GI Flashcards
what is coeliac disease?
chronic inflammation of the small intestine
Symptoms:
diarrhoea, bloating, abdo pain
what is coeliac disease caused by?
adverse reaction to gluten
Gluten is found in cereals, wheat, barley, rye
what are the treatment options for coeliac disease?
gluten-free diet
vitamin and mineral supplementation
assess for risk of osteoporosis and treat
what are people with coeliacs disease at risk of develpoing?
malabsorption of key nutrients (vitamin D and calcium) leading to osteoporosis
what are diverticula?
small pockets/ bulges that develop on the lining of the intestine?
what is diverticular disease?
diverticula present
symptoms:
abdo pain, constipation, diarrhoea, rectal bleeds
what is acute diverticulitis and what can this lead to?
diverticula become inflamed/ infected
symptoms include sever abdo pain, fever, rectal bleeding
can lead to complicated acute diverticulitis:
abscess, perforation, fistula, obstruction, haemorrhage, sepsis
how can you treat diverticular disease?
high fibre diet
bulk forming laxatives
paracetamol
ABX - diverticulitis
what are the two types of IDB?
crohn’s & UC
what is crohn’s?
inflammation of the GI tract from mouth to anus
what are the symptoms of crohn’s?
abdo pain, diarrhoea, rectal bleeding, weight loss, low grade fever, fatigue
what are the complications of crohn’s?
malnutrition, anaemia, cancers, arhritis, intestinal strictures/ abscesses/ fissures
what lifestyle advice can be given to patients with crohn’s?
high fibre diet
smoking cessation - reduces risk of relapse
what options are available to treat diarrhoea associated with crohn’s?
loperamide
codeine
cholestyramine
what is the treatment options for a patient with crohn’s who presents with their first flare up in 12 months?
prednisolone, methylprednisolone, IV hydrocortisone
what is the treatment options for a patient with crohn’s who has had 2 or more flare ups in the past 12 months?
1st azathioprine/ mercaptopurine
2nd methotrexate
if severe - MABs
what treatments can be used to manage maintenance of remission in crohn’s?
1st azathioprine/ mercaptopurine
2nd methotrexate
what medications should be initiated for maintenance of remission of crohn’s following surgery?
azathioprine + metronidazole
what is UC?
inflammation and ulcers affecting colon/ rectum
symptoms:
bloody diarrhoea (mucus or pus), abdo pain, urgent need to defecate
Acute flare up: mouth ulcers, arthritis, sore skin, weight loss, fatigue
what are the complications of UC?
colorectal cancer, osteoporosis, VTE, toxic megacolon
can loperamide and codeine be used to treat diarrhoea in acute flare up of UC?
No
can cause paralytic ileus - increased risk of toxic megacolon
what are the different types of UC?
extensive (proximal) - affects entire colon
left sided (distal) - inflammation up to distal colon
proctosigmoiditis - inflammation of rectum and sigmoid colon
proctitis - inflammation of rectum
*treatment depends on area affected
how would you treat an acute mild/ moderate flare up of UC?
proctitis:
1st topical aminosalicylate for 4 weeks, if not improved THEN
2nd oral aminosalicylate
3rd corticosteroid for 4-8 weeks
proctosigmoiditis:
1st topical aminosalicylate for 4 weeks, if not improved THEN
2nd + oral aminosalicylate
3rd + corticosteroid for 4-8 weeks
extensive (proximal and distal):
1st topical + oral aminosalicylate
2nd + corticosteroid for 4-8 weeks
how do you treat a severe acute flare up of UC?
IV corticosteroid
if symptoms don’t improve/ worsen in 72 hour:
IV ciclosporin + IV corticosteroids
OR surgery
what are the side effects of the aminosalicylates?
blood dyscrasias
nephrotoxicity
hypersensitivity
what colour does sulfasalazine turn bodily fluids?
yellow/ orange
how does lactulose interact with mesalazine?
lactulose lowers stool pH preventing sufficient release of drug in EC or MR preparations
what are the side effects of azathioprine/ mercaptopurine?
hypersensitivity
bone marrow suppression
what pre-test must be done prior to treatment with azathioprine/ mercaptopurine?
TPMT
low enzyme activity increases risk of myelosuppression
how does azathioprine and allopurinol interact?
inhibits metabolism of purines, leading to toxicity
what are the symptoms of IBS?
lower abdo pain, bloating, alternating constipation and diarrhoea
what types of food exacerbates IBS?
coffee, alcohol, milk, fried food, stress
what are the treatment options for IBS?
antisposmodics: alverine, mebeverine, peppermint oil
antimuscarinics: hyoscine butylbromide, atropine
laxatives: NOT LACTULOSE (causes bloating)
loperamide
2nd line for abdo pain:
TCAs and SSRIs
what are the complications of short bowel syndrome?
deficiency of vitamins A,D,E,K and B12
what treatment can be used for short bowel?
loperamide
what are the red flags for constipation?
blood in stool, anaemia, abdo pain, weight loss, new onset, age > 50
what are the different classes of laxatives?
stimulant
osmotic
bulk forming
stool softener
what are the bulk forming laxatives?
isphagula husk
methylcellulose
stercula
what is the mechanism of action of bulk forming laxatives?
increase faecal mass to stimulate peristalsis
when should bulk forming laxatives be used?
ideal for small, hard, stools
works within 2-3 days
swallow with plenty of water and not immediately before bed
what are the osmotic laxatives?
macrogol
lactulose
what is the mechanism of action of osmotic laxatives?
increase water in the colon
lactulose - osmotic diarrhoea of low faecal pH
macrogol - sequester fluid in bowel
when should osmotic laxatives be used?
second line if stools remain hard
works within 2-3 days
side effects: flatulence, cramps, nausea (reduced when administered with liquid/ meals)
what is the MHRA alert for macrogol?
do not take with starch base thickeners (increased risk of aspiration)
name the stimulant laxatives?
senna
bisacodyl
glycerol suppositories
co-danthramer
docusate
what is the mechanism of action of stimulant laxatives?
increases gut motility
when should stimulant laxatives be used?
stools soft but difficult to pass
short term use (~ 1 week)
6-12 hours to work (glycerol 15-30 mins)
side effects: abdo cramps, hypokalaemia, diarrhoea, lazy bowel
avoid in obstruction
what colour can senna colour urine?
yellow/ brown
when should co-danthremer be used?
in palliative patients
*carcinogenic
colours urine red
name the stool softeners?
liquid paraffin, docusate, glycerol
what laxatives should be used in patients with opioid induced constipation?
osmotic + stimulant
naloxegol when not responding to other laxatives
- AVOID bulk forming
what laxatives should be used in patients with chronic constipation?
1st bulk forming
2nd + macrogol
after 6 months prucalopride
what laxatives should be used in pregnant patients?
1st bulk forming
osmotic
bisacodyl or senna (avoid senna near term)
what are the red flag symptoms for diarrhoea?
weight loss, rectal bleeding, persistent diarrhoea, systemic illness, recent hospital treatment, following foreign travel
what is first line for diarrhoea?
oral rehydration (diarolyte)
what is the age limit for loperamide?
> 12
what is the dose of loperamide?
take 2 tablets, then one tablet after each loose stool for up to 5 days
*max 8 tablets (16mg) per day
what is the MHRA alert for loperamide?
QT prolongation
what is the reversal agent in loperamide overdose?
naloxone
what are the symptoms and causes of dyspepsia?
symptoms: upper abdo pain, fullness, early satiety, bloating, belching, nausea
causes: indigestion, GORD, gastritis, gastric/ duodenal ulcer
what are the red flags of dyspepsia requiring urgent endoscopy?
anaemia
loss of weight
anorexia
recently changed (unexplained, new dyspepsia in >55)
malaena
what can be used to treat dyspepsia?
antacids - neutralise stomach pH
alginates - form viscous gel raft to prevent reflux
what are the PPIs?
omeprazole
esomeprazole
lansoprazole
which of the PPIs interact with clopidogrel?
omeprazole & esomeprazole
what are the side effects of PPIs?
GI upset
increased fracture risk
c.diff risk
hypomagnesaemia
what is the MHRA alert for PPIs?
subacute cutaneous lupus erythematosus
how do you test for h.pylori infection?
c-urea breath test
do not perform within 4 weeks of abx or 2 weeks of PPIs
how do you treat h.pylori infection?
triple therapy for 7 days
PPI BD +
one of:
amoxicillin
clarithromycin
metronidazole
how do you treat GORD?
Mild:
antacids + alginates
H2 receptor antagonists/ PPI
Severe:
PPI for 4-6 weeks
how do you treat GORD in pregnancy?
antacids/ alginates
ranitidine
omeprazole
how do you treat GORD in children?
common in infants, resolves after 12-18 months
thickened feeds or alginates
what is the MHRA alert for hyoscine butylbromide?
risk of adverse events in patients with underlying cardiac disease
contraindicated in tachycardia
how should you treat acute anal fissure?
bulk forming/ osmotic laxative
topical local anaesthetic
how should you treat chronic anal fissure?
1st GTN rectal ointment
or nifedipine, diltiazem
how can you manage pruritis associated with cholestasis?
cholestyramine
ursodeoxycholic acid
rifampicin
how can you manage pain associated with gall stones?
mild/ moderate:
paracetamol/ NSAID
severe:
IM diclofenac
how do you manage stoma care?
EC/ MR preparations unsuitable
vulnerable to GI side effects (avoid NSAIDs)
PPI to reduce gastric acid secretion
use K sparing diuretics (risk of hypoK)
high doses of loperamide/ codeine
