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Pradeepa's notes > Gastro-Intestinal System > Flashcards

Gastro-Intestinal System Flashcards

1
Q

coeliac disease

A

-occurs in small intestine
-associated with gluten; wheat, barley, rye
->causes immune response = intestinal mucosa
-may cause malabsorption of nutrients
-

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2
Q

coeliac disease aim

A

-avoid gluten
-manage symptoms; diarrhoea, bloating, abdominal pain
-avoid malnutrition; give vit D, calcium + other nutrients (supervision)

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3
Q

diverticular disease

A

small pouches but asymptomatic

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4
Q

diverticulitis

A

small pouches but symptomatic

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5
Q

diverticulitis symptoms

A

abdominal pain
constipation
diarrhoea
rectal bleed

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6
Q

acute diverticulitis

A

pouches inflamed/infected

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7
Q

acute diverticulitis symptoms

A

severe abdominal pain
fever
significant rectal bleed

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8
Q

complicated acute diverticulitis

A

abscess, perforation, fistula, obstruction, sepsis, haemorrhage

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9
Q

diverticular disease + diverticulitis tx

A

-fibre bulking forming laxatives
-paracetamol PRN

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10
Q

Crohns disease

A

affects whole GIT assoc with thickened wall, extending through all layers with deep ulceration

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11
Q

complications caused by crohns disease

A

-intestinal strictures or fistulae
-anaemia + malnutrition
-colorectal + small bowel cancer
-growth failure + delayed puberty
-extra-intestinal manifestation; arthritis, joints, eyes, liver + skin abnormalities

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12
Q

acute crohns disease 1st falre up in 12 month period tx

A

-monotherapy with either; prednisolone, methylprednisolone/IV hydrocortisone
-if pt - distal ileal, ileocecal or right sided disease use budesonide if normal tx x work
-aminosalicylate may be used (sulfasalazine/mesalazine)
->less effective but less side effects

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13
Q

acute crohns disease 2+ flare up in 12 month period tx

A

-add azathioprine or mercaptopurine
-methotrexate may added if azath/merca is CI
severe; monoclonal antibodies

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14
Q

crohns disease maintenance

A

-stop smoking
-monotherapy of azathioprine or mercaptopurine
-methotrexate can be used if used in induction or can not tolerate aza/merc
-after surgery
->azathioprine + metronidazole
->azathioprine alone if metronidazole x tolerated

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15
Q

fistulating crohns disease

A

-when fistula develops between intestine + perianal skin, bladder + vagina
-can be left alone if asymtomatic

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16
Q

fistulating crohns disease
tx (not fully healed)

A

-metronidazole +/- ciprofloxacin
-metronidazole usually for ONE month no longer three due to perianal neuropathy
-maintenance; azathioprine/mercaptopurine (infliximab if x response)
-tx; must be at least ONE yr

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17
Q

ulcerative colitis

A

can affect region from rectum to whole colon
-common age 15-25yr

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18
Q

ulcerative colitis symp

A

bloating
diarrhoea
defecation urgency
abdominal pain

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19
Q

ulcerative colitis complications

A

colorectal cancer
secondary osteoporosis
VTE
toxic megacolon

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20
Q

ulcerative colitis different types (continous)

A

-proctitis
-proctosigmoiditis
-distal/left sided
-extensive colitis
pancolitis

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21
Q

tx ulcerative colitis acute (mild-moderate)

A

-distal rectal preparation (suppository or enema)
->foam preparation used if pt = difficulty retaining liquid enema
-extended systemic medication needed
-diarrhoea avoid loperamide or codeine as it can cause toxic megacolon
->only initiate under specialist advice

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22
Q

proctitis tx

A

1)topical aminosalicylates
2) + oral aminosalicylates (if no impr in 4WK)
3) still no improv topical/oral corticosteroids 4-8wk

-pt = oral aminosalicylates if preferred but less effective
-if aminosalicylates = CI then corticosteroids

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23
Q

proctitis acute (mild-moderate) tx

A

-proctosigmoiditis + left sided UC
1)topical aminosalicylates
2) + high dose aminosalicylates if no improv after 4wk or
2) switch to high oral dose of aminosalicylates + 4-8wk of of topical corticosteroids
3)start topical tx + offer oral aminosalicylate + 4-8wk of oral corticosteroid

-pt - high dsoe of aminosalicylates if perferred byt less effective if CI then topical//oral cortiocsteorids for 4-8wk

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24
Q

extensive UC tx

A

1) topical aminosalicylates + high dose aminosalicylates
2) no change after 4wk -> stop topical aminosalicylates + offer high dose oral aminosalicylates + oral corticosteroids 4-8wk

-if CI = corticosteroids 4-8wk

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25
UC acute (severe) tx
-life-threatening - medical emergency -IV hydrocortisone or methylprednisolone -> assess need for surgery -if IV steroids = CI -> IV ciclosporsin/surgery -if symp x improve in 72hr = IV steroid + IV ciclosporin -> surgery -if ciclosporin CI then infliximab
26
UC tx maintenance
-oral aminosalicylates ->CI = corticortosteroids ->more effect as OD but more s/e -procititis / proctosigmoiditis = rectal +/- oral aminosalicylates -.oral can be given -left sided/extensive - low dose oral aminosalicylate -2+ flares - 12months; oral azathioprine/erc ->give monoclonal antibodies if no effect
27
aminosalicylates
sulfasalazine balsalazine mesalazine olsalazine
28
aminosalicylates monitoring
-nephrotoxic - monitor before initiation*3mt*annually -hepatotoxic - monitor monthly for 1st 3MT -blood disorder: monitor monthly 1st 3MT ->blood count + stop if signs of blood dyscaria -CI in salicylate hypersensitivity -sulfasalazine; stains contact lenses = orangey/yellow
29
irritable bowel syndrome
common chronic, relapsing + often life-long assoc with abdominal pain, diarrhoea, constipation, urgency, incomplete defaecation + passing mucus - more common women 20-30
30
irritable bowel syndrome what excacerbates it
caffeine alcohol milk large meals fried food stress
31
irritable bowel syndrome non-drug tx
-excerise -eat regular meals -less fresh fruit = TDS -less insoluble fibre -8 cups of water -less caffeine, alcohol + fizzy -avoid sorbitol = diarrhoea -less stress
32
irritable bowel syndrome drug tx
OTC -antispasmodics = aiverine, mebeverine, peppermint oil -laxatives = if constipation x lactulose - bloating -loperamide = diarrhoea -antimuscarinic = hyoscine butylbromide avoid in coeliac disease 2nd line for pain x otc work - amitriptyline = unlicensed - SSRI if TCS = X work
33
short bowel syndrome
-shortened bowel due to large surgical resection -need to ensure adequate absorption of nutrients + fluids
34
short bowel syndrome nurtritional deficiences
-replace vit A, B12, D, E, K, essential fatty acids, zinc, selenium
35
short bowel syndrome diarrhoea and high output stoma
-loperamide + codeine less intestinal motility
36
constipation
infrequent difficult stools
37
constipation risk factors
women elderly pregnancy
38
constipation red flags
-blood in stools -anaemia -abdominal pain -weight loss -new onset in over 50yr+
39
constipation non-drug tx
-inc dietary fibre -adequate fluid intake -exercise -review medications
40
constipation bulkforming laxatives
-methylcellulose, ispagula husk, sterculia -small hard stools inc faecal mass, stimulating psitalsis -2-3DY to work -inc fluid intake so no intestinal blockage
41
constipation stimulant laxative
-bisacodyl, sodium picosulfate, senna, docusate, glycerol -stimulating colonical nerves - peristalsis - 6-12HR to work -avoid in intestinal obstruction -co-danthramer + co-danthrustate used in terminal illness due to cacinogenicity (red urine)
42
constipation faecal softners
-liquid paraffin, docusate, glycerol -inc water retention to stools -quick acting = docusate enema = 5-20mins -liquid paraffin - avoid in anal seepage, granulomatous disease of GIT, lipid pnuemonia on aspiration
43
constipation osmotic laxatives
-lactulose, macrogol -inc fluid to large bowel - persistalsis -2/3 DY to work -faecal softening properties
44
constipation short duration
-bulk forming + good hydration - osmotic
45
constipation chronic
-bulk forming + good hydration -if still hard stools add/change to macrogol (lactulose 2nd line) -if still no change after 6MT = procalopride -withdraw lactulose slowly when improvement
46
constipation faecal impaction
-hard stools = macrogol + stimulant once softened -soft stools = stimulant -rectal bisacodyl +/ or glycerol if still there
47
constipation opioid induced
-osmotic + stimulant -naloxegol if x work -avoid bulk forming
48
constipation pregn + BF
-dietary + lifestyle - fibre supplements e.g. bran, wheat -bulk forming- lactulose -bisacodyl/senna x use senna near term
49
constipation children
-1st line = dietary advice + macrogol if no faecal impaction -> stimulant -if stool = hard -> lactulose/docusate
50
loperamide drug tx
-acute usually w/o meds -oral rehydration sachets -severe dehydration x drink - hosp for IV fluids -if rapid control is needed/travellers - loperamide -> avoid bloodly/suspected inflammatory -loperamide = 1st line = faecal incontinence
51
loperamide
-12+ otc -4+ pom -1-2 doses (2-4mg) at first then one every loose stool max 8 doses -serious cardiac reactions (QT prolongation) inc doses -naloxene tx overdose
52
dyspepsia
-upper abdominal pain, heartburn, gastric reflux, bloating, N+V
53
dyspepsia red flags/urgent referral
-GI bleeding -55+ -unexplained weight loss -dysphagia
54
dyspepsia tx
- uninvestigated dyspepsia -> PPI 4WK if x work then test for h.pylori -functional dyspepsia -> test for h.pylori -> x infected 3WK of PPI/h2 receptor antagonist
55
helicobater pylori infection
- most common cause of peptic ulcer -urea 13C breath test/stool helicobacter antigen test (SAT) ->PPI stopped 2wk before test ->antibiotics should be stopped 4WK before test
56
h.pylori triple therapy
-PPI +2x antibiotics -PPI = BD -Amoxicillin - 1g BD -Clarithromycin - 500mg BD -metronidazole = 400mg BD -7DY tx
57
GORD
-Increased with ->fatty foods ->pregn ->hiatus hernia ->FH ->stress, anxiety ->obesity ->S/E meds (ablocker, bblocker, CCB, anticholingeric, benzo, bisphosphates, corticosteroids, NSAIDs, nitrates, TCA) ->smoking + alcohol
58
GORD lifestyle advice
-1st line -healthy eating -weight loss (obese) -avoid triggering food -smaller meals -evening meals 3-4hr before sleep -raising head of bed -smoking cessation -less alcohol consumption
59
GORD tx
-medication review -uninvestigated GORD - 4WK PPI + test for h.pylori -confirmed GORD= tx 4WK of PPI
60
GORD pregn tx
-lifestyle + dietary -antacid / alginate -omeprazole/ranitidine
61
antacids
-mg containing antacids = laxative -Aluminium containing = constipating -Ca containing = induces rebound acid secretion -simeticone added to antacids to relieve flatulence
62
antacid + aliginate
- inc viscosity of stomach content -forms viscous gel that floats on surface of stomach
63
antacid interactions
-inc stomach pH (inc alkali) - enteric coated caps damage before reaching intestine -Na+ content of anatacid x take with Li+ in hypertension lower NA+ = co-magaldrox -antacid x other drugs - impairing absorption ->bisphophonates, tetracyclines, ciprofloxacin
64
PPI
omeprazole, esomeprazole, lansoprazole, rabeprazole
65
PPI MHRA warning
-low rise of subacute cutaneous lupus erythematosus
66
PPI RISKS
-inc risk of factures/oestoprosis - due to hypomagnaesmia -high risk of c.diff -masks symptoms of gastric cancer -interaction - esomeprazole, clopidogrel (use lansoprazole) -inc conc of methotrexate, phenytoin, warfarin, digoxin
67
h2 receptor antagonist
ranitadine cimetidine (cyp450 inhibitor) famotidine nizatidine
68
h2 receptor antagonist s/e
-may mask gastric cancer symptoms so rule out symptoms of cancer before tx - diarrhoea - headaches - dizziness - rash - tiredness
69
h2 receptor antagonist interaction
reduces absorption of azole antifungals
70
cholestatis
impaired bile formation or flow = fatigue, pruritus, dark urine, pale, jaundice
71
cholestatic pruritus
relieved by cholestyramine, uroseodeoxycholic acid, rifampicin
72
intrahepatic cholestasis in pregnancy
during late pregnancy - adverse fetal outcomes -tx of puritis assoc = uroseodeoxycholic acid
73
gallstones
-hard mineral or fatty deposits forming stones in gallbladder bile duct -majority = assymptomatic -irritated/blocked gallbladder = pain, infection + inflammation
74
untreated gallstones
- complications bililary colic cholecystitis, cholastits, prancreatin -if symptoms = surgical removal
75
gallstones tx
-mild-moderate pain = paracetamol/NSAIDs -severe = IM diclofenac
76
anal fissures
-tear/ulcer in anal canal causing bleeding + pain on defecation
77
anal fissures acute tx
-ensure stools = passing easily ->bulk-forming/osomotic laxative ->short term topical = local anaesthetic (lidocaine) or anagesia
78
anal fissures chronic tx
-6wk + GTN rectal (high headache s.e) -topical/oral diltiazem/nifedipine (less s/e) -specialist = botulinum toxin type A -surgery - when no response to drug tx
79
haemorrhoids
swelling of vascular mucosal + cushions around anus (high risk during pregnancy) -internal = painless -external = itchy/painful
80
haemorrhoids tx
-maintain easy stools to minimise straining; inc dietary fibre + fluid or bulk-forming laxative -pain = paracetamol (opioids -> constipation, NSAIDs exacerbate rectal bleeding) -pain + itching: topical preparations (anaesthetics, corticosteroids, lubricants, antiseptics) ->topical anesthetics (lidocaine few days) ->topical corticosteroids no more than 7DY -pregnancy: bulk-forming no topical tx only soothing if needed
81
pancreatic insufficiency
less secretion of pancreatic enzymes into duodenum can be due to pancreatic, CF, pancreatic tumors, coeliac disease, GI resection, may lead to maldigestion + malnutrition
82
exocrine pancreatic insufficiency
tx -pancreatic enzyme replacement - pancreatin ->lipase, amylase, protease - digests fats, carbs, protein so it can be absorbed ->take snacks + meals to prevent early breakdown -if CF then fibrosing colonpathy at high dose pancreatin ->no more than 10000 units/kg/day of lipase ->report any new abdominal pain -lvls of fat soluble vits + micronutrients = monitored ->give supplements PRN
83
Stoma care
artifical opening on abdomen to divert flow of faeces on urine into an external pouch located outside body
84
Stoma care preparation
EC/MR not suitable less effect so use forms = quick action = liquids, caps, uncoated/ soluble tabs
85
Stoma care diarrhoea
sorbitol, mg+ antacids, iron (ileostomy)
86
Stoma care constipation
opioids, Ca+ antacids, iron (colostomy)
87
Stoma care GI irritation + bleed
aspirin + NSAIDs
88
Stoma care diuretics/laxatives
- dehydration = hypokal use K+ sparing diuretics or k+ supplements -liquid form k+ preferred to MR -fluids + NA deplation - hypoka inc digixon toxity

Pradeepa's notes (12 decks)

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