Gastro- intestinal system Flashcards
What are the two main types of inflammatory bowel diseases?
Crohn’s disease and Ulcerative colitis.
What are the potential side effects of aminosalicylates?
Blood disorders
Give an example of an aminosalicylate
Mesalazine
What symptoms should patients using aminosalicylates report immediately? (4)
- Unexplained bleeding and bruising
- purpura
- sore throat
- malaise
What action should be taken if there is suspicion of a blood dyscrasia in a patient using aminosalicylates?
A blood count should be performed
and the drug should be stopped immediately.
What advice should be given to patients if they need to switch to a different brand of mesalazine?
Patients should be advised to report any changes in symptoms.
What demographic group is most commonly affected by Irritable Bowel Syndrome (IBS)?
People aged between 20 and 30, mostly women
What are the common symptoms of Irritable Bowel Syndrome (IBS)? (3)
- Abdominal pain or discomfort
- disordered passage of mucus
- bloating
What dietary and lifestyle recommendations are important for self-management of IBS?
A high-fiber diet and exercise
Name types of antispasmodics used in the management of IBS (6)
- Alverine
- mebeverine
- peppermint oil
- dicycloverine
- hyoscine
- propantheline
In which condition should all antispasmodics be avoided?
Paralytic ileus
What is the main cause of Clostridium difficile infection?
Colonization of C. difficile in the colon, often following antibiotic therapy.
(usually Ampicillin, Amoxicillin, Co-Amoxiclav, Cephalosporins, Clindamycin and Quinolones)
Name some antibiotics that can increase the risk of Clostridium difficile infection (6)
- Amoxicillin
- ampicillin
- co-amoxiclav
- second- and third-generation cephalosporins
- clindaymycin
- quinolones
What are the treatment options for Clostridium difficile infection?
- Metronidazole
- vancomycin
- fidaxomicin
What potential complication can arise from excessive laxative use?
Hypokalaemia
What are the side effects associated with light liquid paraffin? (2)
- Anal seepage of paraffin and consequent anal irritation after prolonged use
- lipoid pneumonia
What is the main aim in treating diarrhea?
To reverse fluid and electrolyte depletion
(especially important in infants, frail, and elderly)
What are commonly used antimotility drugs in uncomplicated diarrhea?
Loperamide
Is routine prophylaxis against travelers’ diarrhea recommended?
No, routine prophylaxis is not recommended
What antibiotic can be used for travelers’ diarrhea if necessary?
Ciprofloxacin
What are the alarm symptoms associated with dyspepsia? (4)
- Bleeding
- dysphagia
- recurrent vomiting
- weight loss
A patient is over 55 and is presenting with new- onset dyspepsia. What should be done?
consider referring patient to GP
What are the treatment options for dyspepsia? (3)
- Antacids
- proton pump inhibitors (PPIs)
- H2 receptor antagonists
What are the potential side effects of magnesium-containing antacids?
Laxative effect
What lifestyle changes are advised for patients with gastro-oesophageal reflux disease (GORD)?
- Avoidance of aggravating foods such as fats
- weight reduction
- smoking cessation
- raising the head of the bed
What medications are used in the treatment of GORD? (3)
- Antacids
- proton pump inhibitors (PPIs)
- H2 receptor antagonists
What medication is reserved for women with severe or complicated reflux disease during pregnancy?
Omeprazole
What is the most likely cause of duodenal and gastric ulcers if not caused by NSAIDs?
H. pylori infection.
What is the first-line treatment for dyspepsia
Lifestyle modifications and over-the-counter antacids.
What is the recommended duration for initial treatment of Helicobacter pylori infection?
A one-week triple-therapy regimen
What does triple-therapy for Helicobacter pylori infection typically include? (3)
- A proton pump inhibitor
- clarithromycin
- and either amoxicillin or metronidazole.
What treatment duration is associated with higher side effects and lower compliance for Helicobacter pylori infection?
Two-week triple-therapy.
What is recommended if an ulcer occurs in a patient taking NSAIDs?
Whenever possible, the NSAID should be withdrawn.
What medication can be considered for gastric and duodenal protection in patients at risk of ulceration with NSAIDs?
A proton pump inhibitor.
What are some alternatives to proton pump inhibitors for gastric and duodenal protection in patients at risk of ulceration with NSAIDs?
H2-receptor antagonists or misoprostol.
What may limit the dose of misoprostol in patients at risk of ulceration with NSAIDs?
Colic and diarrhea
Name some examples of chelates and complexes used as antisecretory drugs and mucosal protectants.
Sucralfate, peptobismol, triopotassium dicitratobismuthate.
What do these drugs do in the context of ulcer treatment?
They chelate and form ulcer-protecting complexes.
What are examples of H2-receptor antagonists?
famotidine, cimetidine, nizatidine.
How do H2-receptor antagonists work to reduce gastric acid output?
through histamine H2-receptor blockade
Name examples of proton pump inhibitors (3)
- Lansoprazole
- omeprazole
- rabeprazole
How do proton pump inhibitors inhibit gastric acid secretion?
They block the hydrogen-pump of the gastric parietal cell.
What is the risk associated with sucralfate use?
Bezoar formation
which is the risk of indigestible material accumulating in the GI tract.
In which patients is caution advised when using sucralfate? (3)
- Seriously ill patients
- those under intensive care receiving enteral feeds
- and those with predisposing conditions such as delayed gastric emptying
What is ursodeoxycholic acid used for?
It is used for the dissolution of gallstones and in primary biliary cirrhosis
What is the treatment for oesophageal varices?
Terlipressin
a vasoconstrictor that reduces portal hypertension.
How is obesity generally classified?
BMI of ≥ 30 kg/m2.
When should treatment with Orlistat be discontinued in obese patients?
Treatment should be discontinued after 12 weeks if weight loss has not exceeded 5% of starting weight.
What is the recommended treatment focus for haemorrhoids?
Ensuring that stools are soft and easily passed
What type of laxatives are recommended for haemorrhoid treatment?
Bulk-forming laxatves
What alternative laxative can be used for haemorrhoid treatment?
An osmotic laxative
What are some components found in topical preparations for haemorrhoids? (5)
- local anaesthetics
- corticosteroids
- astringents
- lubricants
- antiseptics
Are there licensed preparations for treating haemorrhoids during pregnancy?
No, but a simple soothing preparation can be considered.
What are the main clinical indicators of exocrine pancreatic insufficiency?
Maldigestion and malnutrition
associated with low circulating levels of micronutrients, fat-soluble vitamins, and lipoproteins
What are some gastrointestinal symptoms associated with exocrine pancreatic insufficiency? (3)
- Diarrhoea
- abdominal cramps
- steatorrhoea
Steatorrhea= excessive amounts of fat in poo. Looser, smellier, paler
What is the mainstay of treatment for exocrine pancreatic insufficiency?
Pancreatic enzyme replacement therapy
What enzymes are contained in pancreatin to assist with digestion? (3)
- Amylases
- lipases
- proteases
What is Coeliac disease?
Coeliac disease is an autoimmune condition
associated with chronic inflammation of the small intestine
triggered by gluten consumption
What dietary proteins can trigger an abnormal immune response in individuals with Coeliac disease?
Gluten
which is found in wheat, barley, and rye
can trigger an abnormal immune response in individuals with Coeliac disease.
What are the symptoms of Coeliac disease? (4)
- abdominal pain
- diarrhoea
- rectal bleeding
- weight loss due to malabsorption of nutrients
What is the non-drug treatment for Coeliac disease?
The non-drug treatment for Coeliac disease is a strict, lifelong gluten-free diet.
What is the risk associated with drug treatment for Coeliac disease?
Drug treatment for Coeliac disease can increase the risk of malabsorption of key nutrients
like calcium and vitamin D
leading to the risk of osteoporosis.
What is the non-drug treatment for Crohn’s disease
Smoking cessation
What side effect is associated with Aminosalicylates?
orange/yellow staining of body fluids, such as urine.
What precaution should be taken before starting treatment with monoclonal antibodies?
Patients must be screened for tuberculosis before starting treatment with monoclonal antibodies.
If latent tuberculosis is diagnosed, appropriate treatment must be initiated prior to starting treatment.
What should be done if tuberculosis is diagnosed during treatment with monoclonal antibodies?
treatment should be discontinued until the infection is resolved
How can flu-like infusion reactions associated with monoclonal antibodies be prevented or lessened?
with an antihistamine and paracetamol with or without a corticosteroid.
What precautions should be taken regarding contraception during and after treatment with monoclonal antibodies?
Effective contraception is required during
and for at least 18 weeks after treatment with monoclonal antibodies.
What should be monitored closely in breastfeeding individuals receiving monoclonal antibodies?
should be monitored closely for infection before, during, and after treatment due to the increased risk of opportunistic infections
How should fresh fruit consumption be limited for individuals with IBS?
Fresh fruit consumption should be limited to no more than 3 portions per day for individuals with IBS.
What type of dietary fibre is recommended for individuals with IBS?
Soluble fibre, such as Isphagula Husk or foods high in soluble fibre like oats, is recommended for individuals with IBS.
Why should intake of insoluble fibre be reduced or discouraged for individuals with IBS?
because it can exacerbate symptoms.
How much fluid intake, mostly water, is recommended for individuals with IBS?
: Individuals with IBS should increase their fluid intake to at least 8 cups per day, mostly water.
What are some drug treatment options available over the counter for IBS?
antispasmodic drugs (such as Alverine citrate, Mebeverine hydrochloride, and Peppermint Oil)
laxatives (excluding Lactose)
and Loperamide as the first-line choice anti-motility drug for diarrhea.
When is Peppermint Oil contraindicated in IBS treatment?
in pregnancy
What is the recommended first-line choice anti-motility drug for diarrhea in IBS?
Loperamide
What is the second-line treatment option for abdominal pain/discomfort in IBS for patients who haven’t responded to antispasmodics, anti-motility drugs, or laxatives?
A low dose of Tricyclic Antidepressant (TCA) such as Amitriptyline
How is constipation defined?
the evacuation of hard stools less frequently than is normal for an individual
What are examples of bulk-forming laxatives? (4)
- bran
- ispaghula husk
- methylcellulose
- sterculia
What is the onset of action for bulk-forming laxatives?
is up to 72 hours
What precaution should be taken when using bulk-forming laxatives?
Adequate fluid intake must be maintained when using bulk-forming laxatives
to avoid intestinal obstruction
and patients should be advised not to take these laxatives immediately before bed.
What are examples of stimulant laxatives? (5)
- Bisacodyl
- sodium picosulfate
- senna
- co-danthramer
- co-danthusate
How do stimulant laxatives work?
by increasing intestinal motility
but they often cause abdominal cramps
so they should be avoided in cases of intestinal obstruction.
Who should Co-danthramer and Co-docusate only be used in?
should only be used in the terminally ill due to their carcinogenicity and genotoxicity.
How do faecal softeners work?
increase the penetration of intestinal fluid into the faecal mass
An example is Docusate sodium + Glycerol.
Give an example of faecal softener
Docusate sodium + Glycerol.
What are examples of osmotic laxatives? (4)
- lactulose
- macrogol 3350 with potassium chloride
- sodium bicarbonate
- sodium chloride
What is the first-line treatment for short-term constipation?
a bulk-forming laxative while ensuring adequate fluid intake
What should be done if stools remain hard after using a bulk-forming laxative?
f stools remain hard after using a bulk-forming laxative, an osmotic laxative can be added to or switched to.
What should be added if stools are soft but difficult to pass or if a person complains of inadequate emptying in short-term constipation management?
a stimulant laxative
What is the recommended treatment for opioid-induced constipation?
an osmotic laxative (or docusate sodium to soften stools)
along with a stimulant laxative is recommended.
What should be considered if the response to other laxatives is inadequate in palliative care?
Methylnaltrexone bromide and Linaclotide can be used as adjunctive therapy
What is the initial treatment approach for chronic constipation?
involves starting with a bulk-forming laxative while ensuring good hydration.
What should be done if stools remain hard after using a bulk-forming laxative in chronic constipation management?
an osmotic laxative such as macrogol can be added or changed to
(If macrogols are ineffective or not tolerated, lactulose can be given)
What should be considered if the response to laxatives is inadequate even after trying different classes for 6 months in chronic constipation?
the use of prucalopride (in women)
or lubiprostone should be considered.
What should be done if regular bowel movements have been achieved in chronic constipation management? (3)
one laxative should be reduced and stopped at a time.
If possible, the stimulant laxative should be reduced first
but it may be necessary to adjust the osmotic laxative dose to compensate.
What is the first-line treatment for constipation in pregnancy if dietary and lifestyle changes fail?
is fibre supplements in the form of bran or wheat
which are clinically safe and effective
What laxative is first-line during pregnancy if fibre supplements fail?
A bulk-forming laxative is first-line during pregnancy if fibre supplements fail
What precaution should be taken when using Senna during pregnancy?
Senna should be avoided near term or if there is a history of unstable pregnancy
What is the first-line treatment for constipation during breastfeeding if dietary measures fail?
A bulk-forming laxative
What can be used if stools remain hard during breastfeeding?
Lactulose or Macrogol can be used if stools remain hard during breastfeeding.
Alternatively, a short course of a stimulant laxative such as Bisacodyl or Senna can be used.
What is the first-line treatment for constipation in children?
laxative in combination with dietary modification
What should be avoided in the diet of children with constipation due to potential side effects?
Unprocessed bran should be avoided in the diet of children with constipation
due to potential side effects such as bloating, flatulence, and absorption of micronutrients.
What is the first-line laxative for children if faecal impaction is not present or has been treated?
a macrogol laxative, such as macrogol 3350 with potassium chloride, sodium bicarbonate, and sodium chloride.
What should be added if there is an inadequate response or poor tolerance to the first-line laxative in children?
n, a stimulant laxative can be added or changed to.
If stools remain hard, lactulose or another laxative with softening effects, such as docusate sodium, can be added.
How long should laxatives be continued after establishing a regular pattern of bowel movements in children with chronic constipation?
Laxatives should be continued for several weeks
after establishing a regular pattern of bowel movements in children with chronic constipation.
How should the dose of laxatives be adjusted after several weeks of regular bowel movements in children with chronic constipation?
gradually tapered over a few months
What is the recommended treatment approach for faecal impaction in children over 1 year old?
an oral preparation
containing a macrogol, such as macrogol 3350 with potassium chloride, sodium bicarbonate, and sodium chloride
is recommended to clear faecal mass and establish and maintain soft, well-formed stools.
What is a general side effect for all laxatives?
Abdominal pain
What is the onset of action of senna?
8- 12 hours
What is the onset of action of Bisacodyl?
10 - 12 hours
What are antispasmodic drugs, such as Hyoscine (Buscopan), used for?
abdominal cramp
Why should antispasmodics and anti-emetics be avoided in young children with gastroenteritis?
because they are rarely effective and have troublesome side effects.
What is the recommended treatment approach for abdominal cramp in children with chronic constipation?
Antispasmodic drugs, such as Hyoscine (Buscopan)
How are bulk-forming drugs useful in diverticular disease?
Bulk-forming drugs such as ispaghula husk and methylcellulose
are useful in controlling diarrhoea associated with diverticular disease.
What is the typical cause of most cases of diarrhoea?
Most cases of diarrhoea are due to viruses and do not need antibiotic treatment
When is colestyramine used for diarrhoea?
following ileal disease or resection
What precaution should be taken when taking other medication with colestyramine?
Patients on colestyramine should take other medication an hour before
or 4 to 6 hours after taking it
What is the age restriction for using Loperamide over the counter (OTC)?
Loperamide is only licensed for use in children over 12 when sold over the counter (OTC)
but it can be used in children over 4 under medical supervision.
What symptoms are commonly associated with dyspepsia (indigestion)?
- heartburn
- feeling full (satiety)
- bloating
- nausea (often occurring after eating or drinking)
What dosage adjustment may be necessary for patients over 65 years old who are taking NSAIDs along with a PPI?
may require a double dose of the PPI
for example, Omeprazole 20mg twice daily
instead of 20mg once daily
(due to being at high risk of developing ulcers from NSAIDs)
In which population can Misoprostol be used for long-term NSAID therapy?
Misoprostol can be used for the elderly who are on long-term NSAID therapy, such as aspirin.
Why is Misoprostol contraindicated in pregnancy?
because it can induce labor or abortion.
What treatment options are available for gastro-oesophageal reflux disease (GORD) during pregnancy?
lifestyle advice
antacids/alginate
(Omeprazole is reserved for women with severe or complicated reflux disease)
What lifestyle advice can be given for the treatment of GORD in children? (2)
changing the frequency and volume of feed
and using a feed thickener or thickened formula.
What pharmacological treatment can be used for children with GORD who do not respond to lifestyle changes?
an antacid (alginate)
and if resistant, a H2 antagonist or Omeprazole may be used.
What is a stoma?
an artificial opening on the abdomen
used to divert the flow of faeces or urine
into an external pouch located outside of the body.
What are the most common forms of stoma? (2)
- colostomy
- ileostomy
Why are enteric-coated and modified-release medicines not suitable for patients with a stoma?
because there may not be sufficient release of the active ingredient.
What types of medicines are more suitable for patients with a stoma?
- Soluble tablets
- liquids
- capsules
- uncoated tablets
due to their quicker dissolution
Why should preparations containing sorbitol be avoided for stoma patients?
because sorbitol has laxative side effects
which may exacerbate gastrointestinal issues for these patients
In patients who have a history of upper GI bleeding or have 3 or more risk factor
what type of NSAID would we give with a PPI?
What are alternatives to this treatment?
Risk factors for NSAID associated ulcers include age >65, history of ulcers, additional co-morbidities (diabetes, CV disease etc.) and medicines that G.I. side effects.
a selective COX-2 inhibitor
Alternatives are:
* H2 Antagonist e.g. Ranitidine
- Prostaglandin analogue e.g. Misoprostol.
What type of laxatives have the fastest onset of action?
Faecal softeners have the fastest onset of action
typically within 15 minutes
What can be added if faecal impaction does not occur after 2 weeks of first line treatment in children?
a stimulant laxative can be added
or if stools are hard, it can be used in combination with an osmotic laxative such as lactulose.
What is the purpose of glycerol suppositories?
act as a lubricant and rectal stimulant
How should pancreatin preparations be taken to maximize effectiveness? (2)
They should be administered with meals and snacks
and excessive heat should be avoided.
What patient populations are considered at high risk of developing gastrointestinal complications with NSAIDs? (3)
- Patients aged over 65 years
- those with a history of gastrointestinal complications
- those with serious co-morbidities such as cardiovascular disease, diabetes, renal or hepatic impairment.
What is the first-line recommendation for treating constipation if dietary and lifestyle changes are ineffective?
A bulk-forming laxative
