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Pre-reg > Gastro > Flashcards

Gastro Flashcards

1
Q

What is diverticulitis?

A

When the pockets (diverticula) in the lining of the intestine become inflamed or infected

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2
Q

What are the symptoms of diverticulitis?

A

Lower abdominal pain
Constipation
Diarrhoea

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3
Q

What are the treatment options for diverticulitis?

A

High-fibre diet
Bulk-forming drugs
Antibiotics

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4
Q

What is first-line oral treatment for suspected/ confirmed acute diverticulitis?

A

Co-amoxiclav

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5
Q

What are the oral treatment options for diverticulitis in a patient who is allergic to penicillin?

A

Cefalexin with metronidazole
Trimethoprim with metronidazole
Ciprofloxacin with metronidazole (only if switching from IV)

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6
Q

What is first-line IV treatments for suspected/confirmed diverticulitis? (2 options)

A

Co-amoxiclav or cefuroxime with metronidazole
Amoxicillin with gentamicin and metronidazole

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7
Q

What is first-line IV treatments for suspected/confirmed diverticulitis with a penicillin allergy?

A

Ciprofloxacin with metronidazole

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8
Q

What are the symptoms of UC?

A

Bloody diarrhoea
Abdominal pain
Urgent need to defecate

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9
Q

What are the signs of an acute flare-up in UC?

A

Mouth ulcers
Arthritis
Sore skin
Weight loss
Fatigue

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10
Q

What are the long-term complications of UC?

A

Colorectal cancer
Secondary osteoporosis (corticosteroids)
Venous thromboembolism
Toxic megacolon

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11
Q

What is toxic megacolon?

A

Swelling and inflammation spread into deeper laters of the colon, which makes it stop working and widens.

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11
Q

What is contraindicated during an acute flare up in UC and why?

A

Loperamide
Codeine
Increases the risk of toxic megacolon. Avoid anti-motility / antispasmodics - can cause paralytic ileus

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11
Q

What type of formulation is best to treat proctitis?

A

Suppositories

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11
Q

What type of formulation is best to treat proctosigmoiditis?

A

Foam preparations
(foam/suppositories easier to retain than liquid)

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12
Q

What type of formulation is best to treat left-sided colitis? (distal)

A

Enemas

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12
Q

What type of formulation is best to treat extensive colitis? (proximal)

A

Oral

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13
Q

What scoring system is used to asses the severity of UC and how is it classified?

A

Truelove and Witts Severity Index
Mild, Moderate, Severe

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14
Q

What is the treatment for acute mild-moderate UC proctitis/proctosigmoiditis?

A

First line: Aminosalicylate (rectal)
Alternative: rectal corticosteroid, oral prednisolone

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15
Q

What is the treatment for acute mild-moderate UC extensive colitis/ left sided?

A

First line: High dose oral aminosalicylate
Plus rectal aminosalicylate or oral beclometasone if prn
Alternative: Oral prednisolone alone

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16
Q

What can be given if treatment fails in all extents of acute mild-moderate UC?

A

Oral prednisolone (after 4 weeks with aminosalicylate)
Add tacrolimus if no response after 2-4 weeks

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17
Q

What is the treatment for subacute moderate-severe UC?

A

Oral prednisolone
Alternative: MABs

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18
Q

What is the treatment for severe acute UC?

A

IV corticosteroid
Alternative: IV ciclosporin
If symptoms dont improve or worsen in 72 hours give IV corticosteroids and ciclosporin

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18
Q

What is the treatment for proctitis/ proctosigmoiditis for remaining in remission in UC?

A

Rectal aminosalicylate alone
Or with oral aminosalicylate

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19
Q

What is the treatment for extensive colitis / left sided for remaining in remission in UC?

A

Low dose oral aminosalicylate

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20
Q

When is azathioprine / mercaptopurine indicated for maintaining remission in UC?

A

If there has been 2+ acute flare ups in 12 months that require systemic corticosteroids
Or if remission has not maintained by aminosalicylates
Or after a severe flare up

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21
Q

What are the symptoms of Crohn’s Disease?

A

Abdominal pain
Diarrhoea
Rectal bleeding
Weight loss
Low grade fever
Fatigue

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22
Q

What is fistulating Crohn’s disease?

A

Involves formation of a fistula between the intestine and adjacent structures such as perianal skin, bladder and vagina

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23
Q

How is the first presentation of Crohn’s disease treated? (1 acute flare in 12 months)

A

Corticosteroid (pred, methylpred, hydrocortisone)
Alternative: budesonide or aminosalicylates in patients with distal ileal, ileocaecal or right sided colonic disease

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24
Q

How is 2 acute flare ups in 12 months treated in Crohn’s disease?

A

Azathioprine or mercaptopurine
Alternative: Methotrexate
Alternative: MABS

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25
Q

Give examples of aminosalicylates

A

Balsalazide
Mesalazine
Olsalazine
Sulfasalazine

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26
Q

Which aminosalicylate can colour urine / stain contact lenses?

A

Sulfasalazine

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27
Q

What are the side effects of aminosalicylates?

A

Blood dyscrasias
Nephrotoxicity
Hypersensitivity
Yellow/orange bodily fluids with sulfasalazine

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28
Q

What is the interaction between lactulose and mesalazine?

A

Lactulose lowers stool pH in the intestines. This prevents sufficient release of the AI in E/C or M/R preparations

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29
Q

What is the difference between budesonide and prednisolone?

A

Budesonide is locally acting with minimal systemic absorption, whereas prednisolone is metabolised throughout the body.

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30
Q

List the immunosuppressants used in Crohn’s Disease

A

Azathioprine
Ciclosporin
Mercaptopurine
Methotrexate
MABS

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31
Q

What is a contraindication for starting azathioprine treatment?

A

Absent thiopurine methyltransferase (TPMT) activity

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32
Q

What pre-treatment screening is need for azathioprine?

A

TPMT activity
(metabolises thiopurine drugs. Risk of myleosuppression is increased in patients with reduced activity of the enzyme)

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33
Q

What are side effects of azathioprine?

A

Bone marrow depression
Increased risk of infection
Leucopenia
Pancreatitis
Thrombocytopenia

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34
Q

What drug classes can be used for GI spasms in IBS?

A

Antispasmodics (alverine, mebeverine, peppermint oil)
Antimuscarinics (hyoscine butylbromide, atropine, dicycloverine, propantheline bromide)

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35
Q

Is lactulose recommended in IBS?

A

No - causes bloating

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36
Q

What is first line for diarrhoea in IBS?

A

Loperamide

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37
Q

What class of drugs has an unlicensed use for abdominal pain in IBS?

A

Antidepressants
-Tricyclic
-SSRI

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38
Q

What is the NICE CKS definition of constipation?

A

Bowel opening less than 3 times a week

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39
Q

List the red flag symptoms for constipation

A

New onset in over 50 years
Anaemia
Abdo pain
Unexplained weight loss
Blood

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40
Q

Give examples of Bulk-Forming laxatives

A

Sterculia
Isphaghula husk
Methylcellulose

41
Q

How long do Bulk-Forming Laxatives take to have their full effect

A

72 hours

42
Q

How do Bulk-Forming laxatives work?

A

Swells into gut to increase faecal mass to stimulate peristalsis

43
Q

What are the side effects of Bulk-Forming Laxatives?

A

Bloating
Cramping
Flatulence
Gut obstruction

44
Q

What are counselling points to give with Bulk-Forming Laxatives?

A

Maintain adequate fluid intake to avoid gut obstruction
Swallow with plenty of water and not immediately before bed

45
Q

Name examples of osmotic laxatives

A

Macrogol
Lactulose
Magnesium hydroxide

46
Q

What laxative is used first line after dietary advice

A

Bulk-Forming

47
Q

What type of laxatives are used second line?

A

Osmotic
If stools remain hard add or switch to osmotic

48
Q

How do osmotic laxatives work?

A

Increase water into colon by drawing fluid from the body

49
Q

How long does it take for lactulose to work?

A

Within 48 hours

50
Q

How long does it take for macrogol to work?

A

Works within 2-3 days

51
Q

List examples of stimulant laxatives

A

Bisacodyl
Sodium picosulfate
Senna
Glycerol
Docusate

52
Q

What type of laxatives are used third line?

A

Stimulant
Add if stools are soft but difficult to pass / incomplete emptying

53
Q

How do stimulant laxatives work?

A

Increases intestinal motility by irritating the gut lining. Work within 6-12 hours

54
Q

What are the side effects of stimulant laxatives?

A

Abdominal cramps
Senna colours urine yellow/brown
Excessive use= diarrhoea, hypokalaemia, lazy bowel

55
Q

What is Dantron and what type of patients is it used in?

A

Co-danthramer, codanthrusate
Used in terminally ill patients only
Red urine
Local irritation
Genetoxic and carcinogenic

56
Q

What laxatives are given for opioid induced constipation?

A

Osmotic or Docusate + Stimulant

57
Q

What type of laxatives should be avoided in opioid induced constipation

A

Bulk-forming laxatives = obstruction

58
Q

What laxatives should be used in children (who are not faecally impacted)

A

First line: Macrogol (along with diet/behaviour intervention
Add stimulant laxative if inadequate response
Add lactulose or facecal soften if stool remains hard

59
Q

What laxative is first line for constipation in pregnancy?

A

First line: Bulk forming (if fibre supplements fail)
Osmotic (lactulose) can be used
Bisacodyl or senna if a stimulant effect is necessary
Docusate or glycerol suppositories

60
Q

What laxative should be avoided near term or in patients with a history of an unstable pregnancy?

A

Senna - can stimulate uterine contractions

61
Q

What type of laxatives are first line in patients who have constipation and are breastfeeding?

A

Bulk-forming (if dietary measures fail)

62
Q

What is first line treatment for diarrhoea?

A

Oral rehydration therapy (dioralyte)
Replaces electrolytes and fluid depletion

63
Q

What drug is occasionally used for propylaxis against travellers diarrhoea, but routine use is not recommended?

A

Ciprofloxacin

64
Q

What type of drug is loperamide and how does it work?

A

Antipropulsive
Prolongs the duration of intestinl transit by binding to opioid receptors in the GI tract

65
Q

What is the adult dose of loperamide?

A

Initially 4mg (2 tabs), then 2mg (1 tab) for up to 5 days. Take a dose after each loose stool

66
Q

What is the max dose of loperamide?

A

16mg (8 caps) a day

67
Q

What is the MHRA warning for loperamide?

A

September 2017
Cardiac adverse reactions with high doses (overdose, misuse or abuse)
QT prolongations, torsade de pointes, cardiac arrest and fatalities

68
Q

What are the common side effects of loperamide?

A

Dizziness, flatulence, headache, nausea

69
Q

What are the contraindications of loperamide?

A

Active UC
Antibiotic associated colitis
Conditions where peristalisis is inhibited
Avoid in bloody diarrhoea/inflammatory diarrhoea

70
Q

What is dyspepsia?

A

Range of upper GI symptoms which are typically present for 4 or more weeks

71
Q

What are the symptoms of dyspepsia?

A

Upper GI pain
Fullness
Heartburn
Gastric reflux
Bloating
N&V

72
Q

What are the treatment options for uninvestigated dyspepsia?

A

Antacids for symptomatic relief
PPI for 4 weeks if symptoms persist
H Pylori test if no response to PPI

73
Q

What are the treatment options for investigated functional dyspepsia?

A

H Pylori test
PPI or H2 antagonist for 4 weeks

74
Q

What are the 3 common salts used in antacids?

A

Aluminium (constipating, long acting)
Magnesium (laxating, long acting)
Calcium (induce rebound acid secretion)

75
Q

What are examples of low sodium preparations of antacids?

A

Maalox
Mucogel
Altacite plus

76
Q

List interactions with antacids

A

Tetracyclines
Quinolones (cipro)
Bisphosphonates
Impaired absorption of drugs - leave 2 hour gap
Damages enteric coating by increasing gastric pH

77
Q

What conditions should antacids be avoided in?

A

High sodium content
Avoid in HTN, heart/liver/kidney failure
Avoid in sodium-restricted diet eg. lithium

78
Q

Which PPI is the most safe in pregnancy?

A

Omeprazole

79
Q

What are the cautions with PPIs?

A

Mask symptoms of gastric cancer
Increased risk of osteoporosis
Increased risk of fractures
Increased risk of GI infections (c diff - reduced acidity)

80
Q

What are the side effects of PPIs?

A

GI upset: abdominal pain, constipation, diarrhoea, nausea

81
Q

What is the MHRA alert associated with PPIs?

A

September 2015
Very low risk of subacute cutaneous Lupus
Lesions occur, consider stopping PPI

82
Q

What are consequences of long term uses of PPIs?

A

Hypomagnesaemia / hyponatraemia
Fractures
Rebound acid secretion, protracted dysepsia after stopping

83
Q

What is a monitoring requirement with PPI

A

Measurement of serum magnesium before/during prolonged treatment. Especially when used with other drugs that cause hypomagnesaemia or with digoxin

84
Q

Which PPI interacts with clopidogrel and what is the interaction?

A

Omeprazole
Reduced antiplatelet effect

85
Q

Which PPI interacts with methotrexate and what is the interaction?

A

Omeprazole
Decreased clearance of methotrexate

86
Q

What are side effects of H2 receptor antagonists?

A

Headaches, rashes, dizziness, diarrhoea, confusion, depression

87
Q

What class of drugs can reduce the risk of acid aspiration in obsteric patients at delivery? (menedelson’s syndrome)

A

H2 receptor antagonists

88
Q

When are H2 receptor antagonists cautioned?

A

Gastric cancer, can mask symptoms

89
Q

What are common causes of peptic ulcer disease?

A

NSAIDs
H Pylori
Smoking
Alcohol consumption
Stress

90
Q

How should peptic ulcer disease be treated if the ulcer is associated with NSAID use?

A

PPI or H2 receptor antagonist for 8 weeks

91
Q

What is the treatment regime for H Pylori ulcer eradication?

A

Triple therapy with PPI + CLARITHROMYCIN + AMOX/MET

92
Q

What is the first line treatment of GORD?

A

PPI for 4 or 8 weeks
If no response then offer H2 receptor antagonist

93
Q

What should severe oesophagitis be treated with and how long for?

A

PPI and 8 weeks

94
Q

What are the treatment options for GORD in pregnancy?

A

Dietary and lifestyle - first line
Antacid and alginate if fails
If ineffective - omeprazole or ranitidine (unlicensed) may be used

95
Q

How does cholestasis present in a patient?

A

Fatigue
Pruritus
Dark urine
Pale stools
Jaundice
Signs of fat soluble vitamin deficiencies

96
Q

What is the drug of choice to treat cholestatic pruritus?

A

Colestyramine

97
Q

What are second/third line drugs used to treat cholestatic pruritus?

A

Ursodeoxycholic acid
Rifampicin (unlicensed) - caution in liver disease
Sertraline, naltrexone - use is limited due to side effects

98
Q

What is the treatment for intrahepatic cholestasis in pregnancy?

A

Ursodeoxycholic acid

99
Q

What is the treatment for primary biliary cholangitis?

A

Ursodeoxycholic acid

100
Q

What is the treatment for oesohageal varices?

A

Tazocin 4.5g TDS for 5 days
Terlipressin 2mg IV QDS

101
Q

What are the cautions with terlipressin?

A

Arrhythmia, elderly, electrolyte and fluid disturbances, heart disease, history of QT interval, respiratory disease, uncontrolled hypertension, vascular disease

102
Q

What is Gilbert’s syndrome?

A

Slightly higher than normal levels of bilirubin build up in the blood

103
Q

What is the treatment for ascites?

A

Spironolactone - it is an aldosterone antagonist
Furosemide can be used if spiro fails

104
Q

What is the treatment for hepatic encephalopathy?

A

Lactulose 10-30ml prn qds
and/or phosphate enema
If treatment fails can add in PO rifaxamin 550mg BD

105
Q

What is the treatment for Wernicke’s encephalopathy?

A

IV pabrinex 2 pairs TDS for 3-5 days
then thiamine 100mg tds
and multi vits OD

106
Q

What drug can be given to patients with a high bilirubin?

A

Fluconazole

107
Q
A

Pre-reg (20 decks)

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