Gastrointestinal Flashcards
What type of diet is advised in symptomatic Diverticultis patients?
high fibre
What 2 conditions are classified as chronic inflammatory bowel diseases
Crohns and Ulcerative colitis
Extra-intestinal manefistations of Crohns disease
Arthritis, abnormalities of the joints, eyes, liver,skin. Cause of secondary osteoporosis
How is acute crohns attack treated first line
Prednisolone/methylpred or IV hydrocortisone
- if contraindicated, Budesonide or aminosalicylates
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?
Azathioprine or mercaptopurine or MTX or Mabs
what medocation can be used to manage diarrhoea in Crohns patients?
Loperamide, colestyramine or Codeine
Fistulating crohns disease can be managed with whihc antibiotics
Metronidazole for 1 month (no more than 3 months) and/or cipro
What is proctitis?
Inflammation of the rectum
What is proctosigmoiditis inflammation of?
Sigmoid colon + rectum
Why are loperamide and codeine contraindicated in ACUTE ulcerative colitis?
They increase the risk of toxic megacolon
First line medication for Proctitis and proctosigmoiditis?
Aminosalicylate (rectal formulation) or rectal corticosteroid
First line medication for Extensive colitis or left sided colitis
High dose ORAL aminosalicylate +/- rectal aminosalicylate or oral beclomethasone
If there is no responce in a Crohns patient who has been taking ASA and pred what else is added in?
Tacrolimus
Treatment of severee UC (medical emergency)
IV corticosteroids ( if CI IV ciclosporin) if symptoms worsen in 72 hours IV cisloporin and IV corticosteroids
During acute UC exacerbations, if IV ciclosporin is C/I what MAb can be used
Infliximab
Side effects of aminosalicylates
Blood dycrasias
Salicylate hypersensitivity - itching and hives
Nephrotoxicity- monitor RF
How should mesalazine be prescribed
by brand
Taste altered, insomnia, discoloration of contact lenses are side effects of which ASA?
Sulfasalazine
What monitoring is required ofr sulfasalazine
LFT - baseline, monthly for 3 months
U&Es
Blood disorders - FBC monthly for 3 months
What is the significance of the interaction between Lactulose and mesalazine?
Lactulose lowers ph in intestine preventing API in E/C or MR preparation to be released
Patients being started on MAB must be screend for what first?
TB
Can a patient with active infection have a MAB?
No - contraindicated use
What is some lifestyle advise to counsel patients with IBS?
- 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
-
Antispasmodic drugs used in IBS
Alverine, Mebervine, Peppermint oil capsules
Which laxative should be avoided in IBS?
Lactulose - causes bloating
If a patient does not respond to antispasmodic drugs, antimotility or laxatives in IBS, what other medication can be trialled for adbominal pain?
Amitripyline
Patients with short bowel syndrome may require replacement of what?
Vitamins, fatty acids, zinc, selenium. Also magnesium (IV or PO)
Oral adminsitration of magnesium can cause what bowel issue?
Diarrhoea
What limits the use of Co-phenotrope as an antimotility drug in short bowel syndrome?
It crosses the BBB so can cause CNS effects
What class of drug is Teduglutide?
GLP2 - used in short bowel syndrome to faciliate fluid, electrolyte and micronutrient absorption
