coeliac disease, food allergy, antimuscarinics, reduced exocrine secretions, chelators, H2 receptor antagonists and misoprostol

Question 1

Chronic bowel disorders

Answer 1

Examples:
IBS, IBD, coeliac disease, diverticulosis, diverticular disease, diverticulitis, shirt bowel syndrome.

Coeliac disease:
Autoimmune disease linked with chronic inflammation of the small intestine.
It’s triggered by gluten (wheat, barely, rye etc)
- body will fight against gluten as body will think gluten is a foreign substance so it attacks it.
Due to this attack small intestine is hurt. So can’t absorb nutrients properly. (Ie lack of calcium, vit D, folic acid, iron) this can lead to things like osteoporosis, anaemia (iron etc).

SYMPTOMS:
- ABCD (Abdominal pain, Bloating, constipation, Diarrhoea)
Treatment:
Treatment is aimed at eliminating symptoms.

Non drug:
- Strict long gluten free diet (only effective treatment)

Drug:
- Supplementation with calcium, vit D & folic acid.
- Advise not to self medicate with OTC vitamins/minerals.
- Osteoporosis/Bone disease treat if needed.
- Prednisolone (initial whilst waiting for specialist) used in some cases.

Question 2

Memory tricks (pneumonics)

Answer 2

ADRs for chapter 1
- symptoms that happen all throughout chapter 1.
A - abdominal pain
D - diarrhoea
R - rectal bleeding

Question 3

Food allergy

Answer 3

Allergy VS Intolerance:
Allergy = immune response antibodies fighting itself due to food.
Intolerance - some minor ADR like bloating from a food.
Allergy is immunological but intolerance isn’t.

Common allergens:
Cows milk, eggs, soy, wheat, peanut, fish etc.

Management:
AVOID the food.
- Sodium cromoglicate (adjunct) [inhibits mast cell degranulation this prevents release of histamine which prevent allergic reaction]

DRUGS:
Chlorphenamine - Controls symptoms.
Food induced anaphylaxis - 1st line = Adrenaline (epi-pen)
- Dose: 100-150mcg up to 6 months. 150mcg 6 months - 5yrs. 300mcg 6 to 11 yrs. 500mcg 12-17 yrs [unless prepubertal or small]. 500mcg adults
ALL repeated after 5 min PRN.
[150 not on market rn as they used to fail and not give full dose and PTs must have 2 adrenaline prescribed at once]

Question 4

GI smooth muscle spasms

Answer 4

Antimuscarinics and other antispasmodic drugs:
- Relax intestinal smooth muscle.
- Reduce intestinal motility.
AM.- Hyoscine butylbromide, dicycloverine
AS.- Alverine, Mebeverine.

AEs AM.:
Cant see, pee, spit, shit.

Question 5

Reduced exocrine Secretions

Answer 5

Exocrine pancreatic insufficiency; reduced secretions of pancreatic enzymes to the duodenum. (part of small I)
- Without pancreatic enzymes cant digest food. ie less amylases, lipases, proteases = cant break carbs, lipids [gets help from bile], proteins.

Symptoms
- Maldigestion & Malnutrition.
- Diarrhoea
- Abdominal cramps
- Steatorrhea (Fatty poo)

Causes
Chronic pancreatitis, CF, coeliac disease, ZES, pancreatic tumours, GI surgery.

Treatment aims to relieve symptoms and achieve normal nutritional state.

DRUG:
Main treatment with Pancreatin (Creon, nutrizym 22 etc)
- They inactivated by gastric enzymes so take with food and avoid heat.
- Pancreatin contains 3 groups of enzymes (lipase, amylase, protease) helps digest food.

NON DRUG:
Diet advise, take food with 3 meals, avoid foods hard to digest, reduced fat diets NOT recommended, avoid alcohol, TAKE adequate hydration if on HIGH strength.

Question 6

Gastroprotective complexes & Chelators - Protect stomach lining

Answer 6

Chelators (Eg Sucralfate) protect the mucosa from acid-pepsin attack in gastric/duodenal ulcers.

Complex of aluminium hydroxide + Sulphated sucrose (SUCRAL = aluminium + sucrose) - has minimal antacid properties.

CAUTION: (intensive care pts) Bezoar formation (solid indigestible mass. take caution with these pts and these drugs as they can make that mass).
Is worse in enteral feeds and in pts with predisposing factors like delayed gastric emptying (blocks the feeding tube)
TAKE drug 1 hr B4 meals.

MEMORY TRICK: SucralfATE = ATE 1 hr b4 bed.
ATE take late at bed time.

Question 7

H2 Receptor antagonist

Answer 7

Examples: Famotidine, ranitidine, cimetidine etc
- Heal gastric/Duodenal ulcers.
- Relieve GORD symptoms
- AVOID in ZES (syndrome where body produces excess stomach acid) PPI more effective

Ranitidine - Safe in pregnancy but has been discontinued.
Cimetidine - Potent enzyme inhibitor interacts with many drugs so rarely used.

CAUTION - These drugs can mask symptoms of gastric cancer. (ALARM symptoms)

Common AE - Diarrhoea, dizziness, headaches, constipation, fatigue.

Question 8

Misoprostol

Answer 8

Synthetic PGA.
- Promotes Healing of Gastric/duodenal ulcers.
(can be used in abortion)

Conception/Contraception advise:
AVOID in women of child bearing age unless pregnancy excluded.
- Use effective contraception during treatment