Drugs in GI disease Flashcards
What type of stool indicates constipation on the Bristol stool chart?
Type 1/2
What is constipation?
Unsatisfactory/incomplete defecation due to infrequency + difficulty when emptying the bowels
Symptoms:
- Abdominal
- Bloating
- Nausea
- Straining during bowel movements
What drugs can cause constipation?
Aluminium antacids
Anitmuscarinics
Antidepressants
Antiepileptics
Sedating antihistamine
Cholestyramine
Antihypertensives
Opioids
Iron supplements
Antispasmodics
Diuretics
Calcium supplements
What are the treatment options?
Correct identifiable causes = modifiable (lack of advice) vs non-modifiable (parkinsons)
Lifestyle advice = diet: increase fibre + fluid intake; regular exercise
Laxatives
- bulk forming (bulk bowels = easier to pass)
- osmotic = absorb all the water in my intestines
- stool softeners = stool is too
- stimulants (stimulate brain for body)
- prucalopride (5-HT4 agonist) = palliative care
How do you treat acute/chronic constipation?
Bulk-forming laxative
Adequate fluid intake is important
+/- osmotic laxative
+ stimulant laxative
Stop laxatives once stools are soft + easy to pass
Take regularly during each episode but when required between episodes
How do you treat opioid-induced constipation?
Use osmotic + stimulant laxatives
Avoid bulk-forming laxatives
How do you treat constipation due to pregnancy?
Dietary measures, fluids (8-10 cups/day)
Bulk-forming, osmotic, glycerol suppositories (stimulants = but avoid near term)
State some red flags in constipation
Rectal bleeding
Blood in stools
Narrowing of stool calibre
Severe, persistent constipation
Unexplained weight loss
Fever
Iron-deficiency anaemia
Palpable mass in the lower right abdomen or pelvis
What are haemorrhoids?
What are the causes?
How do we manage it?
Abnormally enlarged vascular mucosal cushions (blood vessels) around anal canal
Affect 13-36% of population
Causes:
- straining when pooing = pregnancy
- ageing
- raised intra-abdominal pressure
- hereditary factors
Management:
- Laxatives
- Lifestyle advice - minimise constipation + straining
- Symptomatic relief - simple analgesia +/- haemorrhoidal prep.
What is diarrhoea?
The abnormal passage of loose/liquid stools > 3 times daily +/- volume of stool > 200g/day
When going to the toilet too often, you can suffer from dehydration (due to kidneys)
Causes:
- medication-induced
- stress
- travel
- infection = fever
What are the red flag symptoms for diarrhoea?
Painless, watery, high volume diarrhoea
Weight loss
Persistent vomiting
Nocturnal symptoms disturbing sleep
Recent hospital/antibiotic treatment
Travel history to endemic regions
Blood/mucus in stool
Name the drugs that can cause diarrhoea
Allopurinol
AII receptor antagonists
Antibiotics
Digoxin
Cytotoxic drugs
Colchicine
Theophylline
NSAIDs
Metformin
PPIs
SSRIs
Statins
High dose vitamin C
Magnesium-containing antacids
LAXATIVES
How do you manage acute diarrhoea?
Address potential causes
Loperamide (4mg STAT followed by 2mg after every loose)
If infection:
- minimise contact with others + 48 hrs after it stops
- Self-limiting
- If C.diff = oral vancomycin
Hydration
- oral hydration solution = dioralyte
- 200-400mL solution after every loose motion
What is overflow diarrhoea?
Severe constipation can cause a bowel blockage.
Bowel begins to leak out watery stools around the blockage from higher up in the bowel
The leak from the bowel can look like diarrhoea
What is irritable bowel syndrome?
A chronic, relapsing, lifelong disorder of GI function with no discerniblestructural/biochemical cause (stress related)
Characterised by:
- abdominal pain
- abdominal bloating
- abdominal cramping
- change in bowel habit
- distinguished from cancer pain - fixed site
OTC treatment if patient has been diagnosed
In ulcerative colitis, specific regions affected are their own conditions.
From the image name the conditions that affect each region of the small intestines.
The drugs have to be topical + local to treat areas (modified release)
What are the different types of enteral feeding tubes?
Nasogastric (NG) - through nose and to stomach
Percutaneous gastronomy (PEG) - tube that goes straight into stomach
What is bariatric surgery?
Name the different types of bariatric surgery.
Weight loss surgery
Reduces the size of the stomach
Not allowed any solids for 4 weeks post surgery
- Gastric band is reversible - band can be taken off; loosen band*
- Gastric bypass + vertical sleeve are irreversible*
