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cardiovascular system 1 > Gastrointestinal system > Flashcards

Gastrointestinal system Flashcards

1
Q

What is coeliac disease?

A

An autoimmune condition associated with chronic inflammation of small intestine triggered by dietary protein (gluten)

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2
Q

List examples of food that contain gluten

A

Wheat, barley, rye, cakes etc

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3
Q

Gluten activates an abnormal immune response in the intestine that leads to malabsorption of what kind of essential vitamins?

A

Folic acid, vit D, Ca and Fe

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4
Q

Symptoms of celiac disease

A

ABCD
Abdominal pain
Bloating
Constipation
Diarrhoea

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5
Q

What is the only effective tx for coeliac disease

A

A strict life long gluten free diet

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6
Q

Drug tx of coeliac disease

A

Supplementation with ca, folic acid and vit D
Osteoporosis tx

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7
Q

What is diverticulosis

A

Asymptomatic condition
Presence of diverticula
Age dependent usually 40+

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8
Q

Difference between diverticulitis and diverticular disease

A

Diverticular disease is a condition where diverticulitis are present and cause symptoms such as abdominal tenderness, constipation and diarrhoea, rectal bleeds and Intermittent lower abdominal pain WITHOUT inflammation or infection
Whereas Diverticulitis causes inflammation and Infection

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9
Q

Signs and symptoms of acute diverticular disease

A

Constant lower abdominal pain
Fever
Significant rectal bleeding
Sudden change in bowel habit
Abdominal tenderness
Abdominal mass

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10
Q

State when to refer patients with diverticulitis

A

Pts with complications such as
Abscess
Bowel perforation
Intestinal obstruction
Sepsis

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11
Q

Non drug tx for Diverculitis

A

Diet ,lifestyle changes
Eat healthy, balanced diet ,increase fibre
Weight loss, smoking cessation
Exercise

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12
Q

State what to give patient with diverticulosis suffering from constipation

A

Bulk foaming laxative

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13
Q

Tx for acute diverticulitis

A

Simple analgesia
Refer pts with Complications
No antibacterial prescribing

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14
Q

What is IBD

A

A term to define to conditions Crohn’s disease and Ulcerative colitis

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15
Q

Causes of IBD

A

Genes
Environment
Smoking
Alcohol

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16
Q

Difference between Crohn’s disease and Ulcerative colitis

A

Crohn’s disease is an inflammation of the whole GI tract whereas UC is the inflammation of the colon

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17
Q

Drug tx of IBD

A

Aminosalicylates
Medicine affecting the immune system
Biologic therapy
Corticosteroids
Abx
Other medication for Diarrhoea and constipation

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18
Q

Mnemonic for medication used to tx IBD

A

IBD ACTS BAD
Aminosalicylates
C- corticosteroids
T- Thiopurine
B- Biological agents
A- Antibiotics
D- Diarrhoea, constipation and other drugs

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19
Q

Antidiarrhoal drug is contraindicated in acute UC. True or False?

A

True

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20
Q

Facts about Ulcerative colitis

A

Chronic inflammatory condition associated with significant morbidity and life long disease
Common in ages 15 and 25

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21
Q

What’s the tx for mild to moderate Ulcerative colitis ( Procitis)

A

Ist line line tx- Give topical aminosalicylates
No improvement, give oral aminosalicylates
No improvement, give oral or topical corticosteroids for 4-8weeks

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22
Q

Tx for Proctosigmoidisis and left sided UC

A

First line- Topical aminosalicylates

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23
Q

Tx for Extensive Ulcerative colitis

A

First line- Topical amonosalicylates and high dose of oral aminosalicylates

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24
Q

Tx of acute severe UC(life threatening)

A

I.V corticosteroids and Infiximab

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25
Q

What drug is used to maintain remission in mild, moderate or severe Ulcerative colitis

A

Use aminosalicylates
AVOID corticosteroids because of side effects

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26
Q

State when to use Oral Azathioprine or mercaptopurine?

A

It is used when two or more inflammatory exacerbations in a 12month period that required a systemic corticosteroids

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27
Q

Complications of Ulcerative colitis

A

Colorectal cancer
Secondary osteoporosis
Venous thromboembolism
Toxic megacolon ( widening of colon ,rare but life threatening

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28
Q

Facts about Sulfasalazine

A

Older aminosalicylates
With more side effects eg stains contact lenses

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29
Q

List eg of newer aminosalicylates with less side effects

A

Mesalalzine
Balsalazide
Olsalazine

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30
Q

State the most Important side effect of aminosalicylates

A

Bone marrow suppression
Blood dyscaria( perform blood count and stop drug immediately if blood dyscaria suspected)

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31
Q

What are the signs and symptoms of blood disorder

A

Unexplained bleeding
Bruising purpura
Sore throat
Fever or malaise

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32
Q

Monitoring requirements with Aminoglycoside

A

Renal function before starting, at 3months of tx and then annually

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33
Q

Does sulfasalazine stain bodily fluids?

A

Yes, orange/yellow

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34
Q

Is aminosalicylates nephrotoxic?

A

Yes

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35
Q

What is IBS( irritable bowel syndrome)

A

A long term condition of the bowel
Mainly affect s people BTW 20-30yrs
More common in women

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36
Q

What are the causes of IBS

A

Alcohol, stress, caffeine, certain spicy/fatty food

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37
Q

Symptoms of IBS

A

ABCD
Abdominal pain
Bloating
Constipation
Diarrhea
Symptoms worsen by eating and relieved by defecating
Flatulence
Passing mucus from bottom
Lethargy
Bowel incontinence

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38
Q

Non drug tx of IBS

A

Soluble fibre eg fybogel, oat, sterculia
Increase water intake( 8cups/day)
Diet and lifestyle changes
Increase physical activity
Eat regularly without missing meals
Limit fresh fruit consumption
Reduce alcohol, alcohol and fizzy drinks

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39
Q

Drug tx of IBS

A

Diarrhoea- loperamide
Bloating- peppermint oil
Constipation- increase fibre, avoiding lactose as can cause Bloating
Antispasmodic/ Antimuscarinic- abdominal pain( mebeverine, hyoscine butybromide and peppermint oil)
CBT- depression
Antidepressants

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40
Q

Drug used in moderate to severe IBS associated with constipation

A

Linaclotide
It’s shown to reduce pain , Bloating and constipation

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41
Q

Causes of constipation

A

Inadequate fibre
Inadequate fluid intake
Certain medication eg codeine, morphine, some antacids aluminium and some Antidepressants and Iron tablets
Medical condition such as IBS, underactive thyroid
Pregnancy due to hormonal changed slowing bowel movements and baby growing

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42
Q

Red flag symptoms for constipation

A

New onset constipation 50+
Anaemia
Abdominal pain
Unexplained weight loss
Blood in the stool( black and mixed in stool)
Cancer or G.I bleed

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43
Q

Different types of laxative

A

BOSS
Bulk
Osmotic
Stimulant
Softeners

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44
Q

Give an example of Bulk laxative

A

Bran, isphaghula husk, sterculia, methyl cellulose

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45
Q

Give example of Osmotic laxative

A

Macrogols eg Laxido , lactulose

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46
Q

Give an example of stimulant laxative

A

Bisacodyl, senna

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47
Q

Give example of Softener laxative

A

Liquid paraffin

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48
Q

List examples of other laxative used in constipation

A

Linaclotide and pricalopride

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49
Q

Facts about bulk forming laxative

A

Onset of action = 72hrs
It’s also a fecal softener eg methylcellouse
MOA: increase bulk in the stool like fibre
Maintain adequate fluid intake to prevent intestinal obstruction
Can cause symptoms of Bloating, flatulence and cramp occasionally

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50
Q

State other conditions Bulk forming laxatives are used in

A

Colostomy, ileostomy, haemorrhoids, anal fissure, IBS , diverticular disease and UC

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51
Q

List examples of stimulant laxative

A

Bisacodyl, sodium picosulfate , senna, glycerol and co- danthramer

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52
Q

A stimulant laxative that also acts as a fecal softener is called

A

DOCUSATE SODIUM

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53
Q

A stimulant laxative that is reserved for terminally ill patients due to carcinogenicity and colours urine RED is called

A

Co-danthramer and Co-danthrusate

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54
Q

State how Stimulant laxative work

A

They increase intestinal motility therefore causing abdominal cramps
Onset of action 8-12 hrs
Suppositories-20-60mins
Bed time dose recommended

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55
Q

Stimulant laxative is contraindicated in

A

Intestinal obstruction and undiagnosed abdominal pain

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56
Q

Side effects of stimulant laxative

A

Abdominal cramps
Abuse risk which can cause hypokaelamia

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57
Q

MHRA update on stimulant laxative

A

Following a national safety review and concerns over misuse and abuse, the MHRA has introduced new pack size restrictions, revised recommended ages for use, and new safety warnings for over-the-counter stimulant laxatives (administered orally and rectally). Patients should be advised that dietary and lifestyle measures should be used first-line for relieving short-term occasional constipation, and that stimulant laxatives should only be used if these measures and other laxatives (bulk-forming and osmotic) are ineffective.

Smaller packs will remain available for general sale for the treatment of short-term, occasional constipation in adults only, and will be limited to a pack size of two short treatment courses. Stimulant laxatives should not be used in children under 12 years of age without advice from a prescriber; in children aged 12 to 17 years, products can be supplied under the supervision of a pharmacist.

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58
Q

Facts about faecal softener

A

Decrease surface tension and increase penetrative of liquid into faecal mass. Softens and wet faeces

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59
Q

Facts about liquid paraffin as a faecal softener

A

Can cause malabsorption of fat soluble vitamins ADEK

Avoid- can cause anal seepage with prolonged use

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60
Q

Facts about docusate sodium as a fecal softener

A

Most commonly used softener

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61
Q

Facts about Peanut( arachis) as a fecal softener

A

Enemas soften and lubricate faeces

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62
Q

List the two types of osmotic laxative

A

Lactulose
Macrogols

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63
Q

MOA of osmotic laxative

A

Increase amount of water in large bowel either by drawing fluid from the body into bowel maintaining fluid in the bowel

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64
Q

Onset of action of lactulose to tx constipation

A

Can take up to 2days for max effect
Not suitable for immediate relief
Macrogols acts faster

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65
Q

Side effect of lactulose

A

Abdominal pain and Bloating
Electrolyte imbalance

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66
Q

Lactulose is also use to treat

A

Hepatic encephalopathy

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67
Q

Which drug cause constipation

A

Verapamil
Opiates
Antimuscarinics
Antihistamines
Antiepileptic
Antispasmodic
Antipsychotics
Antidepressants
Antacids (Aluminium)

68
Q

Mnemonic of drugs that cause constipation

A

Very Old Aunties get Constipation

69
Q

Pt and carer advice for those on bulk forming laxative

A

Preparation that swell in contact with liquid should be carefully swallowed with water and should not be taken immediately before going to bed. Full effect may take a few days to develop

70
Q

List the two types of diarrhoea

A

Acute Diarrhoea < 14days
Chronic Diarrhoea > 14days

71
Q

What are the causes of diarrhoea

A

Infection
Gastroenteritis
Side effects of drug
Symptoms of GI disorder

72
Q

Mnemonic of drug that cause Diarrhoea

A

CALM diarrhoea
Colchicine
Abx
Laxatives
Magnesium (antacids)
Digoxin

73
Q

Aim of tx diarrhoea

A

To prevent dehydration and fluid/electrolytes depletion esp in children and elderly

73
Q

Signs of dehydration

A

Tiredness
Headaches
Light headedness
Muscular cramps
Sunken eyes
Dry mouth and tongue
Weakness, confusion, reduced urine output

73
Q

What is dyspepsia

A

Umbrella term for upper G.I tract symptoms which typically present for 4 or more weeks
Upper abdominal pain or discomfort
Heartburn
Acid reflux
N and V

73
Q

When to refer a pt with diarrhoea

A

Unexplored weight loss
Rectal bleeding
Persistent diarrhoea
Systemic illness
Has received recent hospital or abx tx
Recent foreign travel ( other than western Europe, North America, Australia and New Zealand)

74
Q

How to tx diarrhoea

A

Hydration
ORS
Loperamide
Kaoline with morphine
Ciprofloxacin ( occasional prophylaxis for travellers diarrhoea, routine use not recommended)

75
Q

Symptoms of dyspepsia for 4wks and more

A

Upper abdominal pain
Heartburn
Gastric reflux
Early satiety
Bloating
N and V

76
Q

Red flags for dyspepsia

A

Bleeding
Dysphagia
Recurrent vomiting
Weight loss
55+( unexplained recent onset not responded to tx)

77
Q

Lifestyle advice for dyspepsia

A

Lifestyle measures
Eat 3-4hrs before going to bed
Avoid smoking and etoh
Raising the head of the bed
Assess patient for stress, anxiety or depression as these may Exacerbate symptoms

78
Q

State when urgent endoscopy is required in dyspepsia

A

Patients with dysphagia, significant acute GI bleed, age 55 and over with unexplained Weight Loss and symptoms of Upper abdominal pain reflux or dysphagia

79
Q

Causes of dyspepsia

A

Too much acid( GORD, peptic uler Gastroesophageal malignancy, side effect from drugs , lifestyle)

80
Q

List the two types of dyspepsia

A

Functional and Uninvestigated dyspepsia

81
Q

Explain functional dyspepsia

A

Dyspepsia symptoms but no underlying cause. Normal endoscopic findings

82
Q

What is uninvestigated dyspepsia

A

Symptoms in patients who have not had an endoscopy

83
Q

Drugs that cause dyspepsia

A

Nsaids, theophylline, alpha blockers, aspirin, benzodiazepine, beta blockers, bisphosphonates, CCB, nitrate, TCA
Antacids can be used for short term control

84
Q

How to tx dyspepsia

A

Antacids/ Alginate short term

85
Q

Initial management of Dyspepsia ( uninvestigated )

A

Offer PPI for 4 weeks
Test for H.plyroi
Offer H2 receptor antagonist if inadequate response to
PPI

86
Q

Initial management for functional dyspepsia

A

Lifestyle advice
Test for H.pylori and tx if positive
Leave a 2week wash put period after PPI use before testing for H.pylori
If no H.pylori tx with PPI or histamine receptor antagonist for 4weeks

87
Q

State what to do in pts with uninvestigated dyspepsia unable to stop NSAIDs

A

Reduce NSAID dose and use long term gastro protection with acid suppression therapy
Switch to alternate to NSAID eg PCM or COX 2 inhibitors ( risk of CV event)
Pt on aspirin unable to stop- switch to an alternative Antiplatelet

88
Q

What are symptoms of GORD

A

Heart burn
Acid regurgitation
Chest pain
Hoarseness
Cough
Wheezing
Asthma

89
Q

Causes of GORD

A

Fatty food, pregnancy, hiatus hernia, family hx of GORD, stress , anxiety, obesity, smoking,

90
Q

Drug used to tx GORD

A

Alginate
Antacids
H2 receptor antagonist
PPI

91
Q

Drug tx in pregnancy

A

First line- diet and lifestyle
Antacids or alginate
Omeprazole ( for severe symptoms)
Or Ranitidine (discontinued due to cancer stuff)

92
Q

How is GORD managed in children?

A

Change frequency and volume of feed
Use feed thickener
Older children- tx like adults( gaviscon sachet)

93
Q

Counselling and Pt advice with dyspepsia

A

Avoid ppt factors such as spicy food, coffee, alcohol and smoking
Eat small.meals ,slowly and avoid eating at bed time .
Sleep with head raised, lose weight

94
Q

Key points on antacids

A

See photo fav.

95
Q

Memory trick for Antacid Ingredients

A

SCAM
Sodium bicarbonate
Calcium bicarbonate
Aluminium Hydroxide
Magnesium Hydroxide
Affect absorption of certain drugs eg tetracycline take 1-2hrs b or after

96
Q

Antacids duration of action

A

Don’t last long
Provide quick symptoms relief in 15-30mins

97
Q

What is the definition of low sodium content

A

< 1mmol/tablet or 10ml dose

98
Q

Which antacids has a low sodium content

A

MAM
Co- magaldrox = Mg and Al( MAALOX and MUCOGel
2. Co- simalcite eg Altacite plus simeticone

99
Q

Example of antacids with high sodium

A

Magnesium carbonate
Magnesium Trisilicate
Sodium alginate with Potassium bicarbonate eg Gaviscon advance contains double Sodium compared to gaviscon original

100
Q

High Sodium antacids should be avoided in

A

Liver, kidney failure, htn, sodium restricted diet and CVD

101
Q

Eg of PPI

A

Pantoprazole
Omeprazole
Lansoprazole
Esomeprazole
Rabeprazole

102
Q

Indication of PPI

A

Gastric Ulcer
Duodenal Ulcer
H.pylori
Dyspepsia
Gord
Nsaid associated Ulcerative
Zollinger - Ellison syndrome

103
Q

Monitoring requirements for PPI

A

Measure serum Magnesium conc. Especially when used with other drugs that cause hypomagnesemia or with digoxin( toxicity if low)

104
Q

MHRA warning for PPI

A

Lupus

105
Q

Cautions with PPI

A

Risk of fracture
Risk of G.I infection
Mask symptoms of gastric cancer
Risk of osteoporosis

106
Q

Mnemonic for PPI caution

A

MC GOLF
Osteoporosis ( give VIT D and Ca)

107
Q

What are the signs of Hypomagnesaemia

A

Convulsions, muscle pain and weakness

108
Q

MHRA advice with PPIs

A

Low risk of subacute cutaneous lupus erythematous (SCLE)
Lesions appear on skin when exposed to the sun, advice patients to avoid exposing the skin
Discontinue meds if possible
Most cases resolved when PPI is stopped

109
Q

PPI safe in pregnancy

A

Omeprazole

110
Q

Important Omeprazole interaction

A

Avoid CLOE
Omeprazole and esomeprazole decrease efficacy of clopidogrel.

Methotrexate: Omeprazole decreases the clearance of Methotrexate
High dose( use with caution)
Monitor Magnesium with Digoxin

111
Q

PPI and Breastfeeding

A

Use with caution

112
Q

Drug tx for H plyori

A

PPI
Clarithromycin
Amoxicillin/Metronidazole
Tetracycline and levofloxacin( unlicensed)
Bismuth subsalicylate
Rifabutan/

113
Q

Memory trick for Triple therapy for H.pylori

A

PCM
PAM
PAC
PAT/PAL

114
Q

First line tx for H.pylori in pen. Allergy

A

PPI + clarithromycin + Metronidazole

115
Q

2nd line tx for H.pylori in pen allergy pt

A

PPI plus Metronidazole and Levofloxacin

116
Q

Alternative first line tx in pt previously tx with clarithromycin

A

PPI plus bismuth plus Metronidazole plus tetracycline

117
Q

What test do you use to confirm H.pylori

A

Urea(13) breath test
SAT

118
Q

Public England advice for H.pylori test

A

See photo fav

119
Q

Gastroprotective complexes

A

See photo fav
Sucrafate
Causes bezoar formation in pt in ITU

120
Q

Facts about Sucralfate

A

Take it ONE hr before you eat
Take late( at bed time)
Take 1 hrs before meals or enteral feeds and at bed time

121
Q

H2 receptor antagonist

A

See photo

122
Q

What is misoprostol

A

Synthetic prostaglandin analogue
Promote healing of gastric and duodenal Ulcer

123
Q

Conception and contraception with misoprostol

A

Do not use in women of child bearing age
Use effective contraception during treatment

124
Q

What’s a difference between food allergy and intolerance

A

Food allergy is immunological while food intolerance is not

125
Q

Most common allergen

A

Cow’s milk
Hen’s egg
Soy
Wheat
Peanuts
Fish
Shell fish

126
Q

Management of food allergy

A

Strict avoidance of causal food
Drug tx
Educate people about the allergens

127
Q

Drug tx for food allergy

A

Sodium cromoglicate given as adjunct to dietary avoidance

128
Q

What drug is licensed for the symptomatic control of food allergy

A

Chlorphenamine maleate

129
Q

State what to offer for food induced anaphylaxis

A

Adrenaline. Check bnf for dose

130
Q

State drugs used in gastro intestinal smooth muscle spasms

A

Antimuscarinic and other antispasmodic drugs used to relax intestinal smooth muscle and reduce intestinal motility

131
Q

Examples of antimuscarinic drugs used

A

Hyoscine butylbromide
Dicycloverine HCL

132
Q

List examples of antispasmodic drugs

A

Alverine, mebeverine

133
Q

Side effect of antimuscarinic side effects

A

Can’t see- blurry vision
Can’t pee- urinary retention
Can’t shit-constipation
Can’t speak- Dry mouth

134
Q

What is Obesity

A

BMI > or= 30kgm/m2

135
Q

Obesity classification

A

See pic

136
Q

State when to tx obesity with drugs

A

If BMI is greater than 30 in whom atleast 3months of diet, exercise fail to achieve a reduction in weight
Or if BMI is greater than 28 with associated risk factors eg T2D , HTN and hypercholeterolaemia

137
Q

Drug for obesity

A

Orlistat
Vit D supplementation if concerned about deficiency of fat soluble vitamins

138
Q

Patient with type 2 diabetes lose weight slower true or false?

A

True

139
Q

State when an obesed patient should stop taking Orlistat

A

If when loss since start of tx does not exceed 5% within 3months

140
Q

State when Bariatric surgery is suitable for obesed patient?

A

BMI greater than or equal to 40kg/m2( Class 111 Obesity) or between 35-39kg/m2 with a significant disease or high bp

141
Q

State other drugs used as adjunct in weight management with diet and exercise

A

Saxenda( Liraglutide)
GLP receptor agonist
Used in pt With BMI >or = 30kg/m2 or 28kg/m2 with associated risk factors

142
Q

What’s the max daily dose of Saxenda?

A

3mg

143
Q

State when to avoid Saxenda in obesed patient

A

If CrCL is < 30ml/min

144
Q

Nice recommends Saxenda should be used with…

A

Caution

145
Q

What is Anal fissure?

A

A tear or ulcer in the lining of the anal canal

146
Q

Symptoms of anal fissure

A

Bleeding
Persistent pain on defecation
Linear split in the anal mucosa

147
Q

Aim of tx

A

To relieve pain and promote healing of fissure

148
Q

Drug tx for Acute Anal fissure

A

Present <6weeks
Bulk forming laxative
Osmotic laxative
Short term use of topical preparation containing local anaesthetic eg lidocaine
Simple analgesic - for prolonged burning following defecation

149
Q

Drug tx for chronic anal fissure

A

> 6weeks
GTN rectal ointment (s/e: headache)
Alternatively,
Oral or topical diltiezem or nifidipine

150
Q

Non drug tx for anal fissure

A

Increase dietary fibre
Increase fluid intake
Good personal hygiene

151
Q

What’s Haemorrhoid

A

Abnormal Swellings of vascular mucosal around anus

152
Q

What is Internal Haemorrhoids

A

Painless unless they become stragulated

153
Q

Facts about External Haemorrhoids

A

Itchy or painful

154
Q

Haemorrhoid is common in pregnancy . T/F

A

True

155
Q

Drug Tx

A

Bulk forming laxative ( for constipation)
Simple analgesic ( pcm)
Avoid opoids because they cause constipation and avoid NSAID if rectal bleeding present.
Topical Prep. Containing local anaesthetics, corticosteroids, astringent, lubricants and antiseptic ( to reduce pain and itching)
Lidocaine, benzocaine, cinhocaine, pramocaine- should only be used for a few days as they may cause sensitization of the Anal skin.

156
Q

Duration of tx for hemorrhoids

A

Short term use for 7days( steroids)
Long term use can cause UC.
Continous use of steroids can cause adrenal suppression

157
Q

Tx of haemorrhoids in pregnancy

A

Bulk forming laxativeuse simple soothing products if a tx with topical Prep is required

158
Q

Symptoms of reduced exocrine secretion

A

Maldigestion and malnutrition
Diarrhoea
Abnormal cramps
Steartorrhea- fatty stool

159
Q

Causes of exocrine insufficiency

A

Chronic pancreatitis
Cystic fibrosis
Ceoliac disease
Zollinger Ellison syndrome
Pancreatic tumors
G.I enzyme

160
Q

Drug tx for Exocrine Insufficiency

A

Pancreatin eg Creon, pancrex v and nutrizym22
Take with food( inactivated by gastric enzyme)and avoid heat

161
Q

Two types of stoma

A

Colostomy
Ileostomy

162
Q

Prescribing for pts with stoma

A

Avoid enteric coated tablet and MR pre due to insufficient release of active ingredients
Avoid preparation that contains Sorbitol as an excipients ( laxative effect)

163
Q

Painkillers for pts with stoma

A

Paracetamol most suitable
Opioid may cause constipation in colostomy pts and aspirin, NSAID gastric irritation and bleeding

cardiovascular system 1 (42 decks)

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