Chronic bowel disorders

Question 1

Coeliac disease

Answer 1

gluten allergy causes inflammation in small intestine = malabsorption

Question 2

Coeliac disease: symptoms

Answer 2

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

Question 3

Coeliac disease: Treatment

Answer 3

• Gluten free diet
• Vitamin supplement

Question 4

Diverticular disease + diverticulitis

Answer 4

• diverticula develop in mucosal lining of colon
• Diverticulitis is an infection

Question 5

Diverticular disease + diverticulitis: symptoms

Answer 5

• Fever
• Lower abdominal pain
• General malaise

Question 6

Diverticular disease + diverticulitis: treatment

Answer 6

• High fibre diet + bulk forming drug
• Uncomplicated: paracetamol

Question 7

Inflammatory bowel disease: symptoms

Answer 7

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

Question 8

Inflammatory bowel disease: symptoms (UC)

Answer 8

Ulcerative colitis

• Ulcers
• Continuous inflammation in mucosa of colon + rectum

Question 9

Inflammatory bowel disease: symptoms (CD)

Answer 9

Crohn’s disease

• Cobblestone surface
• Affects mouth to anus
• Fissures
• Thick wall

Question 10

Inflammatory bowel disease: treatment (what not to use)

Answer 10

Loperamide + codeine CI in colitis - may cause paralytic ileus, leading to toxic megacolon → infections

Question 11

Inflammatory bowel disease: treatment acute flare ups + maintenance (CD)

Answer 11

Acute (1 episode)
- Corticosteroid

Acute (2+ episodes + remission)
- Immune system drugs

Question 12

Inflammatory bowel disease: treatment acute flare ups + maintenance (UC)

Answer 12

Mild to mod:
- First line: aminosalicylate
- Alt: corticosteroids

Mod to severe
- Immune system drugs

Question 13

Inflammatory bowel disease: drugs

Answer 13

Aminosalicylates
- Mesalazine
- Sulfasalazine

Corticosteroids
- Prednisolone
- Hydrocortisone
- Budesonide

Drugs affecting immune system
- Azathioprine
- Methotrexate
- Ciclosporin
- Mercaptopurine

Question 14

Aminosalicylate: MOA

Answer 14

Red cytokine + free radical formation + inhibit prostaglandin synthesis

Question 15

Aminosalicylate: side effect

Answer 15

Blood disorders
- Monitor: STOP drug + take FBC

Nephrotoxic
- Monitor: RFT

Salicylate hypersensitivity

Sulfasalazine: yellow-orange fluid
- Counsel: stains soft contact lenses
- Label: this medicine may colour your urine, this is harmless

Question 16

Aminosalicylate: interaction

Answer 16

Mesalazine (MR/entericoated) + lactulose → lactulose RED pH (prevent release of mesalazine)

Question 17

Irritable bowel syndrome: risk factors

Answer 17

• affects 20-30 year olds
• more common in women

Question 18

Irritable bowel syndrome: symptoms

Answer 18

• Lower abdominal colic
• Bloating
• Diarrhoea + constipation
• Aggravated by psychological factors like stress, anxiety, or depression bloating

Question 19

Irritable bowel syndrome: treatment (GI spasms)

Answer 19

• Mebeverine
• Peppermint oil (heart burn, throat irritation)

Question 20

Irritable bowel syndrome: treatment (Constipation)

Answer 20

• Any class except lactulose (causes bloating)
• Linoclotide (unresponsive)

Question 21

Irritable bowel syndrome: treatment (diarrhoea)

Answer 21

Loperamide

Question 22

Irritable bowel syndrome: treatment (antimuscarinic)

Answer 22

• Hyoscine butylbromide
• Propantheline bromide

Question 23

Short bowel syndrome

Answer 23

intestinal failure after large surgical resection

Question 24

Short bowel syndrome: symptoms

Answer 24

• Malnutrition
• Diarrhoea
• Poor drug absorption

Question 25

Short bowel syndrome: treatment

Answer 25

• Deficiency: vitamin + mineral supplements
• Diarrhoea: loperamide

Poor absorption, patients need:

• Higher dose/IV: warfarin, oral contraceptives, digoxin
• Avoid: EC + MR (designed to dissolve in small intestines)
• Use uncoated + soluble tablets + liquids instead