Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Victor BNF Notes > Gastro-Intestinal System Part 1 > Flashcards

Gastro-Intestinal System Part 1 Flashcards

1
Q

What is Coeliac Disease

A
  • Autoimmune condition with chronic inflammation of small intestine.
  • Can’t absorb nutrients anymore
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the Cause of Coeliac Disease

A
  • Adverse Reaction to Gluten
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms of Coeliac Disease

A
  • Diarrhoea, abdominal pain and bloating
  • High risk of malabsorption of key nutrients (vitamins and calcium)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment of Ceoliac Disease

A
  • Strict gluten free diet (life long)
  • Assess risk of osteoporosis and treat if needed
  • Vitamin and mineral supplements following blood tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Diverticular Disease

A
  • Small bulges/pockets (diverticula) develop in lining of intestine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Diverticulitis

A

Inflamed/infected diverticular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of Diverticular Disease

A
  • Lower abdominal pain, constipation, diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment of Diverticular Disease

A
  • High fibre diet
  • Treat diarrhoea or constipation
  • Antibiotics if diverticulitis (infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Ulcerative Colitis

A

Inflammatory bowel disease
- Mucosal inflammation and ulcers (colon/rectum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the Colon

A

Longest part of the large intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms of Ulcerative Colitis

A

Alternates between acute flare ups and remission
- acute flare up includes: mouth ulcers, arthritis, sore skin, weight loss, fatigue

  • bloody diarrhoea (mucus or puss)
  • abdominal pain (need a poo)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of Ulcerative Colitis

A
  • Colorectal cancer
  • secondary osteoporosis (from corticosteroids or diet)
  • Venous Thromboembolism (vein blood clot)
  • toxic megacolon (swelling and inflammation in colon stopping it from working)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Contraindications during acute flare up in Ulcerative Colitis

A
  • Anti-motility drugs (used to alleviate symptoms of diarrhoea)
    —- Loperamide, Codeine
  • Antispasmodics/Antimuscarinics (muscles relaxants)
    — Oxybutynin (relaxes muscle in bladder)
    — Hyoscine butylbromide (relaxes smooth muscle)
  • Paralytic Ileus (physically impaired motor activity of bowel)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ulcerative Colitis: Extensive Colitis (proximal)

A

Inflammation affecting most of ascending (proximal) colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ulcerative Colitis: Left-sided Colitis (Distal)

A

Inflammation up to descending colon (distal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ulcerative Colitis: Proctosigmoiditis

A

Inflmmation of rectum and sigmoid colon (last part of colon before the rectum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ulcerative Colitis: Proctitis

A

Inflammation of Rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute Mild-Moderate Ulcerative Colitis Treatment (Proctitis and Proctosigmoiditis)

A

First Line:
— Aminosalicylate (retal)
— Rectal corticosteroid (hydrocortisone)

Second Line (after no response within 4 weeks):
— Prednisolone 20-40mg daily until remission
— Oral Tacrolimus (granules for solution, dose based on weight)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute Mild-Moderate Ulcerative Colitis Treatment (Extensive Colitis and Left-Sided Colitis)

A

First Line:
— Hugh dose oral Aminosalicylate + (rectal Aminosalicylate) or (oral beclometasone)

Second Line (after no response within 4 weeks):
— Prednisolone 20-40mg daily until remission
— Oral Tacrolimus (granules for solution, dose based on weight)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Subacute Ulcerative Colitis (rapid onset recent) Treatment

A

Prednisolone 20-40mg daily till remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Severe Ulcerative Colitis Treatment

A

Hospital Admission now

First Line:
— IV Corticosteroid
— IV Ciclosporin
— Removal of colon

Second Line (symptoms don’t improve within 72 hours):
— IV Corticosteroid and Ciclosporin/Infliximab
— Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ulcerative Colitis maintaining Remission

A

— Rectal/Oral Aminosalicylate (depending on where the colitis is)

If 2+ flare ups in 12 months then use:
— Oral Immunosuppressant (Azathioprine)
— Monoclonal Antibodies (only if tolerated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Crohn’s Disease

A

inflammation of gasto-intestinal tract from mouth to anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptoms of Crohn’s Disease

A

alternates between acute flare-ups and remission)
- abdominal pain
- diarrhoea and rectal bleeding
- weight loss, fever, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Complications of Crohn’s Disease

A
  • Intestinal Strictures (intestinal narrowing)
  • Abscesses (collection of puss)
  • Fistulae (abnormal connection between two body parts)
  • Anaemia (not enough healthy red blood cells)
  • Colorectal/small bowel cancer
  • Growth failure/delayed puberty in children
  • Arthritis
    Secondary Osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Crohn’s Disease Lifestyle Advice

A
  • High fibre diet
  • smoking cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Crohn’s Disease: 1 flare up/first presentation treatment

A

— Corticosteroid (prednisolone 20-40mg until remission)

— Budesonide (9mg daily for 8 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Crohn’s Disease: 2+ flare ups in 12 months (or if corticosteroid failed) treatment

A

— Azathioprine 2-2.5mg/kg daily
(immunosuppressant)

— Methotrexate (25mg daily until remission, then 15mg daily)

— Monoclonal Antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Remission maintenance in Crohn’s disease

A

— Azathioprine 2-2.5mg/kg daily or Methotrexate 15mg

After Surgery
— Azathioprine or Aminosalicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Drugs in Inflammatory Bowel Disease:(Aminosalicylates 5-ASA)

A
  • Balsalazide, Mesalazine
  • Olsalazine (5-ASA dimer)
  • Sulfasalazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Drugs in Inflammatory Bowel Disease: Corticosteroids

A
  • Prednisolone
  • Beclometasone (use with 5-ASA in ulcerative colitis)
  • Hydrocortisone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Drugs in Inflammatory Bowel Disease: Immune System affecting drugs

A
  • Azathioprine/Ciclosporin (immunosuppressants)
  • Methotrexate (sows down immune system)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Aminosalicylates MoA

A

Reduces Cytokine and free radical formation and inhibits prostaglandin synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Side Effects of Aminosalicylates

A
  • Report anything unusal to do with blood (unexpected bleeding, bruising, sore throat, fever)
  • Nephrotoxicity (monitor renal function)
  • Allergy (itching and hives)
  • Yellow/orange bodily fluid (soft contact lenses may be stained)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Aminosalicylates Interactions

A
  • Lactulose and Mesalazine
    (lactulose lowers stool pH in intestine, stopping production of sufficient active ingredient)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is Irritable Bowel Syndrome

A
  • Lower abdominal/colic pain
  • Bloating
  • Alternating constipation and diarrhoea
  • Irregular bowel movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is irritable bowel syndrome aggravated by and common patient group

A
  • stress, depression/anxiety, lack of fibre
  • Adult women between 20 to 30 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Irritable bowel syndrome: GI Spasm Treatment

A

Antispasmodics
- Mebeverine
- Alverine
- Peppermint oil

Antimuscarinics
- Hyoscine Butylbromide
- Dicyloverine
- Atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Irritable bowel syndrome: Constipation Treatment

A

First Line:

Laxatives
— Senna, Bisacodyl, Lactulose (not recommended as causes bloating)

If laxatives example fail
— Linoclotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Irritable bowel syndrome: Diarrhoea Treatment

A

First Line:
Anti-motility Drugs
— Loperamid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Irritable bowel syndrome: Second Line for abdominal pain and discomfort

A

Antidepressant
- Tricyclic Antidepressant (Amitriptyline: 5-10mg daily, Max 30mg)
- SSRI (Citalopram)

42
Q

What is Short Bowel Syndrome

A

Malabsorption following extensive resection of the small bowel

43
Q

What is bowel cleansing

A

Nozzle inserted into rectum pumping water into bowels, cleans it form toxins, fluids and waste.

This is done a colonic surgery, colonoscopy, radiological examination.

44
Q

What is constipation

A
  • infrequent stools (less than 3 times a week)
  • difficulty passing stools
  • sensation of incomplete emptying
45
Q

Constipation assosiative symptoms

A
  • excessive straining
  • lower abdominal pain/discomfort
  • bloating
46
Q

Constipation Red Flag Symptoms

A
  • New onset in above 50
  • anaemia
  • abdominal pain
  • unexplained weight loss
  • Overt (seen)/ Occult blood (unseen) blood in stool
47
Q

Constipation Laxative Classes

A
  • Stimulant
  • Chloride channel agonist
  • Opioid receptor antagonist
  • Osmotic
  • Bulk forming
  • Stool Softener
48
Q

Stimlant laxative Exmaples

A

Senna, Docusate, Bisacodyl, Glycerol Supp, Sodium Picosulfate

49
Q

Osmotic laxative Examples

A

Macrogol, Lactulose

50
Q

Bulk Forming laxative Examples

A

Ispaghula Husk, Methylcellulose

51
Q

Stool Softener laxative Examples

A

Liquid Parafin

52
Q

Laxative: Bulk Forming: Mode of Action

A
  • Swells in gut to increase faecal mass - - To stimulate peristalsis (muscle flexing in intestine)
  • push faecal matter forward
  • works in 24 hours (full effect 3 days)
53
Q

Laxative: Osmotic: Mode of Action

A
  • Increases water in colon from bodily or drank fluids
  • 2-3 days
54
Q

Laxative: Stimulant: Mode of Action

A
  • increases intestinal motility by gut irritation
  • 6 to 12 hours
  • glycerol supp within 30 mins
55
Q

Laxative: Faecal Softener: Mode of Action

A
  • increases amount of water and fat stool absorbs
  • softening stools
56
Q

Bulk Forming Laxative

A

Examples
- Ispaghula Husk

  • good for small hard stools, and fibre deficient diets

Side Effects
- bloating
- cramping
- flatulence
- gut obstruction

Counselling
- good fluid intake to avoid gut obstruction
- not before bed

57
Q

Osmotic Laxatives

A

Second line:
Macrogol, Lactulose

Side Effects
- Discomfort, flatulence, cramps, nausea

reduce nausea by consumption with fluids or food

58
Q

Stimulant Laxative

A

Third Line:
Glycerol Supp, senna

Side Effects
- Abdominal cramps, (senna colours urine yellow)
Excessive use:
- Lazy bowel, diarrhoea, hypokalaemia

Counselling:
- take at night
- wet suppositories before use

59
Q

Co-Danthramer/Co-danthrusate: Stimulant Laxative

A

it is genotoxic and carcinogenic

Side Effects
- carcinogenic
- red rine
- local irritation (avoid prolonged contact with patient)

60
Q

Faecal Softener Laxative

A

Liquid Parafin

Side Effects (Harsh)
- anal seepage
- lipid pneumonia (fat collection in lungs)
- granulomatous
- malabsorption of fat soluble vitamins

61
Q

If 2 laxatives from different classes fail for 6 months, use…

A

Chloride Channel Agonsit
- Lubiprostone

Selective 5HT-4 Agonist
- Prucalopride (women only)

62
Q

Opioid Induced Constipation Treatment

A

[Osmotic laxative or Docusate Sodium ] + [Stimulant Laxative]

Co-Danthramer/Danthrusate (palliative care only)

Methylnaltrexone/ Naloxegol

(avoid bulk forming= obstruction and painful colic)

63
Q

Chronic Constipation Treatment

A

First Line:
Bulk Forming

Second Line:
Osmotic

Third Line:
Stimulant

64
Q

Constipation in Children Treatment

A

First line:
Osmotic + diet change

Second Line:
+ stimulant laxative

Third Line:
+ lactulose

65
Q

Constipation in Pregnancy Treatment

A

First Line:
Fibre Supplement

*Second Line: *
Bulk Forming

Third Line:
Osmotic

Fourth Line:
Senna, Bisacodyl, Docusate, Glyceral Supp
(avoid senna close to term)

66
Q

Constipation in Breast feeding treatment

A

First Line:
Bulk Forming (if diet change fails)

Second Line:
Osmotic or Stimulant

67
Q

What is diarrhoea

A

frequent loose, water stools

68
Q

Associated symptoms of Diarrhoea

A

Cramps, Nausea and Dehydration

69
Q

Red Flag symptoms of Diarrhoea

A

unexpected weight loss, rectal bleeding, persistent diarrhoea, systemic illness, recent hospital treatment, recent foreign travel

70
Q

Diarrhoea Treatments

A

**First Line: **
Oral Rehydration Therapy
(replaces electrolytes and fluid depletion)
— Diarolyte

Second Line:
Anti-Diarrhoeals
— Codein (anti-motility)
— Loperamide (anti-motility)
— Rifamaxin (for travellers diarrhoea)

71
Q

Loperamide Treatment for Diarrhoea

A

Antipropulsive

Prolongs the duration of intestinal transit by biding to opioid receptors in GI Tract

72
Q

Loperamide Diarrhoea Use

A

Second Line only in over 12

**Dose: **4mg, then 2mg for up to 5 days
Maximum 16mg a day
Take after each loose stool

73
Q

Loperamide Cautions and Monitoring

A
  • Overdose can cause serious cardiac side effects
  • Give Naloxone if overdose symptoms occur
  • Patients. monitored for CNS depression for 48 hours after start
74
Q

Loperamide side effects, contra-indications

A

Side Effects:
- dizziness, flatulence, headache, nausea

Contra-indications
- Ulcerative colitis
- antibiotic associated colitis
- conditions with impaired gut mobility
- Conditions with abdominal distention (swollen out abdomen)
- Bloody diarrhoea
- severe abdominal pain

75
Q

What is Dyspepsia

A

Group of upper abdominal symptoms
(upper abdominal pain, fullness, early satiety, bloating, belching, nausea)

76
Q

Causes of Dyspepsia

A

Indigestion, GORD (gasto-oesophegal reflux disease), gastritis (stomach lining inflammation), Gastric Ulcers

77
Q

Dyspepsia Urgent Endoscopic Referral

A
78
Q

Uninvestigated Dyspepsia Treatment

A

First Line:
Antacids (sodium bicarbonate, calcium carbonate, Gaviscon)

Second Line:
PPI (omeprazole, lansoprazole)
— for 4 week

*Third Line: *
H. Pylori Test

79
Q

Investigated Dyspepsia

A

H. Pylori Test

PPI (omeprazole) or H2 Antagonist (Famotidine)
— for 4 weeks

80
Q
A
81
Q

Antacids Mode of Action

A

Neutralises stomach acid
Immediate relief within 30 mins

Liquid better than tablets

82
Q

Alginates Mode of Action and examples

A

Forms viscous gel raft on top of stomach contents to prevent reflux

Alginic Acid
Sodium Alginate

83
Q

Antacids Interactions

A
  • impairs drug absorption (leave 2 hours when taking other drugs)
    (tetracyclines, quinolones, Bisphosphonates)
  • Damages drug enteric coating due to high pH
  • High sodium content, causing high sodium and water retention
    (avoid in cardiac conditions, liver and kidney failure)
84
Q

Proton Pump Inhibitors Mode of Action

A

Stops gastric acid secretion by blocking hydrogen-potassium ATPase (proton pump) of gastric parietal cell.

Best antisecretory drug

85
Q

PPI Administration advice

A

Swallow whole, don’t chew

No indigestion remedies 2 hours before or after taking

86
Q

PPI Cautions

A
  • Masks symptoms of gastric cancer
  • raises risk of fractures and risk of osteoporosis
  • increased risk of GI infections (c. difficile)
87
Q

PPI Dose and Side Effects

A

use lowest effective dose for shortest period

Side Effects:
- GI Upset (abdominal pain, constipation, diarrhoea, nausea

88
Q

PPI Long term use and interactions

A

Long Term Use:
- Hypomagnesaemia
- fractures
- rebound acid secretion due to PPI withdraw

Interactions:
Omeprazole with…
- Clopidogrel (reduced anti-platelet effect)
- Methotrexate (reduced clearance of methotrexate)

89
Q

H2 Receptor Antagonists Mode of Action

A

Reduces gastric acid secretion by blocking H2 receptors in gastric parietal cell

(antisecretory)

90
Q

H2 Receptor Antagonist examples

A

Famotidine

Ranitidine (safe in pregnancy)

91
Q

H2-R Antagonist Side Effects and Cautions

A

Side Effects:
Headaches, rashes, dizziness, diarrhoea
— Psychiatric reactions (confusion, depression)

Cautions:
- masks symptoms of gastric cancer

92
Q

Where is the duodenum

A

cord connecting below the stomach

93
Q

Gastric/Duodenal Ulceration Treatment

A

PPI (omeprazole)

H2R Antagonist (famotidine)

94
Q

Gastric/Duodenal Ulceration Treatment Specific Drugs

A

**Misoprostol **
(synthetic prostaglandin analogue)
AVOID IN PREGNANCY
Colic (sever pain in abdomin)

Sucralfate
1 hour before meals/ 1 hour gap between enteral feeds (tube feeding)

95
Q

H.Pylori Ulcers Treatment

A

1 week triple therapy

PPI (twice daily)
+
Amoxicilin / Metronidazole *( give if penicillin allergy or if recently treated with it) *
+
Clarithromycin (if using Macloides - any ‘YCIN’- use metronidazole)

96
Q

NSAID-Induced Ulcers Treatment

A
  1. Stop NSAID if possible
  2. PPI / H2R Antagonsit
  3. Test for H.Pylori on healing (if positive, start H.Pylori Treatment)

If Non-selective NSAID continued, continue PPI
If history of upper GI bleeding, continue PPI + switch to COX-2 inhibitor

97
Q

NSAID-Indced Ulcers: High Risk Patinets

A
  • 65+
  • Previous History
  • Significant Co-morbidity (kidney liver heart disease or diabetes)
98
Q

Gastro-Oesphaegal Reflux Disease Treatment: Mild

A
  • Antacids + Alginates
  • H2R Antagonist/PPI

maintain remission via intermisttant treatment

99
Q

Gastro-Oesphaegal Reflux Disease Treatment: Severe

A
  • PPI for 4 to 6 weeks

maintain remission with low dose PPI or intermittant PPI or using H2R Antagonist

100
Q

Gastro-Oesphaegal Reflux Disease Treatment: Pregnancy

A

First Line:
Antacids / Alginates

Second Line:
Ranitidine

** Third Line:**
Omeprazole

101
Q

Gastro-Oesphaegal Reflux Disease Treatment: Children

A

Self limiting after age 12-18 months

Thickened Feeds / Alginates

Victor BNF Notes (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions