Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paeds, MEP, OTC & Misc. > GI bits and pieces! > Flashcards

GI bits and pieces! Flashcards

1
Q

COELIAC DISEASE

A
  • Only effective option = AVOID GLUTEN
  • Occurs in the small intestine
  • Associated with GLUTEN: wheat, barley and rye => causes an immune response in intestinal mucosa
  • Can cause malabsorption of nutrients

Aims:
- Manage symptoms => diarrhoea, bloating and abdo pain
- Avoid malnutrition => give Vit D, Ca, and other nutrients under supervision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DIVERTICULAR DISEASE AND DIVERTICULITIS

A

Treatment PRN:
- fibre
- bulk-forming laxatives - treats constipation
- paracetamol - pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DIVERTICULOSIS

A

Small pouches but asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DIVERTICULAR DISEASE

A

Small pouches but SYMPTOMATIC
- abdo pain
- constipation
- diarrhoea
- rectal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ACUTE DIVERTICULITIS

A

Pouches become inflamed or infected
- severe abdo pain
- fever
- significant rectal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

COMPLICATED ACUTE DIVERTICULITIS

A
  • abscess
  • perforation
  • fistula
  • obstruction
  • sepsis
  • haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CROHN’S DISEASE

A

This affects the whole GI tract - associated with thickened wall, extending through all layers, with deep ulceration and SKIPPED LESIONS!

Complications include:
- intestinal strictures or fistulae
- anaemia and malnutrition
- colorectal and delayed puberty in kids
- growth failure and delayed puberty in kids
- extra-intestinal manifestation => arthritis or joints, eyes, liver and skin abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Crohn’s disease - ACUTE treatment

A

1st flare-up in 12-MONTH PERIOD:
1. Monotherapy w/ either PREDNISOLONE, METHYLPREDNISOLONE or IV HYDROCORTISONE
2. If pt has distal ileal, ileocaecal or right sided disease:
- BUDESONIDE if normal treatment doesn’t work
3. Aminosalicylates (SULFASALAZINE or MESALAZINE) - less SEs, but less effective

2+ flare-ups in 12-MONTH PERIOD:
1. Add AZATHIOPRINE or MERCAPTOPURINE
2. METHOTREXATE may be added if 1st line is CI
3. Severe = monoclonal antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Crohn’s disease - MD treatment

A
  • Encourage smoking cessation
  • Monotherapy of either AZATHIOPRINE or MERCAPTOPURINE
  • METHOTREXATE can be used if used in induction or can’t tolerate A/M

Post-surgery:
- AZATHIOPRINE + METRONIDAZOLE
- AZATHIOPRINE alone if metronidazole isn’t tolerated

Diarrhoea associated, thus, can use:
To manage diarrhoea in those who don’t have colitis
- LOPERAMIDE
- CODEINE
- COLESTYRAMINE - relief of diarrhoea associated with CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fistulating Crohn’s Disease

A

This is when a fistula develops between the intestine and perianal skin, bladder, and vagina.

Can be left ALONE if asymptomatic

To improve symptoms (not fully heal):
- METRONIDAZOLE +/- CIPROFLOXACIN
- Metronidazole is given for 1 month - no longer than 3 months due to peripheral neuropathy

MD
1. AZATHIOPRINE or MERCAPTOPURINE
2. Infliximab if not responding
- treatment lasts AT LEAST 1 YEAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UC

A
  • Most common in 15 - 25 years!

Affects region from the rectum to the whole colon - associated with bloody diarrhoea, defecation urgency or abdominal pain.

Complications include:
- colorectal cancer
- secondary osteoporosis
- VTE
- toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

UC - types

A

UC is a continuous pattern.

CD is patchy and has skipped lesions.

  1. Proctitis
  2. Proctosigmoiditis
  3. Distal/ Left-sided
  4. Extensive colitis
  5. Pancolitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

UC - Acute (mild - moderate)

A

DISTAL
- Rectal prep = suppositories or enemas
- foam preps if pt has difficulty retaining liquid enema

EXTENDED
- systemic meds

DIARRHOEA
- AVOID loperamide OR codeine as it can cause toxic megacolon. This is only initiated under specialist advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

UC - Acute (mild - moderate) - PROCTITIS (suppositories)

A
  1. Topical aminosalicylate
  2. Add oral aminosalicylates if no improvement after 4 wks
  3. Still no improvement => TOPICAL or PO corticosteroid for 4-8 wks
    - Pts can use PO aminosalicylates 1st line if preferred although not as effective
    - If aminosalicylates CI => TOPICAL or PO corticosteroids for 4-8 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

UC - Acute (mild - moderate) - PROCTOSIGMOIDITIS (foam preps - foam preps and suppositories are easier to retain than liquid enemas) & LEFT-SIDED UC (enemas)

A
  1. Topical aminosalicylates

2a. Add high-dose PO aminosalicylate if no improvement after 4 wks OR

2b. high-dose PO aminosalicylate + 4-8 wks of TOPICAL corticosteroids

  1. Stop treatment and offer PO aminosalicylate + 4-8 wk of PO corticosteroids
  • Pts can use high-dose PO aminosalicylates first if preferred although less effective. If aminosalicylates are CI => topical or PO corticosteroids fro 4-8 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UC - Acute (mild - moderate) - EXTENSIVE UC (PO)

A
  1. Topical aminosalicylate + high-dose PO aminosalicylate
  2. No change after 4 wks => stop topical aminosalicylate and offer high-dose PO aminosalicylate + PO corticosteroid for 4-8 wks
  • If aminosalicylate CI => PO corticosteroid for 4-8 wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

UC - Acute (SEVERE)

A

MEDICAL EMERGENCY

  • life-threatening
  • IV HYDROCORTISONE or METHYLPREDNISOLONE and assess need for surgery
  • If IV steroids CI => use IV CICLOSPORIN or surgery
  • If symptoms haven’t helped within 72h
    1. IV STEROID + IV CICLOSPORIN
    2. Surgery
  • INFLIXIMABif ciclosporin is CI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

UC - MD

A
  1. PO AMINOSALICYLATES
    - corticosteroids not okay due to SEs
    - more effective as OD, but may cause more SEs

Proctitis or Proctosigmoiditis:
1. RECTAL +/- PO AMINOSALICYLATES
- PO can be given alone if rectal isn’t required

LEFT-SIDED or EXTENSIVE:
1. Low dose PO AMINOSALICYLATE

2+ flares in 12 months:
1. PO AZATHIOPRINE or MERCAPTOPURINE
- Give monoclonal antibodies if no effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

UC - MD after a single ep of acute-severe UC

A

1st: PO azathioprine or mercaptopurine
2nd: CI in 1st line => PO aminosalicylates

Disease refractory to immunomodulatory therapy despite dose optimisation or where conventional treatment is not tolerated or CI:
1st: Infliximab, adalimumab or golimumab - choice made on an individual basis
2nd: Vedolizumab
3rd: Tofacitinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Aminosalicylates

A

Sulfasalazine (5-ASA and sulfapyridine), Balsalazide, Mesalazine (5-ASA), Olsalazine

  • Nephrotoxic = monitor b4 initiation, at 3 months, then annually
  • Hepatotoxic = monitor at monthly intervals for first 3 months
  • Blood disorders = monitor at monthly intervals for first 3 months. Perform FBC and stop drug STAT if signs of blood dyscrasia
  • CI: salicylate hypersensitivity - e.g. itching and hives
  • Stains contact lenses orange-yellow

SE: (common) leucopenia, GI se’s, pruritis, headache

Monitoring: FBC, CrCl/eGFR, LFTs. Haematological abnormalities occur in the first 3 - 6 months of treatment - discont. if these occur.

Interactions:
- Lactulose + mesalazine = lactulose lowers pH in the intestines, preventing the sufficient release of the active ingredient in EC or MR preps.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

IBS - condition and risk factors

A

Common, chronic, relapsive and often life-long - associated with abdominal pain, diarrhoea or constipation, urgency, incomplete defaecation and passing mucous

More common in women and ages 20 - 30 years

Exacerbated by:
- coffee, alcohol, milk
- large meals
- fried foods
- stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

IBS - non-drug treatment

A
  • increase exercise
  • eat regular meals
  • reduce fresh fruit consumption to 3 portions/day
  • reduce insoluble fibre
  • drink at least 8 cups of water/day
  • reduce caffeine, alcohol and fizzy drinks
  • avoid SORBITOL (sugar alcohol) if you’ve diarrhoea
  • reduce stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

IBS - drug treatment

A

OTC:
- Antispasmodics (direct relaxants of intestinal smooth muscle): ALVERINE (dizziness; driving warning), MEBEVERINE- (alverine and mebeverine are CI in paralytic ileus); and peppermint oil (heartburn; local irritation of mouth/oesophagus - SWALLOW CAPS WHOLE!)
- Laxatives: if constipated (not LACTULOSE as it can cause bloating)
- LOPERAMIDE: if experiencing diarrhoea
- Antimuscarinics: Hyoscine BUTylbromide (avoid in cardiac disease)

2nd line treatment for pain if OTC fails:
1. Low dose TCA: AMITRIPTYLINE
2. SSRI if TCA fails
Use is UNLICENSED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ANTIMUSCARINICS - sympathetic pathway

A

SE: blurred vision, urinary retention, constipation, dry mouth
- tachycardia, palpitations and arrhythmias (increases heart rate)
- pupil dilation
- reduced bronchial secretions
- angle-closure glaucoma = raises intraocular pressure
- confusion in elderly
- drowsiness; impairs driving

Caution:
- susceptibility to angle-closure glaucoma
- conditions causing tachycardia => e.g. hyperthyroidism
- CVS => e.g. arrhythmias, congestive HF

CI:
- prostatic enlargement, urinary retention
- paralytic ileus, GI obstruction, toxic megacolon
- myasthenia gravis (characterised by muscle weakness)
- narrow-angle (closed-angle) glaucoma

Hyoscine butylbromide injection:
MHRA = risk of serious AE in pts with underlying cardiac disease = tachycardia, hypotension, anaphylaxis (likely fatal in coronary heart disease)
- CI in tachycardia. Caution in cardiac disease. Monitor pts and have resuscitation equipment readily available.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Short Bowel Syndrome

A

Shortened bowel due to large SURGICAL RESECTION

Need to ensure adequate absorption of nutrients and fluid

Nutritional deficiencies:
- Replace Vit A, B12, D, E, and K, essential fatty acids, zinc and selenium and hypomagnesaemia

Diarrhoea and high output stomas:
- LOPERAMIDE (if inadequate digestion) and CODEINE to reduce intestinal motility

Incomplete drug absorption:
- Higher doses of warfarin, COC, digoxin or give IV
- EC and MR preps not suitable - uncoated tabs, soluble tabs are better!
- Liquid formulations may be suitable but it’s dependent on osmolarity, excipients and volume required

26
Q

Constipation - Condition and Risk factors

A

Infrequent, difficult stools - most common in women, elderly and pregnant

Red flags: BAAWN
- Blood in stools
- Anaemia
- Abdo pain
- Wt loss
- New onset constipation 50 years +

27
Q

Constipation - Non-drug treatment

A

Increase in dietary fibre

Adequate fluid intake

Exercise

R/V meds as they could be causing it! - Opioids, Al, Clozapine

28
Q

Constipation - Laxatives

A

Bulk-forming = Methylcellulose, isphagula husk, sterculia

Stimulant = bisacodyl, sodium picosulfate, senna, docusate, glycerol

Faecal softeners = liquid paraffin, docusate, glycerol

osmotic = lactulose, macrogol

opioid receptor antagonist = naloxegol, mathylnaltexone

selective 5HT-4 agonist = prucalopride

29
Q

Constipation - BULK-FORMING

A

Methylcullose, isphagula husk (contains potent allergens = hypersensitivity reactions), sterculia

Small hard stools. Swells in gut to increase faecal mass to stimulate peristalsis.

Takes 2 - 3 days to work but works within 24h

SE: Bloating, cramping, flatulence, gut obstruction

Must take enough water to prevent intestinal blockage

Swallow with plenty of H2O and not immediately before bed! - gut slows down while you’re sleeping, so the medicine is more likely to cause a blockage in the gut.

30
Q

Constipation - STIMULANT

A

Senna (yellow-brown colour), bisacodyl (CI in severe dehydration), sodium picosulfate, docusate, glycerol (work within 15-30 mins)

Stimulating colonic nerves => peristalsis by irritating the gut lining

Takes 6 - 12h to work - use for ~1 wk

Avoid in intestinal obstruction

SE: abdo cramps, excessive use = hypOkalaemia, diarrhoea, lazy bowel

Counselling: ON to pass stool in morning; moisten suppositories with water before use

Co-danthramer and co-danthrusate used in terminal illness due to carcinogenicity & RED URINE & local irritation/excoriation - avoid prolonged contact with skin in incontinent pts

31
Q

Constipation - FAECAL SOFTENERS

A

Liquid paraffin

Other laxatives with stool-softening properties: docusate, glycerol and ? methylcellulose

Increases water penetration into the stool

QUICKEST ACTING - docusate enema takes 5 - 20 mins

Liquid paraffin: AVOIDED due to anal seepage, granulomatous disease of the GI tract, lipoid pneumonia on aspiration, malabsorption of fat-soluble vitamins

32
Q

Constipation - OSMOTIC

A

Lactulose (CI in galactosaemia and caution in lactose intolerance) - causes osmotic diarrhoea of low faecal pH, macrogol - sequester fluid in bowel

Increases amount of fluid in the large bowel by drawing fluid from the body or retains fluid administered with => peristalsis

Takes 2 - 3 days to work, 48h for lactulose

Also have faecal softening properties

SE: discomfort, flatulence, cramps, N when starting lactulose - this is reduced by giving with water, fruit juice or meals.

Lactulose: withdraw slowly as in constipation, it may not improve or may get worse. In portal-systemic encephalopathy, the ammonia levels in the blood can increase to dangerous levels = coma. => Lactulose is also used to reduce the amount of ammonia in the blood of patients with liver disease. It works by drawing ammonia from the blood into the colon where it is removed from the body.

33
Q

Constipation Drug Treatment = SHORT-DURATION

A
  1. BULK-FORMING + GOOD HYDRATION
  2. OSMOTIC
34
Q

Constipation Drug Treatment = CHRONIC

A
  1. BULK-FORMING + GOOD HYDRATION
  2. If stool remains hard => add or change to macrogol (or lactulose 2nd line)
  3. If still no change after 6 months - at least 2 laxatives have been tried at the highest tolerated recommended doses => PRUCALOPRIDE - 5-HT4-receptor agonist w/ prokinetic properties (BOTH GENDERS)
  4. Withdraw lactulose slowly when pt improves
35
Q

Constipation Drug Treatment = FAECAL IMPACTION

A

HARD STOOLS:
- Macrogol + Stimulant once softened
- Rectal bisacodyl and/or glycerol used if still there

SOFT STOOLS:
- Stimulant
- Rectal bisacodyl and/or glycerol used if still there

36
Q

Constipation Drug Treatment - OPIOID-INDUCED

A
  1. OSMOTIC or docusate sodium + STIMULANT
  2. Naloxegol if no response to 1st line

1b. palliative care only for co-dranthamer or co-danthrusate

AVOID BULK-FORMING = obstruction, painful colic

37
Q

Constipation Drug Treatment - PREGNANCY and BREAST-FEEDING

A
  1. Dietary and lifestyle => fibre supplements such as bran or wheat
  2. BULK-FORMING => then osmotic if persistent: lactulose
  3. Bisacodyl or senna if that doesn’t work (NEVER SENNA AT TERM!!!!)
38
Q

Constipation Drug Treatment - KIDS

A
  1. Dietary advice + Macrogol (if no faecal impaction)
  2. Stimulant
  3. If stool’s hard = LACTULOSE or DOCUSATE
39
Q

Diarrhoea - Treatments

A

ACUTE DIARRHOEA:
- is self-limitng w/o medical treatment
Use oral rehydration therapy (ORT) to prevent or correct dehydration - DIAROLYTE (contains glucose, rice powder, NaCl, and KCl

SEVERE DEHYDRATION or can’t drink:
- Hospital to get IV fluids

TRAVELLER’S DIARRHOEA / rapid control required
- LOPERAMIDE
- Avoid in bloody or suspected inflammatory diarrhoea as it retains the infection if used

FAECAL IMPACTION
- LOPERAMIDE = 1st line

40
Q

Diarrhoea - LOPERAMIDE - antipropulsive = prolongs the duration of intestinal transit by binding to opioid receptors in the GI tract

A

OTC: 12 +
Prescription: 4 +

Take 1 - 2 doses (2 - 4mg) at first, then 1 with every loose stool. Max 8 doses OD (16mg)

MHRA: Serious cardiac reactions (QT Prolongation) with high doses; misuse or abuse; torsade de pointed, cardiac arrest and fatalities.

Treat with NALOXONE in overdose!

Pts monitored for 48h for possible CNS depression

SE: commonly dizziness, flatulence, headache and N

CI: IBD, active UC, antibiotic-associated colitis (e.g. with clindamycin treatment), conditions where peristalsis is inhibited, conditions where abdo distension develops

AVOID: bloody diarrhoea or inflammatory diarrhoea (fever, severe abdo pain)

41
Q

Dyspepsia

A

Upper abdo pain, heartburn, gastric reflux, bloating, N/V

Urgent ENDOSCOPIC referral symptoms: GAUD
- GI bleed
- Aged 55+
- Unexplained wt loss
- Dysphagia

42
Q

Dyspepsia - DRUG TREATMENT

A

Uninvestigated Dyspepsia
1. PPI for 4 wks
2. Test for H.Pylori if PPI don’t work => treat if POSITIVE

Function Dyspepsia (investigated but NO cause present)
1. Test for H.Pylori => treat if positive
2. Not infected = PPI or H2 receptor antagonist for 4 wks

43
Q

Helicobacter Pylori Infection

A

Most common cause of peptic ulcers

Diagnosed with Urea (13C) breath test or Stool Helicobacter Antigen Test (SAT)
- PPIs should be stopped 2 WEEKS prior
- Abx should be stopped 4 WEEKS prior

Treated with Triple Therapy - PPI + 2 Abx: PAC, PAM, PCM
- PPI: BD
- Amoxicillin: 1g BD (use other 2 in penicillin allergy)
- Clarithromycin: 500mg BD
- Metronidazole: 400mg BD
ALL FOR 7 DAYS!

44
Q

GORD - Risk factors

A

Increased risk with:
- Consuming fatty foods
- Pregnancy
- Hiatus hernia = when part of the stomach squeezes up into the chest through an opening (“hiatus”) in the diaphragm
- FH
- Stress and anxiety
- Obesity
- Drug SEs = alpha/beta blockers, CCBs, anticholinergics, benzos, bisphosphonates, corticosteroids, NSAIDs, nitrates - why? Because it loosens up the sphincter between the wind pipe and the stomach so more acid can bounce back into the wind pipe, TCAs
- Smoking
- Alcohol

Urgent referral symptoms: GAUD
- GI bleed
- Aged 55+
- Unexplained wt loss
- Dysphagia

45
Q

GORD - lifestyle advice

A
  • Healthy eating
  • Wt loss if obese
  • Avoid any trigger foods
  • eating smaller meals
  • Eating PM meal 3-4h before going to bed
  • Raising the head of the bed
  • Smoking cessation
  • Reducing alcohol consumption
46
Q

GORD - treatment

A

Med R/V if taking a drug that exacerbates GORD

Uninvestigated GORD treated the same as uninvestigated dyspepsia:
1. PPI for 4 wks
2. Test for H.Pylori if PPI don’t ork - treat if POSITIVE

Confirmed GORD treated with 4-8 wks of PPI

Pregnancy:
- Dietary and lifestyle advice
- Antacid or an alginate
- Omeprazole (reserved for severe or complicated GORD) or Ranitidine (pregnancy okay!)

Kids:
- common in infants and resolves after age 12 - 18 months
- mild-moderate GORD => thickened feeds or alginates

47
Q

GORD - ANTACIDS = neutralises stomach acid and provides STAT relief in 15-30 mins; ALGINATES = forms viscous gel raft on top of stomach contents to prevent reflux

A

Dose: After each main meal and at ON or PRN

Mg-containing antacids = LAXATIVE

Al-containing antacids = CONSTIPATING

Ca-containing antacids = induces rebound acid secretion

Simeticone (antifoaming agent) added to antacid = relieves flatulence

Alginates + Antacid = increases the viscosity of stomach content
- forms a viscous gel (“raft”) that floats on the surface of the stomach contents

Interactions:
- Increase stomach pH = EC caps are damaged b4 reaching the intestine
- Check Na content of antacid - avoid in fluid retention; don’t take with Li or in HTN => Low Na = Co-Magaldrox (Maalox) and Simeticone with hydrotalcite (Altacite Plus)
- Antacids not to be taken with other drugs due to impairing absorption - leave 2h gap: Bisphosphonates, tetracyclines, ciprofloxacin

48
Q

PPIs = inhibits gastric acid secretion by blocking H+-K+ ATPase (proton pump) of the gastric parietal cell.

A

Omeprazole (safe in pregnancy), Esomeprazole, Lansoprazole - take 30 - 60mins b4 food), Rabeprazole

Swallow medicine whole. Don’t chew or crush. Don’t take indigestion remedies 2h before or after you take this medicine.

MHRA: Low risk of Subacute Cutaneous Lupus Ertyrhematosus - avoid sun exposure as lesions can occur on sun-exposed areas.

Increase risk of fractures / osteoporosis => low Mg

Increase risk of C. Difficile due to reduced acidity

Masks symptoms of gastric cancer

SE: GI upset - abdo pain, constipation, diarrhoea, N

Long-term use: Low Mg (predispose digoxin toxicity); fractures; rebound acid secretion, protracted dyspepsia after stopping

Interactions:
- Esomeprazole/Omeprazole + Clopidogrel => use lansoprazole instead
- Increase conc of methotrexate phenytoin, warfarin and digoxin

49
Q

PPIs = https://www.rpharms.com/resources/quick-reference-guides/proton-pump-inhibitors - Omeprazole 10mg tab + Pantoprazole 20mg tabs available as (P) for 18+ with heart burn or acid reflux

A

20mg OD before a meal with a glass of water

If symptoms do not improve after the two-week treatment, patients should be referred to their prescriber.

Treatment with acid reducing drugs, may increase the risk of gastrointestinal infections such as salmonella or campylobacter.

Common SEs:
- abdominal pain;
- constipation;
- diarrhoea;
- flatulence;
- gastro-intestinal disturbances;
- headache;
- nausea;
- vomiting.

Referral:
- Patients over 55 years of age who present with these symptoms for the first time or whose symptoms have recently changed
- Patients over 45 years of age who suffer from long-term recurrent symptoms of indigestion or heartburn should see their doctor at regular intervals and those taking OTC indigestion or heartburn remedies every day
- Patients over 55 years of age with unexplained dyspepsia (ie presenting with symptoms such as pain, fullness, nausea) that have not responded to treatment

50
Q

H2 Receptor Antagonists = reduces gastric acid secretion by blocking H2 receptors in the gastric parietal cell.

A

Ranitidine (safe in pregnancy), Cimetidine (CYP450 enzyme inhibitor), Famotidine, Nizatidine

Caution: can mask gastric cancer symptoms- rule out cancer alarm features before treatment!

SE: Diarrhoea, headache, dizziness, rash, and tiredness
Psychiatric reactions - confusion, depression, hallucinations in the elderly or very ill pts

Interactions
- reduced absorption of -azole antifungals

51
Q

Stoma Care - Artificial opening on the abdomen to divert flow of faeces or urine into an external pouch located outside of the body

A

EC/MR caps not suitable => insufficient effect from drug
- use forms with quicker action = liquids, caps, and uncoated or soluble tabs

Diarrhoea: AVOID Sorbitol - laxative effect, Mg antacids, Iron (ileostomy)

Constipation: AVOID Opioids, Ca antacids, Iron (colostomy)

GI irritation => Mg, Al antacids, NSAIDs, opioids, Fe (given IM)
GI bleeds: Aspirin + NSAIDs

Avoid laxatives => increase fluid or fibre intake or try bulk-forming laxatives!

PPI to reduce gastric acid secretion and stoma output

High dose of loperamide required or add codeine

DIURETICS/LAXATIVES: dehydration => hypokalemia => use K+ sparing diuretics or K+ supplements
- Liquid forms K+ preferred over MR forms
- Fluid & Na depletion => hypokalemia => increased risk of digoxin toxicity

52
Q

LIVER - Cholestasis

A

Impaired bile formation or flow => fatigue, pruritus, dark urine, pale, jaundice

Cholestatic pruritis:
- relieved by CHOLESTYRAMINE, URSODEOXYCHOLIC ACID, RIFAMPICIN

Intreahepatic colestasis in pregnancy:
- During late pregnancy => adverse fetal outcomes
- treatment of pruritus associated => URSODEOXYCHOLIC ACID => In primary biliary cirrhosis, monitor liver function every 4 weeks for 3 months, then every 3 months. Dietary advice (including avoidance of excessive cholesterol and calories).

53
Q

LIVER - Gallstones = Hard mineral or fatty deposits forming stones in the gallbladder bile duct.

A

Majority of pts: ASYMPTOMATIC

Irritated/blocked gallbladder => pain, infection and inflammation
- Untreated => complications (biliary colic, cholecystitis, cholangitis, pancreatitis

If symptoms develop => SURGICAL REMOVAL

Drug treatment:
- Mild - moderate pain: PARACETAMOL or NSAID
- Severe pain: IM DICLOFENAC

54
Q

Anal Fissures = Tear or ulcer in anal canal causing bleeding and pain on defecation

A

Acute management - ensure stools pass easily and help with pain <6 WKS
1. BULK-FORMING + OSMOTIC
2. Short-term topical w/ local ANAESTHETIC (Lidocaine) or ANALGESIC - can’t use this in pregnant ppl!!!

Chronic management
1. 6 wks or longer: GTN rectal (high incidence of headache)
2. Topical/PO Diltiazem or Nifedipine = lower AE, esp in topical
3. Specialist: Botulinum toxic type A (BOTOX)

SURGERY is effective when no drug response

55
Q

Haemorrhoids = Swellings of the vascular mucosal anal cushions around the anus (high risk during pregnancy)

A

Internal => Painless
External => Itchy or painful

Maintain easy stools to minimise straining:
1. Increase dietary fibre + fluid or BULK-FORMING laxative

Pain:
1. PARACETAMOL
(opioids => constipation; NSAIDs can exacerbate rectal bleeding)

Pain/itching:
1. TOPICAL PREPS - anaesthetics, corticosteroid, lubricant, antiseptics
- Topical anaesthetics (LIDOCAINE) => used for a few days
- Topical corticosteroids => use no more than 7 days due to SEs
- Can’t use these in pregnancy!!!

Pregnancy:
1. BULK-FORMING LAXATIVEs
No topical haemorrhoidal preps (only a simple soothing prep if needed)

56
Q

Exocrine Pancreatic Insufficiency - Reduced secretion of pancreatic enzymes into the duodenum. Can be due to pancreatitis, CF, pancreatic tumours, coeliac disease, GI resection and may lead to maldigestion and malnutrition

Dietary advice:
1. distribute food intake between 3 x main meals and 2 - 3 snacks
2. Avoid foods that are difficult to digest: legumes (peas, beans and lentils) and high-fibre foods
3. Don’t consume alcohol
4. Avoid reduced-fat diets.

A

Treatment:
- PANCREATIN - lipase, amylase and protease which digest fats, carbohydrates and proteins so it can be absorbed
- Take with meals and snacks or immediately b4 or after to prevent early breakdown as it’s inactivated by gastric acid.
- EC preps deliver higher pancreatin levels
- Dont mix with excessively hot food or drinks! Pancreatin inactivated by heat. If mixed with food or liquids - don’t keep for more than 1h!

SE:
- GI - common
- Irritation = perioral skin and buccal mucosa; excessive doses = perianal irritation, hyperuricemia, hyperuricosuria, skin irritation and hypersensitivity reactions when handling.
- Pts with CF: fibrosing colonopathy at high dose pancreatin. Risk factors: male kids, more severe CF and laxative use! If new or changing abdo symptoms - exclude colonic damage!
- CF pts shouldn’t exceed 10000units/kg/day of lipase
- Report any new abdominal symptoms

Levels of fat-soluble vitamins and micronutrients should be monitored
- Give supplements PRN

CI:
- Nutrizym 22 / Pancrease HL in kids aged 15 or under with CF: associated with COLON STRICTURES

Counselling:
- Ensure adequate hydration at all times with high-strength preps.

57
Q

Orlistat 60mg P Medicine = weight loss!

A
  • 18+
  • 60mg TDS w/ H20 immediately before, during or up to 1h after each main meal - if the main meal is missed or contains no fat, the dose should be omitted. Max Od dose of 180mg.
  • BMI > or equal to 28 kg/m2
  • In conjunction with a lower-fat, mildly hypocaloric diet to minimise GI SEs

Referral to GP:
- DM - esp acarbose
- HTN or hypercholesterolaemia meds
- Amiodarone - orlistat can cause a decrease in the absorption of amiodarone
- Levothyroxine - orlistat can decrease the absorption of this
- AED = increased risk of convulsions
- Pts on it for longer than 6 months
- Pt unable to lose wt after 12 wks of treatment
- pt reports rectal bleeding while taking orlistat
- pts with kidney disease

C/I:
- hypersensitivity to the active substance
- concurrent treatment with cyclosporin
- chronic malabsorption syndrome
- cholestasis - flow of bile from the liver is blocked
- pregnant or breastfeeding
- concurrent treatment with warfarin or other DOACs
- under 18s

Cautions:
- ADEK vitamins - advise to take multivitamins ON.

SE’s:
- Diet-related SE’s: oily leakage from rectum, flatulence, faecal urgency, fatty oily stools (steatorrhoea)

58
Q

Gastric and duodenal ulceration

A

Misoprostol - synthetic prostaglandin analogue
- teratogenic
- colic and diarrhoea are dose-limiting SEs. Diarrhoea is common and can be severe and require withdrawal

Sucralfate - chelates and complexes - over 15+
- bezoar formation; 1h b4 meals/1h gap between enteral feeds

59
Q

NSAID-induced ulcers

A

Treatment:
- withdraw NSAID if poss.
- PPI => alt: H2 antagonist/misoprostol
- Test for H.Pylori on healing => if positive: eradication therapy

If non-selective NSAID continued => cont. with PPI or misoprostol
If history of upper GI bleed: cont. PPI + switch to COX2i

Prophylaxis:
- High-risk pts: 65+, previous history, taking certain meds, significant co-morbidity e.g. liver, kidney, heart disease and DM
- At risk: PPI => alt: H2 antagonist / misoprostol
- 3 or more factors: PPI w/ COX2i

60
Q

Food allergies

A

Sodium cromoglicate (mast cell stabiliser) as adjunct to dietary avoidance

Paeds, MEP, OTC & Misc. (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions