Drugs in GIT

Question 1

What are some causes of constipation?

Answer 1

social factors - low fibre diet
physiological factors - depression, anxiety
physical factors - immobility, dehydration
side effects - opioids
organic causes - spinal injury, IBS, parkinsons disease

Question 2

What life style advice should be given for constipation?

Answer 2

increase fibre, exercise, increase fluids

Question 3

How to treat acute & chronic constipation?

Answer 3

bulk forming laxative
add or switch to osmotic laxatives
add stimulant laxative
prucalopride for women

Question 4

How to treat opioid induced constipation?

Answer 4

avoid bulk laxatives and use osmotic & stimulant ones
oxycodone with naloxone
methylnatrexone

Question 5

When should a patient be immediately referred relating to GIT

Answer 5

persistent unexplained change in bowel habit
palpable mass in lower right abdomen or pelvis
rectal bleeding
narrowing of stool calibre
fam history of colon cancer or IBS
unexplained weight loss, iron def anaemia, fever or nocturnal symptoms
severe constant constipation which can’t be treated

Question 6

What is haemorrhoids?

Answer 6

abnormally swollen vascular mucosal cushions that are present in anal canal

Question 7

What are the causes of haemorrhoids?

Answer 7

straining while trying to pass stools
ageing
increased intra-abdominal pressure
hereditary factors

Question 8

how to treat Haemorrhoids?

Answer 8

Laxatives if constipated

analgesia for pain/ topical hemorrhoidal prep

Question 9

What are red flag symptoms of diarrhoea?

Answer 9

blood in stools
recent hospital treatment/ antibiotic treatment 
constant vom 
weight loss
painless high water diarrhoea 
nocturnal symtoms

Question 10

How would you manage acute diarrhoea?

Answer 10

avoid contact with people for 48 hours
hygiene advice
oral rehydration slats

Question 11

What is IBS? and how is it characterised?

Answer 11

chronic relapsing and often lifelong disorder of GI function
abdominal pain
bowel habit change
abdominal bloating

Question 12

what are the red flags for IBS

Answer 12

unexplained weight loss
rectal bleeding 
frequent loose stools for more than 6 weeks over age 60 
abdominal mass
rectal mass
anaemia 
fam history of bowel or ovarian cancer

Question 13

treatment for IBS?

Answer 13

antispasmodics - mebeverine, alverine, peppmint oil
dietary & lifestyle advice
constipation - lax
diarrhoea - antimotility
then low dose tricyclic antidepressant - amitriptyline 5-10mg at night (pain relief)
selective serotonin reuptake inhibitor - citalopram

Question 14

What is diverticular disease? and how to treat it?

Answer 14

diverticula are mucosal pouches that push through the muscular wall of the colon
high fibre diet
fluid intake
bulk forming laxatives

Question 15

What does Ulcerative colitis cause? and what can it lead to?

Answer 15

profuse diarrhoea

lead to anaemia, dehydration, poor absorption of drugs

Question 16

What drugs can be given to treat alcohol withdrawal?

Answer 16

benzodiazepine for acute - diazepam and chlordiazepoxide also licensed
carbamazepines or clomethiazole are alternatives
delirium - lorazepam (prevent/ treat seizures, haloperidol, olanzapine

Question 17

What are the symptoms of wernicke’s encephalopathy and what causes it?

Answer 17

acute confusion, psychosis, ataxia, oculomotor dysfunction

lack of thiamine (vitamin B1)

Question 18

How to treat Wernicke’s?

Answer 18

high dose thiamine with multivitamins/ vitamin B complex