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GI disorders Flashcards

1
Q

What is coeliac disease?

A

A chronic inflammatory response to gluten. inflammation of the small intenstine where it is unable to absorb nutrients.

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2
Q

What are the symptoms of coeliac disease?

A

diarrhoea, abdominal pain and bloating. high risk of malabsorption of nutrients like calcium and vitamin d.

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3
Q

What is the treatment of coeliac disease?

A

Gluten-free diet, assess for risk of osteoporosis and treat bone disease, vitamin and mineral supplement following medical assessment.

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4
Q

What is diverticulitis?

A

Inflammation of the pockets or small bulges of the lining of the intestine. appears in ages over 50

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5
Q

What are the symptoms of diverticulitis?

A

lower abdominal pain, constipation, diarrhoea

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6
Q

What is the treatment of diverticulitis?

A

high fibre diet, bulk forming drugs to treat constipation or diarrhoea and antibiotics to treat infection

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7
Q

What are the two conditions under IBD?

A

Ulcerative colitis and Crohns disease

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8
Q

What is ulcerative colitis?

A

inflammation and ulceration of the colon and rectum.

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9
Q

What are the symptoms of ulcerative colitis?

A

alternates between acute flare ups and remission, bloody diarrhoea, abdominal pain and urgent need to defecate. acute flare up can also contain mouth ulcers, arthritis, weight loss.

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10
Q

what is the contraindicated drug for acute flare ups during ulcerative colitis?

A

loperamide and codeine. avoid anti-motility drugs as they can increase risk of toxic megacolon.

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11
Q

what does the treatment for ulcerative colitis depend on?

A

the location of inflammation. inflammation of the rectum and lower colon can be treated with foam preparations, suppositories and enemas. inflammation that affects most of the colon can be treated orally as the other preparations will not be able to travel that far up the colon.

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12
Q

what is the first line treatment for lower down ulcerative colitis? (proctitis and proctosigmoiditis/ inflammation of the rectum and end of colon)

A

first line: aminosalicylate (rectal)

alternative: rectal corticosteroid or oral prednisolone if the patient cannot tolerate aminosalicylate.

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13
Q

what is the first line treatment for ulcerative colitis that is more further up the colon? (extensive colitis and left sided colitis)

A

first line: high dose oral aminosalicylate PLUS rectal aminosalicylate or oral beclomethasone if necessary.

alternative: oral prednisolone alone.

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14
Q

what is the treatment for moderate to severe ulcerative colitis?

A

oral prednisolone.

alternative: monoclonal antibodies

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15
Q

2nd line treatment for mild-moderate UC?

A

(After 4 weeks with an aminosalicylate and no improvement) add oral prednisolone

(if this doesnt work after 2-4 weeks) add oral tacrolimus

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16
Q

what is the hospital treatment for severe acute UC flare ups?

A
  • immediate hospital admission
  • IV corticosteroid + assess need for surgery

Alertnative (if patient cannot take corticiosteroid): IV ciclosporin OR surgery

SECOND LINE: (if symptoms do not improve in 72 hours)

  • IV ciclosporin + IV corticosteroids OR surgery

alternative to ciclosporin: infliximab

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17
Q

what is given to maintain remission in proctitis and proctosigmoiditisis? (rectum or sigmoid colon)

A

aminosalicylates. rectal aminosalicylates alone or with oral aminosalicylates

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18
Q

what is given to maintain remission in extensive colitis and left-sided colitis?

A

low dose oral aminosalicylate. single dose is given as it is more effective than multiple daily doses but has more side effects due to peak plasma concentrations.

  • Oral azathioprine/ mercaptopurine is given if 2+ flare ups in 12 months that needed corticosteroids or if remission is not maintained by aminosalicylate.
  • Monoclonal antibodies continued if effective/tolerated during acute flare-ups.
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19
Q

What is Crohn’s disease?

A

inflammation of the GI tract from mouth to anus.

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20
Q

what are the symptoms of crohn’s disease?

A

Abdominal pain, diarrhea, weight loss

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21
Q

What lifestyle advice would you give for crohn’s disease?

A

high fibre diet, smoking cessation reduce risk of relapse

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22
Q

How would you treat an acute flare up or first presentation of crohn’s disease?

A

corticosteroid (prednisolone, methylprednisolone, IV hydrocortisone)

alternative: budesonide or aminosalicylate in patients with distal ileal ileocaecal or right sided colonic disease.

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23
Q

what would you give for crohn’s disease if there are 2 plus flare ups in 12 months?

A

azathioprine or mercaptopurine added to corticosteroid

alternative: methotrexate

alternative if other therapies fail:

monoclonal antibodies

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24
Q

what important side effects do aminosalicylates have?

A
  • blood dyscrasias - patients should report unexplained bleeding, bruising, sore throat or fever.
  • nephrotoxicity: monitor renal function
  • salicylate hypersensitivity: if the patient cannot take aspirin they cannot take aminosalicylates
  • can cause yellow/orange bodily fluids. this is harmless.
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25
Q

What is the interaction between lactulose and mesalazine?

A

lactulose can prevent the release of mesalazine M/R and E/C preperations. because lactulose lowers stool pH in the intestine.

26
Q

what are the symptoms of IBS?lower abdominal pain, bloating, alternating constipation and diarrhoea.

  • aggravated by stress, depression and anxiety, lack of dietary fibre. commonly affects young adult women between 20 and 30 years.
A
27
Q

what is the non-drug treatment of IBS?

A
  • increase physical activity
  • limit fresh fruit consumption to no more than 3 portions per day.
  • review fibre intake. can take isphaghula husk or high fibre food like oats.
  • increase fluid intake. reduce caffeine, alcohol and fizzy drinks.
28
Q

What is the drug treatment for IBS?

A
  • antispasmodic drugs for GI spasms - alverine, mebeverine and peppermint oil.
  • Laxatives used to treat constipation- (NOT LACTULOSE AS IT CAN CAUSE BLOATING)

linoclotide - given to people who have not responded to laxatives from the different classes and who have had constipation for at least 12 months.

  • Antimuscarinics given for GI spasms - hyoscine butylbromide, atropine etc
  • Antimotility drug given for diarrhoea - Loperamide
  • Antidepressant given for 2nd line for abdominal pain/ discomfort when no response to antispasmodics, anti-motility drugs or laxatives- TCA and SSRIs.
29
Q

What is short bowel syndrome?

A

shorted bowel due to surgical resection. may require medical management to ensure adequete absorption of nutrients and fluid.

30
Q

what nutritional deficiencies do people with shortened bowel have ?

A
  • can cause malabsorption and malnutrition.
  • deficiency of vitamin A, B12, D , E and K, zinc, selenium, essential fatty acids.

hypomagnesium is common and treated with oral supplementation.

alfacalcidol is given to patients for correction of sodium depletion.

31
Q

what is the biggest symptom of shortened bowel syndrome and how is it treated?

A

Diarrhoea - oral rehydration to promote adequate hydration.

Antimotility drugs - loperamide and codeine. loperamide is preferred as it is not sedative and does not cause dependence.

  • Co-phenotrope - has been used alone or in combination with other medications to help decrease faecal output. it crosses the blood-brain barrier and can produce CNS side-effects, which may limit its use, can cause dependance and anticholinergic effects.
32
Q

What is colestyramine used for in short bowel syndrome?

A
  • In patients with an intact colon and less than 100cm of ileum resected, colestyramine can be used to bind the unabsorbed bile salts and reduce diarrhoea. important to monitor for fat malabsorption or fat-soluble vitamin deficiencies.
33
Q

How does short bowel syndrome affect drug absorption?

A
  • can affect absorption of drugs so they may need to be prescribed in higher doses as usual. such as levothryroxine, warfarin, oral contraceptives and digoxin.
  • E/C and M/R formulations not suitable as there may not be sufficient release of the active ingredient.
  • uncoated tablets, soluble tablets and liquid preparations are suitable
  • liquid formulations may be suitable ( depends on osmolarity, excipients and volume required )
34
Q

How do you diagnose H.Pylori?

A

C-Urea breath test.
Patients must not have had an antibiotic within the last 4 weeks.
Patients should not have two weeks of treatment with antisecretory drug.

35
Q

What medicine is given as an adjunct to food allergy?

A

Sodium cromoglicate

36
Q

What medicine is given for food-induced anaphylaxis?

A

Adrenaline

37
Q

What do antimuscarinics do?

A
  • They reduce intestinal motility in IBS. (stop spasms in the gut)
  • they are the competitive inhibitors of acetylcholine which act on muscarinic receptors.
  • antimuscarinic drugs block the antimuscarinic receptors.
  • they have sympathetic effects on the body so used for arrthymias, tremours, urinary incontinence, astma , motion sickness etc
38
Q

What are the examples of antimuscarinics ?

A

hyoscine butylbromide
propantheline bromide
dicylcloverine

39
Q

What are the side effects of antimuscarinics?

A
  • EXCESSIVE SYMPATATHIC NERVOUS SYSTEM STIMULATION
    “Cant see, cant pee, cant poo, cant spit”
  • blurred vision
  • relaxes bladder- urinary incontinence
  • inhibits intestinal motility- constipation
  • inhibits salivation -dry mouth
  • increases HR - tachycardia
  • reduced bronchial secretions.
  • drowsiness
40
Q

What cautions are there with antimuscarinics ? what group of patients should you look out for?

A
  1. susceptibility to angle-closure glaucoma - antimuscarinics can increase intra-ocular pressure
  2. men with BPH. antimuscarinics are contra-indicated
  3. paralytic ileus, GI obstruction, toxic megalcolon.
41
Q

what is the MHRA alert for hyoscine butylbromide injection?

A
  • Risk of serious adverse effect in patients with underlying cardiac disease.

Contraindicated in tachycardia. Caution in cardiac disease.

42
Q

What do antispasmodics do?

A

Relax intestinal smooth muscle.

43
Q

What do antispasmodics do?

A

Relax intestinal smooth muscle.

44
Q

What are examples of antispasmodics?

A
  • Mebeverine
  • Alverine (dizziness: driving warning) - these two should be avoided paralytic ileus)
  • Peppermint Oil
    ( Heartburn. Local irritation of mouth/oesophagus)
  • Patients Counselling: Swallow capsules whole
45
Q

what are the symptoms of anal fissure?

A
  • tear or ulcer in the lining of the anal canal
  • bleeding (bright red blood)
  • Sharp, persistent pain or defecation
  • Linear split in the anal mucosa
46
Q

What is the treatment of anal fissures?

A
  • Acute Anal fissures < 6 weeks
    1. Bulk-forming laxatives - to ensure stools are soft and easily passed
  1. Short-term topical local anesthetic: lidocaine can be given for prolonged burning pain following defecation
    Apply before emptying bowel

Chronic anal fissure > 6 weeks

  • GTN rectal ointment (side effect headache)
    alternative: oral or topical diltiazem, nifedipine - topical is preferred as it causes less adverse effects.
47
Q

What are the symptoms of haemorrouids?

A
  • Abnormal swelling of the vascular mucosal anal cushions around the anus.
  • pain after defecation
  • bleeding after pooing
  • swelling like lumpd
  • itchy sore skin around anus
48
Q

what are the risk factors for haemorroids?

A
  • pregnancy

- constipation

49
Q

what is the non-drug treatment of haemorroids?

A
  • increase dietary fibre and fluid intake to make stools soft and easy to pass
  • perianal hygeine to aid healing and reduce irritation and itching.
50
Q

What is the drug treatment for haemorroids?

A
  1. If patient is constipated, give bulk-forming laxative
    2, Analgesia
  2. Topical preperations -
51
Q

what analgesia can be given for haemorroids?

A

Paracetamol. Avoid opioids as can cause constipation and NSAIDs should be avoided if rectal bleeding is present.

52
Q

What topical preperations can be given for haemmoroids?

A

they contain anaestesia, corticosteroids, astringents, lubricants, and antispetics. offer symptomatic relief of pain and itching.

  • Topical preps containing local anaestetics (lidocaine, benzocaine etc) should be used for a few days as they may cause sensitation to the anal skin. can cause irritation so excessive use should be avoided.
  • Long term topical corticosteroid use should be avoided. (no more than 7 days) - can cause ulceration, adrenal supression and systemic corticosteroid effects. Also, ensure infections have been excluded before giving steroids like HSV, perianal thrush etc.

-

53
Q

How do you treat haemorroids in pregnancy?

A
  • BULK-FORMING LAXATIVES
  • no topical peps are liscenced for use so give a soothing preperation containing simple products (no steroids or corticosteroids)
54
Q

What is exocrine pancreatic insufficiency?

A
  • Reduced secretion of pancreatic enzymes into the duodenom
  • main clinical manifestations are: maldigestion and malnutrition.
  • leads to low levels of nutrients, fat soluble vitamins and lipoproteins
55
Q

what can cause exocrine pancreatic insufficiency?

A
  • cystic fibrosis, chronic pancreatitis, pancreatc tumours, coeliac disease, GI resection.
56
Q

What dietary advice would you give to someone who has exocrine pancreatic insufficiency?

A
  • Food intake should be distributed between three main meals per day, and two or three snacks.
  • food that is hard to digest should be avoided - legumes
  • avoid high-fibre food
  • avoid alcohol
  • Avoid reduced- fat diets
57
Q

What is the main treatment of pancreatic insufficiency?

A

PANCREATIN

  • replaces pancreatic enzymes
  • contains digestive enzymes lipase, amylase and protease. they digest fats, carbs and proteins into smaller compenents to be absorbed.
58
Q

when are the directions for administration for pancreatin?

A
  • Take with meals and snacks - because pancreatin is inactivated by gastric acid
  • Do not mix with excessively hot food or drinks. pancreatin inactivated by heat. if it is mixed with liquids, the preperations should not be kept for more than one hour.
  • Enteric-coated preparations deliver a higher enzyme concentration in the duodenum (provided the capsule contents are swallowed whole without chewing).
  • Manufacturer advises gastro-resistant granules should be mixed with slightly acidic soft food or liquid such as apple juice, and then swallowed immediately without chewing. Capsules containing enteric-coated granules can be opened and the granules administered in the same way.
59
Q

what alert is there in patients with CF taking a high dose pancreatin?

A
  • Risk of fibrosing colonopathy - thickening of the colon.
  • risk factors are male children, use of laxatives, more severe CF.
  • if a patient taking a high dose pancreatin develops new abdominal symptoms they should be reviewed to exclude the possibility of colonic damage.
60
Q

what is the contra-indication of high dose pancreatin NUTRIZYM 22 and PANCREASE HL?

A
  • avoid in children under 15 with cystic fibrosis
61
Q

what caution is there with pancreatin?

A
  • Can cause perioral skin and buccal mucosa irritation if retained in the mouth.
  • excesssive doses can cause perianal irritation.

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