Gastro-intestinal system Flashcards
‘Ulcerative colitis increases your chances of developing venous thromboembolism and colorectal Ca’
True or False?
True
Name some aminosalicylates
Mesalazine, sulfasalazine, olsalazine, balsalazide
Why should mesalazine be prescribed by brand?
Oral preparations may have different delivery characteristics
How is a flare of UC usually treated?
- Topical/oral aminosalicylate
- Oral prednisolone
- Tacrolimus or budesonide multimatrix
How is diarrhoea in UC treated?
With loperamide/codeine during remission
This is CONTRA-INDICATED during active UC as there is a risk of toxic megacolon
What is usual maintenance treatment for Crohns disease?
- No treatment, patients must be aware of signs of relapse
OR - Azathioprine/mercaptorine monotherapy
- Methotrexate
Do not offer a steroid for maintenance treatment
Can loperamide/codeine be used to manage diarrhoea in Crohns?
Yes- if no colitis
What abx are used to treat fistulating Crohns?
Metronidazole/ ciprofloxacin
What lifestyle factors can reduce the risk of relapse in Crohns?
- Smoking cessation
- High fibre diet
What is first line treatment for an acute flare of Crohns?
Corticosteroids
Prednisolone, methylpred or IV hydrocortisone
How should patients on aminosalicylates be counselled?
Risk of blood disorders/dyscrasia
Report any unexplained bleeding, bruising, sore throat etc
What monitoring is required for patients on aminosalicylates?
- FBC if signs of blood disorders
- Renal function, risk of neprotoxicity
Why should aminosalicylates be avoided during breast feeding?
Risk of diarrhoea in the newborn
Which aminosalicylate can turn bodily fluids including contact lenses orange?
Sulfasalazine
Why should mesalazine not be given with lactulose?
Lactulose lowers pH of stools, can prevent sufficient release of MR/EC preparations of mesalazine
Which lifestyle advice can be offered to patients suffering with IBS?
- Increase exercise
- Eat regular meals
- Limit fresh fruit to 3 portions per day
- Increase fibre and fluid intake
- Reduce caffeine, alcohol and fizzy drinks
Why should lactulose not be recommended in IBS?
Can cause bloating
How does NICE define constipation?
Defecation less than 3 times per week
Differs for each person
Which ‘red flags’ would ean you referred a patient presenting with constipation?
- New onset constipation aged over 50
- Anaemia
- Abdo pain/vomiting/bloating
- Unintentional weight loss
- Blood/mucus in stools
- Painful defecation
- Secondary caused by drug, drug should be reviewed
Which patient would you NOT refer?
- Woman in her late 50s presenting with 3 weeks of constipation and this is the first time she has had these symptoms
- Man aged 23 with new constipation after being prescribed co-drydamol for an injury
- Man aged 47 with constipation and a 2 month history of weight loss
- Woman aged 75 with a 3 day history of constipation and she has bought lactulose for this in the past
- Woman aged 60 with constipation, abdominal pain and blood in stools
Woman aged 75 with a 3 day history of constipation and she has bought lactulose for this in the past - if no new/unusual bowel habits or other red flags
What is a sign of laxative abuse?
Hypokalaemia
What is the recommended first line treatment for constipation?
Bulk-forming laxatives
Name some bulk-forming laxatives?
Ispaghula husk, methylcellulose (also softener), sterculia
How long do bulk-forming laxatives take to work?
72 hours
What patient counsellign should be given with bulk-forming laxatives?
- Ensure adequate fluid intake
- Don’t take before bed to avoid obstruction
What laxative is recommended for pregnant women?
bulk-forming laxatives
Name some stimulant laxatives?
Bisacodyl, sodium picosulfate, senna, co-danthramer, co-danthrusate, docusate, glycerol suppositories
How long do stimulant laxatives take to work?
6-12 hours, take before bed for an effect the following morning
Suppositories take 15-30 mins
What can be caused by excess use of stimulant laxatives?
- lazy bowel
- diarrhoea
- hypokalaemia
- cramps
Which stimulant laxative also works as a faecal softener?
Docusate
How long should stimulant laxatives usually be used for?
Approx 7 days
Which stimulant laxatives should only be used in terminally ill patients?
Co-danthramer and co-danthrusate - potential carcinogens