Chronic Bowel Disorders

Question 1

How do you reduce the risk of osteoporosis in patients who have coeliac disease?

Answer 1

• calcium and vit D

- should be advised not to buy OTC unless they have spoken to a HCP

Question 2

What are symptoms of coeliac disease?

Answer 2

• bloating
• diarrhoea
• abdominal pain

Question 3

What is diverticular disease?

Answer 3

• pain in the lower abdomen

Question 4

How do you treat diverticular disease?

Answer 4

• high fibre diet

- if complicated - IV antibacterials

Question 5

What is Chron’s disease?

Answer 5

• parts of the digestive system become inflamed

Question 6

What are some symptoms of Chron’s disease?

Answer 6

• abdominal pain
• diarrhoea
• fever
• weight loss
• rectal bleeding

Question 7

What is the drug treatment for Chron’s disease?

Answer 7

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

Question 8

Some patients do not want maintenance treatment for Chron’s disease but can experience a relapse. Which symptoms indicate a relapse?

Answer 8

• weight loss
• abdominal pain
• diarrhoea
• general ill health

Question 9

What is given to improve symptoms of fistulating Chron’s disease?

Answer 9

• ciprofloxacin or metronidazole

- metro usually given for 1 month

Question 10

What are the symptoms of ulcerative colitis?

Answer 10

• Bloody diarrhoea
• Abdominal pain
• Urgent need to defaecate

Question 11

How do you treat ulcerative colitis?

Answer 11

• First line - aminosalicylates (any salazines)

- If intolerant - rectal corticosteroid

Question 12

How do you treat LEFT SIDED ulcerative colitis?

Answer 12

• High induction dose of oral aminosalicylate with addition of rectal aminosalicylate or beclometasone if necessary
• if unable to tolerate = oral prednisolone

Question 13

When would tacrolimus be added to the treatment of ulcerative colitis?

Answer 13

• If there is still no response after 2-4 weeks of prednisolone

Question 14

How do you treat severe ulcerative colitis?

Answer 14

• IV corticosteroids (e.g. hydrocortisone or prednisolone)
• If corticosteroids can’t be tolerated, then IV ciclosporin
• If ciclosporin cannot be tolerated - infliximab

Question 15

What dietary advice is given for IBS?

Answer 15

• 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

Question 16

What drug treatment can be used for IBS?

Answer 16

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

Question 17

What is short bowel syndrome?

Answer 17

• Patients have a shorter bowel so may need additional help absorbing nutrients

Question 18

What is the drug treatment for short bowel syndrome?

Answer 18

• Usually patients lack in vitamins

- Oral magnesium - hypomagnesaemia is common

Question 19

Diarrhoea is common in short bowel syndrome. Which anti-motility drugs are commonly used for diarrhoea?

Answer 19

• Loperamide (add codeine if desired response not achieved)

- Co-phenotrope - Crosses the BBB so can cause CNS side effects

Question 20

In short bowel syndrome, what do you monitor if a patient is on colestyramine?

Answer 20

• Fat malabsorption

- Fat-soluble vitamin deficiencies

Question 21

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?

Answer 21

• levo
• digoxin
• warfarin
• oral contraceptives