Gastro-Intestinal System Flashcards
What is Coeliac Disease?
Coeliac disease is an autoimmune condition which is associated with chronic inflammation of the small intestine. Dietary proteins such as gluten cause an abnormal autoimmune response in the intestinal mucosa - leading to malabsorption of nutrients.
Non-drug treatment of Coeliac disease?
A lift long strict gluten-free diet.
Should someone with Coeliac Disease self-medicate with OTC vitamins or supplements?
No - this should be decided with the guidance of a HCP.
What is Diverticular Disease/Diverticulitis?
Diverticular disease is a condition where diverticula are present with symptoms such as abdominal tenderness and/or mild, intermittent lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds. Symptoms of diverticular disease may overlap with other conditions such as Irritable bowel syndrome, colitis (bowel inflammation related to Crohn’s disease, Ulcerative colitis, ischaemia or microscopic colitis), and malignancy.
Non-Drug Treatment of Diverticulitis?
Patients with diverticulosis or diverticular disease should be advised to eat a healthy, balanced diet including whole grains, fruit and vegetables. In patients with constipation and on a low fibre diet, a gradual increase of dietary fibre may minimise flatulence and bloating. Patients increasing dietary fibre should be advised to drink an adequate amount of fluid, especially if dehydration is a risk. Advice should also be given about the benefits of exercise, weight loss (if overweight or obese), and Smoking cessation, in reducing the risk of symptomatic disease and acute diverticulitis.
Drug Treatment of Diverticulitis?
Bulk-forming laxatives should be considered when a high-fibre diet is unsuitable, or for patients with persistent constipation or diarrhoea.
Consider the use of simple analgesia such as paracetamol in patients with ongoing abdominal pain, and antispasmodics in those with abdominal cramps. Non-steroidal anti-inflammatory drugs and opioid analgesics are not recommended as their use may increase the risk of diverticular perforation.
What is Chrons Disease?
Crohn’s disease is a chronic, inflammatory bowel disease that mainly affects the gastro-intestinal tract. It is characterised by thickened areas of the gastro-intestinal wall with inflammation extending through all layers, deep ulceration and fissuring of the mucosa, and the presence of granulomas; affected areas may occur in any part of the gastro-intestinal tract, interspersed with areas of relatively normal tissue. Crohn’s disease may present as recurrent attacks, with acute exacerbations combined with periods of remission or less active disease. Symptoms depend on the site of disease but may include abdominal pain, diarrhoea, fever, weight loss and rectal bleeding.
Complications of Chrons Disease?
Complications of Crohn’s disease include intestinal strictures, abscesses in the wall of the intestine or adjacent structures, fistulae, anaemia, malnutrition, colorectal and small bowel cancers, and growth failure and delayed puberty in children. Crohn’s disease may also be associated with extra-intestinal manifestation: the most common are arthritis and abnormalities of the joints, eyes, liver and skin. Crohn’s disease is also a cause of secondary osteoporosis and those at greatest risk should be monitored for osteopenia and assessed for the risk of fractures.
What is Fistulating Chron’s Disease?
Fistulating Crohn’s disease is a complication that involves the formation of a fistula between the intestine and adjacent structures, such as perianal skin, bladder, and vagina. It occurs in about one quarter of patients, mostly when the disease involves the ileocolonic area.
Non-Drug Treatment of Chron’s Disease?
Management options for Crohn’s disease include Smoking cessation and attention to nutrition, which plays an important role in supportive care. Surgery may be considered in certain patients with early disease limited to the distal ileum and in severe or chronic active disease
Monotherapy for Chron’s Disease
A corticosteroid (either prednisolone or methylprednisolone or intravenous hydrocortisone), is used to induce remission in patients with a first presentation or a single inflammatory exacerbation of Crohn’s disease in a 12-month period.
In patients with distal ileal, ileocaecal or right-sided colonic disease, in whom a conventional corticosteroid is unsuitable or contra-indicated, budesonide may be considered. Budesonide is less effective but may cause fewer side-effects than other corticosteroids, as systemic exposure is limited. Aminosalicylates (such as sulfasalazine and mesalazine) are an alternative option in these patients. They are less effective than a corticosteroid or budesonide, but may be preferred because they have fewer side-effects. Aminosalicylates and budesonide are not appropriate for severe presentations or exacerbations
Add on Treatment for Chrons Disease?
Add on treatment is prescribed if there are two or more inflammatory exacerbations in a 12-month period, or the corticosteroid dose cannot be reduced.
Azathioprine or mercaptopurine [unlicensed indications] can be added to a corticosteroid or budesonide to induce remission. In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, methotrexate can be added to a corticosteroid.
Maintenance of Remission of Chrons Disease?
Azathioprine or mercaptopurine [unlicensed indications] as monotherapy can be used to maintain remission when previously used with a corticosteroid to induce remission. They may also be used in patients who have not previously received these drugs (particularly those with adverse prognostic factors such as early age of onset, perianal disease, corticosteroid use at presentation, and severe presentations). Methotrexate can be used to maintain remission only in patients who required methotrexate to induce remission, or who are intolerant of or are not suitable for azathioprine or mercaptopurine for maintenance. Corticosteroids or budesonide should not be used.
Maintaining Remission of Chrons following surgery?
Azathioprine in combination with up to 3 months’ postoperative metronidazole [unlicensed indication] should be considered to maintain remission in patients with ileocolonic Crohn’s disease who have had complete macroscopic resection within the previous 3 months. Azathioprine alone should be considered for patients who cannot tolerate metronidazole.
Other Treatments of Chrons Disease?
Loperamide hydrochloride or codeine phosphate can be used to manage diarrhoea associated with Crohn’s disease in those who do not have colitis.
Colestyramine (Questran Sachet) is licensed for the relief of diarrhoea associated with Crohn’s disease
