Gastro

Question 1

What is the approximate height of villi?

Answer 1

1mm

Question 2

What type of cells are 90% of the epithelial lining cells of the small intestine?

Answer 2

Enterocytes

Question 3

Which enzyme breaks down sucrose and what are the products of the reaction?

Answer 3

Sucrase

Gives glucose and fructose

Question 4

Which enzyme breaks down lactose and what are the products of the reaction?

Answer 4

Lactase

Gives glucose and galactose

Question 5

Which enzyme breaks down maltose and what are the products of the reaction?

Answer 5

Maltase

Gives glucose and glucose

Question 6

Which monosacccharides are transported into enterocytes by SGLT1?

Answer 6

Glucose

Galactose

Question 7

How does the SGLT1 transporter work?

Answer 7

Sodium dependent, works via electrochemical gradient as small molecules cannot penetrate the apical layer alone

Question 8

What transports fructose into enterocytes?

Answer 8

GLUT5

Question 9

How do PEPT1 transporters work?

Answer 9

Proton dependent

Question 10

How do hydrophilic drugs enter the enterocytes?

Answer 10

Absorption via uptake transporters

Question 11

What transporters are involved in drug efflux?

Answer 11

P-glycoprotein

BCRP

Question 12

Give examples of drug substrates for PEPT1.

Answer 12

Cephalosporins
Penicillins
Enalapril
Val-acyclovir

Question 13

Give examples of drug substrates for OCTN2 (efflux).

Answer 13

Quinidine
Verapamil
Imatinib
Valproic acid
Val-acyclovir

Question 14

Give examples of drug substrates for OATP2B1.

Answer 14

Pravastatin
Rosuvastatin
Atorvastatin
Fexofenadine

Question 15

Give examples of drug substrates for P-gp (efflux).

Answer 15

Indinavir
Tacrolimus
Erthromycin
Digoxin
Verapamil
Quinidine
Imatinib

Question 16

Define peptic ulcer

Answer 16

Breach in the continuity of the lining >5mm in diameter with associated inflammation

Question 17

What are the aims of treatment of peptic ulcers?

Answer 17

Complete healing
Managing dyspepsia
Reflux symptoms
GORD

Question 18

What is GORD?

Answer 18

Gastro-oesophageal reflux disorder

Question 19

What are the symptoms are GORD?

Answer 19

Chronic heartburn
Pain
Nausea

Question 20

What is GORD commonly associated with?

Answer 20

Chronic cough and laryngitis

Worsening asthma

Question 21

What are the alarm features of GORD?

Answer 21

Anaemia
Weight loss
Anorexia
Recurrent problems (>55 years)
Malaena
Haematemesis
Swallowing problems

Question 22

What are alginates?

Answer 22

Foaming agent that forms a raft above gastric contents to reduce reflux and protract oesophageal mucosa

Question 23

What the common issues with magnesium and aluminium antacids?

Answer 23

Magnesium- laxative

Aluminium- constipation

Question 24

What is the common excipient in antacids than can cause problems?

Answer 24

Sodium bicarbonate

Question 25

What is the common issue with antacids?

Answer 25

Can impair absorption of drugs that are basic due to increased pH

Question 26

When are H2 antagonists used in peptic ulcers?

Answer 26

Heal ulcers at high doses, used in NSAID prophylaxis and maintenance as well as GORD

Question 27

When are PPIs used in GORD?

Answer 27

For 1-2 months at full dose and then at lowest dose in case of recurrence

Question 28

What is misoprostol?

Answer 28

Prostaglandin analogue with antisecretory and cytoprotective effects. Promotes ulcer healing and protects from NSAID damage.

Question 29

When should misoprostol be avoided?

Answer 29

Pregnancy

Question 30

How is GORD treated in children?

Answer 30

Usually resolves itself by 12-18 months in infancy Can use alginates or thickeners H2 antagonists then PPI if persistent in older children

Question 31

How is H. pylori detected?

Answer 31

Produces antibody that is detectable in serum, saliva or urine

Question 32

What is the treatment process for NSAID associated peptic ulcers?

Answer 32

Assume it is due to H. pylori and discontinue NSAID use | PPI to promote rapid healing and reduce relapse

Question 33

What bacteria is the most common cause of peptic ulcers?

Answer 33

H. pylori

Question 34

What is achlorydia?

Answer 34

Common with long term use of PPI | Low gastric acid production associated with adverse events

Question 35

What are the risks associated with long term use of PPIs?

Answer 35

``` Pneumonia Fracture risk Osteoporosis Reduced calcium absorption GI infection risk Mask GI cancer symptoms ```

Question 36

Define diarrhoea.

Answer 36

Abnormal passing of loose/liquid stools at increased frequency/volume Generally >70% water

Question 37

What are the red flag symptoms of diarrhoea?

Answer 37

``` Unexplained weight loss Blood in stools Systemic illness Foreign travel Symptoms lasting over 1 week Severe pain ```

Question 38

What are the common pathogens causing diarrhoea?

Answer 38

E. coli Campylobacter Salmonella Shigella

Question 39

What is the normal treatment for diarrhoea?

Answer 39

Oral rehydration to replace lost electrolytes | Formulated with dextrose and citrate/bicarbonate

Question 40

What does loperamide do?

Answer 40

Increases salt and water reabsorption by reducing gut motility

Question 41

What is the antidote for opioids?

Answer 41

Naloxone

Question 42

Give examples of antispasmodics.

Answer 42

Meberverine | Dicyclomine

Question 43

When is ciprofloxacin used in IBD?

Answer 43

Prophylaxis of infection from shigella/salmonella

Question 44

Give an example of a probiotic?

Answer 44

Lactobacilli

Question 45

What is racecadotril?

Answer 45

Oral enkephalinase inhibitor reducing hyper secretion of water and electrolytes into the gut lumen

Question 46

What is kaolin?

Answer 46

Very low dose morphine used to bulk out stools

Question 47

What is co-phenotrope?

Answer 47

Diphenoxylate and atropine

Question 48

When is the rotavirus vaccine given?

Answer 48

Two doses at 2 and 3 months old

Question 49

What is pseudomembranous colitis?

Answer 49

Caused by C. difficile and transmitted due to poor hygiene, often associated with antibiotic use

Question 50

How is pseudomembranous colitis treated?

Answer 50

Metronidazole 400mg tds Oral vancomycin 125mg qds Used for 1-2 weeks and can be used together if no resolution

Question 51

What is ulcerative colitis?

Answer 51

Inflammation of the mucosa of the rectum and colon

Question 52

What is Crohn's disease?

Answer 52

Patchy, transmural inflammation of the entire gastrointestinal tract

Question 53

How is IBS managed?

Answer 53

Corticosteroids Mild- enemas, suppositories Diffuse disease- oral aminosalicylate Severe- hospitalisation, IV corticosteroid and immunosuppressants

Question 54

What is sulphasalazine?

Answer 54

Medication used in IBS with no response to local therapy to maintain remission

Question 55

What are the side effects of sulphasalazine?

Answer 55

Headaches Nausea Infertility in males Anaemia

Question 56

What is the treatment for acute relapse of IBD?

Answer 56

IV hydrocortisone/prednisolone | Immunosuppressants where above does not work (cyclosporin, methotrexate, azothioprine)

Question 57

What are cytokine modulators?

Answer 57

Tumour necrosis factor inhibitors given as a 12 month course in IBD

Question 58

Give examples of cytokine modulators.

Answer 58

Infliximab, adalimumab

Question 59

Define constipation.

Answer 59

Excessive water removal causing less frequent, hard stools

Question 60

Give examples of causes of constipation.

Answer 60

Diet and lack of fluid Diverticulae Paralysis Drugs- opiates, CCBs

Question 61

What are bulking agents?

Answer 61

Stimulate peristalsis to reduce constipation

Question 62

Give examples of bulking agents.

Answer 62

Ispaghula husk | Dietary fibre

Question 63

What are osmotic laxatives?

Answer 63

Increase water content of the bowel

Question 64

Give examples of osmotic laxatives.

Answer 64

Lactulose | Macrogol

Question 65

Give examples of softening agents.

Answer 65

Docusate | Glycerol

Question 66

What is coeliacs disease?

Answer 66

Autoimmune response to gluten, causing damage to brush border of small intestine and reduced absorption

Question 67

What are common indications for prescribing ACBS?

Answer 67

``` Disease related malnutrition Intractable mal absorption Dysphagia Pre-operation preparation Short bowel syndrome/bowel fistula ```

Question 68

What is the most common reason for a temporary stoma?

Answer 68

The divert faeces away from surgical site or obstruction

Question 69

Give some examples of problems that may occur with appliances such as stomas.

Answer 69

``` Leaking Stoma size changes Skin problems Dexterity Odours ```