Gastrointestinal

Question 1

What type of diet is advised in symptomatic Diverticultis patients?

Answer 1

high fibre

Question 2

What 2 conditions are classified as chronic inflammatory bowel diseases

Answer 2

Crohns and Ulcerative colitis

Question 3

Extra-intestinal manefistations of Crohns disease

Answer 3

Arthritis, abnormalities of the joints, eyes, liver,skin. Cause of secondary osteoporosis

Question 4

How is acute crohns attack treated first line

Answer 4

Prednisolone/methylpred or IV hydrocortisone

- if contraindicated, Budesonide or aminosalicylates

Question 5

If a patient has 2 or more flare ups of Crohns in 12 months and steroids can not be increased, what else can be added?

Answer 5

Azathioprine or mercaptopurine or MTX or Mabs

Question 6

what medocation can be used to manage diarrhoea in Crohns patients?

Answer 6

Loperamide, colestyramine or Codeine

Question 7

Fistulating crohns disease can be managed with whihc antibiotics

Answer 7

Metronidazole for 1 month (no more than 3 months) and/or cipro

Question 8

What is proctitis?

Answer 8

Inflammation of the rectum

Question 9

What is proctosigmoiditis inflammation of?

Answer 9

Sigmoid colon + rectum

Question 10

Why are loperamide and codeine contraindicated in ACUTE ulcerative colitis?

Answer 10

They increase the risk of toxic megacolon

Question 11

First line medication for Proctitis and proctosigmoiditis?

Answer 11

Aminosalicylate (rectal formulation) or rectal corticosteroid

Question 12

First line medication for Extensive colitis or left sided colitis

Answer 12

High dose ORAL aminosalicylate +/- rectal aminosalicylate or oral beclomethasone

Question 13

If there is no responce in a Crohns patient who has been taking ASA and pred what else is added in?

Answer 13

Tacrolimus

Question 14

Treatment of severee UC (medical emergency)

Answer 14

IV corticosteroids ( if CI IV ciclosporin) if symptoms worsen in 72 hours IV cisloporin and IV corticosteroids

Question 15

During acute UC exacerbations, if IV ciclosporin is C/I what MAb can be used

Answer 15

Infliximab

Question 16

Side effects of aminosalicylates

Answer 16

Blood dycrasias
Salicylate hypersensitivity - itching and hives
Nephrotoxicity- monitor RF

Question 17

How should mesalazine be prescribed

Answer 17

by brand

Question 18

Taste altered, insomnia, discoloration of contact lenses are side effects of which ASA?

Answer 18

Sulfasalazine

Question 19

What monitoring is required ofr sulfasalazine

Answer 19

LFT - baseline, monthly for 3 months
U&Es
Blood disorders - FBC monthly for 3 months

Question 20

What is the significance of the interaction between Lactulose and mesalazine?

Answer 20

Lactulose lowers ph in intestine preventing API in E/C or MR preparation to be released

Question 21

Patients being started on MAB must be screend for what first?

Answer 21

TB

Question 22

Can a patient with active infection have a MAB?

Answer 22

No - contraindicated use

Question 23

What is some lifestyle advise to counsel patients with IBS?

Answer 23

• increase exercise
• Limit fresh fruit intake to 3 a day
• meals regulary, avoid long gaps
  -if fibre needed, solulbe fibre should be offered (not insoluble)
  -Increase fluid intake
  -

Question 24

Antispasmodic drugs used in IBS

Answer 24

Alverine, Mebervine, Peppermint oil capsules

Question 25

Which laxative should be avoided in IBS?

Answer 25

Lactulose - causes bloating

Question 26

If a patient does not respond to antispasmodic drugs, antimotility or laxatives in IBS, what other medication can be trialled for adbominal pain?

Answer 26

Amitripyline

Question 27

Patients with short bowel syndrome may require replacement of what?

Answer 27

Vitamins, fatty acids, zinc, selenium. Also magnesium (IV or PO)

Question 28

Oral adminsitration of magnesium can cause what bowel issue?

Answer 28

Diarrhoea

Question 29

What limits the use of Co-phenotrope as an antimotility drug in short bowel syndrome?

Answer 29

It crosses the BBB so can cause CNS effects

Question 30

What class of drug is Teduglutide?

Answer 30

GLP2 - used in short bowel syndrome to faciliate fluid, electrolyte and micronutrient absorption