Chronic Bowel Disorders Flashcards
How do you reduce the risk of osteoporosis in patients who have coeliac disease?
- calcium and vit D
- should be advised not to buy OTC unless they have spoken to a HCP
What are symptoms of coeliac disease?
- bloating
- diarrhoea
- abdominal pain
What is diverticular disease?
- pain in the lower abdomen
How do you treat diverticular disease?
- high fibre diet
- if complicated - IV antibacterials
What is Chron’s disease?
- parts of the digestive system become inflamed
What are some symptoms of Chron’s disease?
- abdominal pain
- diarrhoea
- fever
- weight loss
- rectal bleeding
What is the drug treatment for Chron’s disease?
Monotherapy - corticosteroid. alternative = budesonide
If there are 2 or more exacerbations in a 12 month period - add on Azathiprine or Mercaptopurine
If neither are tolerated - MTX
For severe active Chron’s disease = adalimumab or infliximab
Some patients do not want maintenance treatment for Chron’s disease but can experience a relapse. Which symptoms indicate a relapse?
- weight loss
- abdominal pain
- diarrhoea
- general ill health
What is given to improve symptoms of fistulating Chron’s disease?
- ciprofloxacin or metronidazole
- metro usually given for 1 month
What are the symptoms of ulcerative colitis?
- Bloody diarrhoea
- Abdominal pain
- Urgent need to defaecate
How do you treat ulcerative colitis?
- First line - aminosalicylates (any salazines)
- If intolerant - rectal corticosteroid
How do you treat LEFT SIDED ulcerative colitis?
- High induction dose of oral aminosalicylate with addition of rectal aminosalicylate or beclometasone if necessary
- if unable to tolerate = oral prednisolone
When would tacrolimus be added to the treatment of ulcerative colitis?
- If there is still no response after 2-4 weeks of prednisolone
How do you treat severe ulcerative colitis?
- IV corticosteroids (e.g. hydrocortisone or prednisolone)
- If corticosteroids can’t be tolerated, then IV ciclosporin
- If ciclosporin cannot be tolerated - infliximab
What dietary advice is given for IBS?
- eat regularly - no large gaps between meals
- increase exercise
- limit fresh fruit (no more than 3 portions a day)
- Fluid intake should be increased to 8 cups a day
What drug treatment can be used for IBS?
Depends on the symptoms
- Antispasmodics (alverine, mebeverine, peppermint oil)
- Laxatives
- Loperamide
- If pts do not respond to this, low dose TCA’s can be used for stomach pain
What is short bowel syndrome?
- Patients have a shorter bowel so may need additional help absorbing nutrients
What is the drug treatment for short bowel syndrome?
- Usually patients lack in vitamins
- Oral magnesium - hypomagnesaemia is common
Diarrhoea is common in short bowel syndrome. Which anti-motility drugs are commonly used for diarrhoea?
- Loperamide (add codeine if desired response not achieved)
- Co-phenotrope - Crosses the BBB so can cause CNS side effects
In short bowel syndrome, what do you monitor if a patient is on colestyramine?
- Fat malabsorption
- Fat-soluble vitamin deficiencies
Drugs arent absorbed well in people with short bowel syndrome so need to be given in higher doses. What are examples of drugs that may need to be given in higher doses?
- levo
- digoxin
- warfarin
- oral contraceptives
