Coeliac Disease Flashcards
What is coeliac disease?
An autoimmune condition which is associated with chronic inflammation of the small intestine.
What can trigger coeliac disease?
Gluten activates an abnormal immune response in the intestinal mucosa, which can lead to malabsorption of nutrients
Examples of where gluten can be found?
Wheat, barley and rye.
Pasta, cereal, bread.
Malt like malted milk or milkshake
What’s the aim of treatment for coeliac disease?
The management is aimed at eliminating symptoms like diarrhoea, bloating, abdominal pain; and reducing the risk of complications including those resulting from malabsorption.
What’s the non-drug treatment for coeliac disease?
A strict life-long gluten free diet.
You can get gluten free products on prescriptions.
What complications can occur from coeliac disease?
Can lead to malabsorption of fe2+, folic acid, vitamin d and ca2+.
Because of the risk in malabsorption, the risk of other conditions like osteoporosis, other bone disease, anaemia is increased.
If these arise there should be an active treatment for the bone disease as part of managing coeliac disease
What can patients with coeliac disease not do?
They cannot self-medicate with over the counter vitamins or mineral supplements.
Imitation of supplementation must involve a discussion with a member of the patient’s healthcare team.
What’s the initial drug treatment for coeliac disease?
Prednisone
Only a short time, whilst waiting for specialist advice.
Symptoms of coeliac disease?
- Abdominal pain
- Bloating
- Constipation
- Diarrhoea
What other drug treatments can be given?
Supplementation with calcium, vitamin D and folic acid, due to malabsorption.
Osteoporosis and bone disease treatment.
What needs to be referred to specialist care?
Confirmed cases of refractory coeliac disease.
What is the difference between food allergy and food tolerance?
Food allergy is an adverse immune response and is more immunological, whilst food tolerance is not.
What is the drug treatment for food allergies?
- Chlorphenamine maleate
For food induced anaphylaxis, Adrenaline is the first line treatment
LEARN ADRENALINE DOSES ON BNF TABLE
What is used to manage food allergies?
- Avoiding certain foods
- Sodium cromoglicate (given as adjunct to dietary avoidance).
What is used for Gastro-intestinal smooth muscle spasms?
Antimuscarinics
- They relax the intestinal smooth muscle and reduce intestinal motility
These include: Dicycloverine hydrochloride & Hyoscine Butylbromide (Buscopan)
Antipasmosdics
- Such as alverine & Mebeverine
What are some antimuscarinic side effects?
- Blurred vision
- Urinary retention
- Constipation
- Dry mouth
Explain reduced exocrine secretions?
This is exocrine pancreatic insufficiency, which is reduced secretion of pancreatic enzymes into the duodenum.
What are the symptoms of exocrine pancreatic insufficiency?
- Maldigestion & malnutrition
- Diarrhoea
- Abdominal cramps
- Steatorrhea
What are the causes of Exocrine pancreatic insufficiency?
- Chronic pancreatitis
- Cystic fibrosis
- Coeliac disease
- Zollinger-Ellison syndrome
- Pancreatic tumors
- G.I surgery
What is the drug treatment for Exocrine pancreatic insufficiency?
And what advice must be given to go with it?
Pancreatic enzyme replacement therapy with Pancreatin (e.g. Creon, pancrex V and nutrizym22)
Take with food due to it being inactivated by gastric enzymes. And avoid heat.
What does Pancreatin contain?
Contains 3 groups of enzymes:
- Lipase
- Amylase
- Protease
These help to digest fats, carbs and proteins.
What non drug management is given for Exocrine pancreatic insufficiency?
- Avoid alcohol completely
- Distribut food intake between 3 main meals a day, and 2 or 3 snacks
- Avoid hard to digest foods like legumes (peas, beans, lentils and high fibre foods)
What is not recommended for Exocrine pancreatic insufficiency?
- Reduced fat diets are not recommended
What must be ensured for those taking Pancreatin?
Ensure adequate hydration for those on high strength pancreatin
What do Gastroprotective complexes & chelators do?
They protect the stomach lining. And they have a minimal antacid properties.
Chelates such as sucralfate protect the mucosa from acid-pepsin attack in gastric and duodenal ulcers.
What is contained in gastroprotective complexes?
A complex of aluminium hydroxide & sulphated sucrose called Sucral (Sucose + aluminium)
What is a caution for Gastroprotective complexes and chelators?
Intensive care patients (seriously ill patients).
It can cause Bezoar formations. Especially those receiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric emptying (blocks feeding tubes).
When should sucralfate be given?
One hour before food and enteral feeds
And at bedtime (and on rising).
What do H2 receptor antagonists do?
Heal gastric and duodenal ulcers.
And relieve GORD symptoms.
What are examples of H2 receptor antagonists?
- Ranitidine
- Famotidine
- Cimetidine
What should H2 receptor antagonists not be used for?
It should not be used for Zollinger-Ellison syndrome like stomach tumours, causing release of too much acid.
What is effective for Zollinger-Ellison syndrome?
Proton pump inhibitor (PPI)
Which H2 receptor antagonists is safe to take in pregnancy?
Ranitidine
(but discontinued at the moment)
Which H2 receptor antagonists interacts with many drugs?
Cimetidine.
It is a potent enzyme inhibitor.
What is the caution for H2 receptor antagonist?
They masks symptoms of gastric cancer so be alert with patients presenting alarm signs
What is the most common side effect of H2 receptor antagonists?
- Diarrhoea
- Dizziness
- Headaches
- Constipation
- Fatigue
- Myalgia
What is Misoprostol?
It is a synthetic prostaglandin analogue.
It promotes healing of gastric and duodenal ulcers.
