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Inori Pre Reg > GI > Flashcards

GI Flashcards

1
Q

What is coeliac disease?

A

An autoimmune condition associated with chronic inflammation of the small intestine unable to absrob nutrients

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2
Q

What causes coeliac diasease?

A

Adverse reaction to gluten - dietary protein found in cereals, wheat, barley and rye

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3
Q

Symptoms of coeliac disease?

A

Diarrhoea, abdominal pain and bloating

Causes higher risk of malabsorption of key nutrients (calcium and vit D)

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4
Q

How to treat coeliac disease?

A

Strict life long gluten free diet
Assess for risk of osteoporosis and treat
Vit and mineral supplements following medical assessment

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5
Q

What is diverticula?

A

Sac like pockets develop in the lining of the intestine causing intermittent lower abdominal pain in the abscense of inflammation/infecrion

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6
Q

What is diverticulitis?

A

When the diverticula pockets become inflamed or infected

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7
Q

How to manage diverticular disease?

A

High fibre diet

Bulk forming drugs

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8
Q

How to manage uncomplicated diverticulitis?

A

Low fibre diet and bowel rest

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9
Q

How to manage complicated diverticulitis?

A

IV antibacterial if infected and bowel rest

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10
Q

Symptoms of UC? And position that it affects?

A

Mucosa inflamma and ulcers restricted to colon and rectum

Alternated between acute flare ups and remission
Bloody diarrhoea (may contain mucus or pus)
Abdominal pain
Urgent need to defecate

Acute flare ups = mouth ulcers, arthritis, sore skins, weight loss, fatigue

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11
Q

Long term complications of UC?

A

Colorectal cancer
Secondary osteoporosis (malabsorption and use of corticosteroid meds)
Venous thromboembolism
Toxic mega colon (esp if used loperamidr/codeine)

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12
Q

Treatment for acute mild to moderate UC in proctitis and proctosugmoiditis?

A

1st line=rectal amino salicylate

2nd line = rectal corticosteroid or oral prednisolone

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13
Q

Treatment for acute mild to moderate UC in extensive colitis and left sided colitis?

A

1st line= high dose oral aminosalicylate
2nd line=+rectal amino salicylate or oral beclometasone if necessary
Alternative to 1st line is oral prednisone alone

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14
Q

Treatment for subacute moderate to severe UC?

A

Oral prednisolone

2nd line= monoclonal antibodies

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15
Q

What to do in initial treatment failure in all extents of acute mild to moderate UC?

A

Add oral prednisolone (after 4wkd with aminosalicylate)

Add oral tacrolimus if no response after 2 to 4 wks

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16
Q

Treatment for severe acute UC?

A

Immediate hospital admission as life threatening medical emergency

1st line = IV corticosteroid + assess need for surgery
Alternative is IV ciclosporin or surgert

2nd line = if symptoms don’t imptove/worsens in 72hrs
IV ciclosporin + IV corticosteroid or surgery
Alternative to ciclosporin is infliximab

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17
Q

Maintaining remission in UC?

A

Generally aminosalicylate as corticosteroid has too many side effects

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18
Q

Maintaining remission in UC proctitis and proctosigmoiditis

A

Rectal aminosalicylate alone or with oral aminosalicylate

can give oral alone if pts prefer not to use enemas/ suppositories but not as effective

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19
Q

Maintaining remission in UC extensive colitis or left sided colitis

A

Low dose oral aminosalicylate

single daily dose more effective that multiple daily dose but has more side effects

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20
Q

2nd line to maintaining UC?

A

Oral azathioprine or meraptopurone
(if 2+ flare ups in 12 months that required systemic corticosteroids, or if remission not maintained on aminosalicylate or after severe flare ups)

Monoclonal antibody can be continued if effective or tolerated during acute flare ups

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21
Q

Bloody sttol is common in which disease? UC or crohns?

A

UC

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22
Q

Malnutrition is more common in which disease? UC or Crohns?

A

Crohns

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23
Q

Complications of crohns?

A

Intestinal strictures, abscess
Malnutrition, anaemia
Colorectal cancer, small bowel cancers
Growth failures and delayed puberty in childrrn
Arthritis, abnormalities of joints, liver, eyes and skin
Secondary osteoporosis

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24
Q

Lifestyle advice on Crohns?

A

High fibre diet
Smoking cessation reduces risk of relapse
Loperamidr or codeine to treat diarrhoea but Not in UC

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25
Q

What to give to crohns pt who had 1 plus acute flare up in 12 months or first presentation?

A

Corticosteroid (pred, methyl or IV hydrocortisone)

Alternative is budesonidr or aminosalicylate in pts with distal ileal
Ileocaecal or right sided colonic disease

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26
Q

What to give to crohns pt who had 2 plus acute flare ups in 12 months? Or if corticosteroid dose cannot be reduced

A

Azathioprine or meraptopurone

Alternative is methotrexate

Alternative or last resort is monoclonal antibodies under specialist supervision in severe flare ups

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27
Q

How to maintain remission in chrons disease?

A

Azathioprine or meraptopurone

Alternative is methotrexate

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28
Q

How to maintain remission of crohns after surgery?

A

Azathioprine or meraptopurone or aminosalicylate

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29
Q

Side effects of aminosalicylate?

A

Blood dyscrasia - report unexplained bleeding, bruising, sore throat and fecer

Nephrotoxicity
Salicylate hypersensitivity

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30
Q

Pt advice on sulfasalazine?

A

Yellow orange bodily fluids with sulfasalazine

Soft contact lenses may be stained

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31
Q

Interaction between lactulose and mesalazine?

A

Lactulose loerts stool oh in the intestine. Thai prevents sufficient release of the active ingredient in e/C or m/r preparations

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32
Q

What drugs is licensed for the relief of diarrhoea associated with CD?

A

Colestyramine

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33
Q

Symptoms of irritable bowel syndrome?

A

Common chronic relapsing and often life long cobdition

Abdominal pain
Blaoting
Alternating constipation and diarrhoea with urgency and incomplete evacuation

Aggravated by stress, depression and anxiety, lack of dietary fibre
Commonly affects young adult women 20 to 30

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34
Q

Name antispasmodic used for irritable bowel syndrome?

A

Mebeverine
Peppermint oil
Alverine

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35
Q

Side effects of Peppermint oil?

A

Heartburn, local irritation of mouth and oesophagus

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36
Q

Non drug treatment of irritable bowel syndrome?

A

Lifestyle changed, limiting fresh fruit consumption to no more than 3 portions a day
The sweetener Sorbitol should be avoided in pts with diarrhoea

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37
Q

Can you sell Peppermint oil?

A

All GSL 1 to 2 caps tds

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38
Q

Can mebeverine be sold?

A

Yes. provided that max. single dose is 135mg and max. daily dose is 405mg;

for uses other than symptomatic relief of irritable bowel syndrome provided that max. single dose is 100mg and max. daily dose is 300mg.

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39
Q

Antimuscarnics used for GI spasm?

A

Hyoscine butylbromidr
Atropine
Dicycloverine
Propantheline bromide

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40
Q

Can you sell hyoscine butylbromide?

A

Yes, to the public for medically confirmed irritable bowel syndrome, provided single dose does not exceed 20mg, daily dose does not exceed 80mg, and pack does not contain a total of more than 240mg.

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41
Q

What laxatives can be used in irritable bowel syndrome?

A

As long as not lactulose as it can cause bloating

Linoclotide can be used if unresponsive to diff laxative classes and have had constipation for 12 months

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42
Q

What can be used 2nd line for abdominal pain and discomfort?

A

Antidepressants like low dose TCA or SSRI

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43
Q

When can carbon 13 urea breath test be performed after certain meds?

A

2wks after PPI treatment

4wks after antibacterial treatment

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44
Q

Characterisation of short bowel syndrome?

A
  1. Malabsorption and malnutrition
    = deficiency of vit A, B12, D, E and K, essential fatty acid, zinc, selenium, hyoomagnesaemua so need supplementation
  2. Inadequate digestion leading to diarrhoea so need loperamide
  3. Incomplete drug absorption
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45
Q

In short bowel syndrome, incomplete drug absorption occurs. How can you manage this?

A

Higher doses of warfarin, COC and digoxin required or give IV

EC/ M/R formulations not suitable
So use uncoated or soluble tabs or liquid

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46
Q

Red flag symptoms of constipation?

A

New onset constipation in over 50

ARARM symptoms

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47
Q

How long does it take for bulk forming laxatives to work?

A

Works within 24hrs but takes 72hrs for full effect

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48
Q

How long does it take osmotic laxatives to work?

A

2-3 days

48hrs for lactulose

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49
Q

How can you reduce nausea caused by osmotic laxatives as a side effect?

A

Administering with water, fruit juice or meals

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50
Q

When to add stimulant laxatives?

A

Third line
Add if stools are soft but difficult to pass or incomplete emptying

For short term use up to 1wk

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51
Q

How long does it take for stimulant laxatives to work?

A

6-12hrs

Glycerol suppositories work in about 15-30mins

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52
Q

Side effects of stimulant laxatives?

A

Abdominal craps
Excessive used leads to Hypokalaemia, diarrhoea, lazy bowel

Senna colour urine yellow brown

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53
Q

Counselling points on senna?

A

Take at night to pass stool in the morning

Moisten suppositories with water before use

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54
Q

What the gentoxic and carcinogenic stimulant laxative?

A

Co-danthramer

Co-danthrusate

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55
Q

Side effects of Co-danthramer?

A

Carcinogenic so ussed only in terminally I’ll pts
Red urine
Local irritation and excoriation so avoid prolonged contact with skin

56
Q

Side effect of faecal softener?

A 
Liquid paraffin has harsh side effects
Anal seepage
Lipoid pneumonia
Granulomatous
Malabsorption of fat soluble vitamins A, D E and K
57
Q

Other laxatives with stool softening properties?

A

Mathylcellulose is a bulk forming
Docusate sodium is a weak stimulant
Glycerol is a rectal stimulant

58
Q

When can you use lubiprostone or prucalopride?

A

If at least 2 laxatives if different classes have been tried at the highest tolerated recommended doses for at least 6 months

Consider prucalopride in women only

59
Q

What laxative to use for opioid induce constipation?

A

Osmotic or Docusate with stimulant

Co-danthramer only in palliative

Methhlnaltrexone or naloxegol when response to laxatives are inadequate

60
Q

Which laxatives need to be avoided in opioid induced constipation?

A

Bulk forming as it can lead to obstruction and painful colic

61
Q

Chronic constipation management?

A

Same stepped approach as shirt

Except macrogol is choice of osmotic

62
Q

Management of constipation in children

A

Macrogol with diet/behaviour interventin

Add stimulant laxative if inadequate response
Add lactulose or faecal softener if stools remain hard
Docusate sodium or Glycerol suppositories

63
Q

Senna and pregnancy

A

Avoid if near term as can stimulate uterine contractions

64
Q

Management of constipation in BF?

A

Laxative
Osmotics

Alternatively: stimulant laxatives

65
Q

Red flag symptoms of diarrhoea?

A

ALARM
Systemic illness
Received recent hospital treatment of antibiotics
Following foreign travel except Western Europe, Australia, North America or New Zealand

66
Q

What’s co-phenotrope?

A

Anti diarrhoeals

Has antimuscarnic and opioid effect

67
Q

Which bill forming laxative can be used to treat both constipation and diarrhoea?

A

Methyl cellulose

68
Q

Loperamide dose?

A

Initially 4mg, then 2mg after each loose stool for up to 5 days

69
Q

Max dose of loperamide?

A

16mg/day (8 tabs)

70
Q

MHRA warning on loperamide?

A

Serious cardiac adverse reactions with high doses, misuse or abuse
QT prolongation, torsade de pointes, cardiac arrest and fatalities

71
Q

How to manage loperamide overdose?

A

Naloxone

And monitor for 48hrs for possible CNS depression

72
Q

Common Side effects of loperamide?

A

Dizziness
Flatulence
Headache
Nausea

73
Q

Contra indications of loperamide?

A

Active UC
Antibiotic associated colitis
When peristalsis is inhibitrd

Avoid in bloody diarrhoea or Inflammatory diarrhoea (fever, severe abdominal pain)

74
Q

What’s dyspepsia?

A

Group of upper abdominal symptoms
Upper abdominal pain
Fullness
Early satiety

75
Q

How to manage uninvestigated Dyspepsia?

A

Antacids for symptoms relief
PPIs for 4 wks if symptoms persist.
H. PYLORI test if no response to PPI

76
Q

How to manage investigated functional Dyspepsia?

A

Do a H. Pylori test first

If negative
PPIs or H2 antagonist for 4wks

77
Q

How long does it take for antacids to work?

A

15-30mins

78
Q

How do alginate work?

A

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

79
Q

Disadvantage of calcium containing antacids?

A

Induce rebound acid secretion

80
Q

Antacids with low sodium preparations?

A

Maalox
Mucogel (co-magaldrox)
Altacite plus (simeticone with hydrotalcite)

81
Q

How to take antacids?

A

Take after each main meal and at bedtime PRN

82
Q

Antacid interactions?

A

Impaired absorption go drugs so leave a 2hr gap
Esp with tetracycline, Quinolones, bisphosphonates, PPIs

Damages enteric coatings by increasing gastric pH

High sodium contain so cause fluid retention
Avoid in hypertention, heat, liver or kidney failure
Avoid in sodium restricted diet like lithium

83
Q

How to take lansoprazole?

A

Take 30-60mins before food

84
Q

Which PPI is safe in Preganancy?

A

Omeprazole

85
Q

Side effects of PPIs?

A

Abdominal pain
Constioation
Diarrhoea
Nauea

86
Q

MHRA warning on PPIs?

A

Very low risk of subacute cutaneous lupus eythematosus

87
Q

Long term use of PPIs can lead to?

A

Hypomagnesium (predispose to digoxin. Toxicity)
Fractures
Rebound acid secretion
Protracted Dyspepsia after stopping

88
Q

Important interactions of PPIs?

A

Omeprazole reduces clopidogrel Antiplatelet effect

Omeprazole decreases clearance of methotrexate

89
Q

Which H2 antagonist is an enzyme inhibitor?

A

Cimetidine

90
Q

Which H2 receptor antagonist is safe to use in pregnancy?

A

Ranitidine

91
Q

Side effects of H2 antagonists?

A 
Headaches
Rashes
Dizziness
Diarrhoea
Psychiatric reactions (confusion, depression, hallucinations in the elderly or very ill pts)
92
Q

What’s milk of magnesium used for?

A

Indigestion

93
Q

What effect does PPI have on serum magnesium

A

Causes Hypomagnesium

Which can occur 1yr after treatment

94
Q

Non drug treatment of haemorrhoids?

A

Keep stools soft and easy to pass to minimise straining by increasing dietary fibre and fluid intake

95
Q

Topical agents for haemorrhoids contain what drugs as a local anaesthetics? How long should they be used and why?

A

Lidocaine
Benzocaine
Cinchocaine
Pramocaine

Use only for few days as can cause sensitisation of the anal skin

96
Q

How long can you use corticosteroid cream for haemorrhoids? What happens if you exceed that day?

A

No more than 7 days

Long term use can lead to ulceration or permanent damage due to thinning of the perianal skin

97
Q

Haemorrhoids and pregnancy?

A

Bulk forming laxatives
No Topical haemorrhoidal preparations are licensed for use during preg so refer

If Topical required, soothing preparations can be considered

98
Q

When to refer for haemorrhoids?

A 
Suspected colorectal cancer for
Over 50 with rectal bleeding
Abdominal pain
Change in bowel habits
Weight loss
Iron deficient anaemia
99
Q

Preparations containing mild astrigents or lubricants are good for haemorrhoids because?

A

Relieve local irritation and are less likely to cause skin sensitisation

100
Q

Drugs that are considered as astrigents?

A

Zinc oxicde
Bismuth oxide
Hamamelis
Allantoin

101
Q

Side effects of colestyramine?

A 
Constipation
Increased tendency to bleed
Nausea and vomiting 
Reduced absorption of vit A, D E And K
Diarrhoea
GI DISCOMFORT
aggregation of hypertriglyceridaemia
Hypoprothrombunaemia
102
Q

What analgesic is not recommended in diverticular disease?

A

NSAIDs and opioid analgesic because may increase the risk of diverticular perforation

103
Q

IBS affect what age group commonly?

A

20-30

Synptoms are usually relieved by defecation
Increase exercise

104
Q

What drugs are used for gastric and duodenal ulceration?

A

PPI
H2 receptor antagonists
Misoprostol
Sucralfate

105
Q

Side effect of Misoprostol?

A

Colic and diarrhoea are dose limiting side effect

Diarrhoea is common and can occasionally be severe and require withdrawal

106
Q

What is sucralfate and how to take them?

A

A chelate

So causes bezor formation, take 1ht before meals and 1hr gap between enteral feeds

107
Q

Treatment of NSAIDs induced ulcers?

A

Withdraw NSAIDs if possiblr
PPIs are first line
Alternative is H2 antagonist / misope

Test for H pylori on healing

If non selective NSAIDs are continued, continue PPI or Misoprostol
If history of upper GI bleeding, continue PPI and switch to COX2 inhibitor

108
Q

Who needs prophylaxis for NSAIDs induced ulcers?

A

High risk pts like 65+, previous history, liver, kidney impairment, heart disease and diabetes

109
Q

What prophylaxis is needed for NSAID induced ulcers at risk pt and for pts with 3 or more risk factors?

A

At risk pts = PPI. Alternatively H2 antagonist/Misoprostol

3 or more risk factors = PPI with Cox selective NSAIDs

110
Q

Management of mild symptoms of GORD?

A

Antacids and alginates

+ H2 receptors/PPI

111
Q

Management of severe symptoms of GORD?

A

PPI for 4-6wks

Or H2 if intolerant

112
Q

Management of GORD in preganant pts?

A

Antacids or alginate
Ranitidine if above is ineffective
Omeprazole is reserved for severe or complicated

113
Q

Management of GORD in children?

A

It’s quite common in infant and usually resolves age 12-18months old

If mild to moderate GORD, thickened feeds or alginate

114
Q

What can be used for management of allergy when it’s not anaphylaxis?

A

Sodium cromoglicate e. G. Eye drops

Chloramphenicol is licensed for symptomatic control

115
Q

What condition can cause GI smooth muscle spasm?

A

IBS
IBD
Bowel colic in palliative care

116
Q

What antimuscarnics are used to manage GP spasm?

A

Hyoscine butylbromide

Atropine

117
Q

Antimuscarnic side effects?

A 
Can't see, pee, poo and spit
Blurred visition
Urinary retention
Constipation
Dry mouth
Tachycardia, pulpitation and arrhythmia
Pupil dilation
Reduced bronchial secretions
Glaucoma
Confusion esp in elderly
Drowsiness so impair driving
118
Q

MHRA warning on hyoscine butylbromide injection?

A

Risk of serious adverse effects in pts with underlying cardiac diseasr
So contraindicated in tachycardia

119
Q

MoA of antispasmodic?

A

Direct relaxants of intestinal smooth muscle

120
Q

Drugs of antispasmodic?

A

Mebeverine
Alverine

Peppermint oil

121
Q

Mebeverine and Alverine are contra indicated in?

A

Paralytic ileus

122
Q

Side effects and pt advice on Peppermint oil?

A

Heartburn, local irritation of the mouth and oesophagus

Pt counselling says Swallow capsules whole

123
Q

What’s considered an acute anal fissures?

A

Less that 6wks

124
Q

Management of acute anal fissures?

A

Ensure soft stools
So bulk forming laxatives
Alternative osmotics

If prolonged burning pain following defecation, short term Topical local anaesthetics applied before emptying bowel

125
Q

What’s considered as chronic anal fissures?

A

More than 6wks

126
Q

Management of chronic anal fissures?

A

GTN rectal ointment (causes headache)

Alternative
Topical diltiazem or nifedipine

127
Q

Lifestyle advice on haemorrhoids?

Risk factors?

A

Increased fluid and fibre intake
Perianal hugiene

Constipation and constipation increase risk of developing haemorrhoids

128
Q

What causes reduced secretions of pancreatic enzymes?

What does it lead to?

A

Maldigestion, malnutrition and GI symptoms

Cystic fibrosis, chronic pancreatitis, coeliac disease, zollinger Ellison syndrome

129
Q

Dietary advice on pancreatic insufficiency?

A

Distribute food intake between 3 main meals and 2-3 snacks

Avoid food that are difficult to digest like peas, beans and lentils and high fibre

Do not consume alcohol

Avoid reduced fat diets

130
Q

What does pancreatin do?

A

Assist with the digestion of starch, fat and protein.

131
Q

How to take pancreatin?

A

Take with meals/snacks or immediately before or after

Pancreatin is inactivated by gastric acid so use acid suppressor like PPIs if symptoms present despite high pancreatin dose

EC preps deliver a higher dose

Do not mix with excessively hot food or drinks as inactivated by heat
If mixed with food or liquids, drink within 1hr

132
Q

Side effects of pancreatin?

A

GI side effects

Irritation in perioral skin and buccal mucosa
Excessive dose can lead to Hyperuricaemia, hyperuricosuria,

Skin irritation and hypersensitivity reactions when handling

Fibrosing colonopathy in cystic fibrosis with high dose
Risk increased with male children, more severe cystic fibrosis and laxative use
If new or changing abdominal symptoms exclude colonic damage

133
Q

Contra indications of pancreatin?

A

Nuttizym and pancrease HL are contraindicated in children below 15 with cystic fibrosis as associated with colon strictures

134
Q

Pt counselling on pancreatin?

A

Adequate hydration at all times with high strength preps

135
Q

Stoma care?

A

Avoid EC and MR preps
Avoid Sorbitol containg preps as laxative effect

Vulnerable to GI side effects so iron given In IM, Opioids as well

Give PPI to reduce gastric acid secretion and stoma output

Vulnerable to water and electrolytes depletion so avoid laxatives by increasing fluid fibre intake or bulk forming

High doses of loperamide needed ot add codeine

Inori Pre Reg (22 decks)

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