugs - leave 2 hour gap (tetracyclines, quiolones - cipro., bisophosphonate
  2. damages EC coating by increasing gastric pH
  3. high sodium content - avoid in fluid retenton, avoid in HTN, HF, avoid in sodium-restircted diet (lithium)
45
Q

what PPI is safe in pregnancy?

A

omeprazole

46
Q

what are the long term risks of PPIs?

A

hypomagnesia, increased risk of c. diff and osteoporosis, rebount acid secretion

47
Q

what are 2 interactions with omeprazole and what happens?

A
  1. clopidogrel = reduced antiplatelet effect
  2. methotrexate = decreased clearance of methotrexate
48
Q

what are the treatment options to treat H. Pylori? (PAC, PAM, PMC)

A

1 week triple therapy: PPI BD + clarithromycin + amoxicillin OR metronidazole

  • give metronidazole if penicillin allergic
  • if pt treated with macrolide for other infection give amoxicillin + metronidazole
  • give amoxicillin and clarithromycin if meronidazole used for recent infection
49
Q

how do you diagnose H pylori and when should you not perform it?

A

do not perform within 4 weeks of antibacterial or 2 weeks of antisecretory drug

50
Q

hyoscine butylbromide can be used to treat smooth muscle spasams by relaxing muscle and reducign gut motility, what’s the MHRA warning for hyoscine butylbromide injections?

A

risk of cardiac adverse effects - contraindicated in tachcardia, caution in cardiac disease

51
Q

what condition is mebeverine and alverine contraindicated?

A

paralytic ileus

Pre-reg (47 decks)

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