GI Part 3 Flashcards
irritable bowel syndrome
- abdominal pain or discomfort accompanied by a change in _____ habit and an abnormal _____ frequency:
- -_____ is a>3 bowel movement/day
- -_____ is <3 movements/week
- prevalence is 10-15%
- more common in _____ 2:1
- often coexists with other GI disorders, both functional (_____, chronic _____) and organic (_____ disease, _____, _____)
bowel stool diarrhea constipation women dyspepsia constipation celiac GERD IBD
MANAGEMENT1: OPIOIDS FOR IBS-D
- _____ (Imodium) - binds to the _____ receptor in the _____. Consequently, inhibiting the release of _____ and _____, thereby reducing _____, and increasing intestinal transit time.
- Improves QOL as it allows planning of trips and socializing- anxious IBS-D patients
- Maximum daily dose is _____ for adults as OTC use and _____ as prescription use.
- Much higher doses can cause _____ and even death.
Loperamide opiate gut wall Ach PGs peristalsis 8mg 16mg cardiotoxicity
2: 5HT3 RECEPTOR ANTAGONISTS FOR IBS-D
- _____ (Zofran) – has excellent safety record
- _____ is present in the entero-chromaffin cells (EC cells)
- These patients have higher mucosal _____ concentrations in the colon
- Improve QOL by slowing transit, reducing bowel frequency, normalizing _____, and reducing _____
- Blocks _____ signals that transmit _____ information (painful and non painful) from the gut to the brain and helps to reduce _____ and abdominal pain.
- SE: _____ (25%) and _____
Ondansetron Serotonin 5-HT stool consistency urgency serotonin sensory diarrhea Constipation Ischemic colitis
3: SECRETAGOGUES FOR IBS-C
-Guanylate cyclase-C receptor agonist: Stimulates _____ secretion by activation of type 2 _____ via _____ (an intracellular second messenger) which in turn promotes _____
–_____ (Amitiza)- does not alter pain thresholds during rectal distension
–_____ (Linzess) - improves pain as well by blocking pain signals
SE: _____
chloride Cl- ion channels cGMP peristalsis Lubiprostone Linaclotide Diarrhea
TRAVELLER’S DIARRHEA
- Acute diarrhea in those who travel to developing countries and have adventuresome _____ behavior
- Main source of infection: Food and water contaminated with _____ matter
- Bacteria: _____, Campylobacter, _____, and Shigella
- Luxury resorts & cruise ships (_____ virus)
- Seafood ingestion syndromes : _____ numbness and reversal of temperature sensation
- More susceptible: Immunocompromised or lowered _____ (e.g., on _____ or _____)
eating fecal E coli Salmonella Noro Perioral gastric acidity H2blockers PPIs
- DD: _____ (e.g.,Staphylococcus aureus,Bacillus cereus)
- _____ : Not recommended
- Avoid high-risk _____ (street vendors) and eating behaviors (cold sauces, salsas)
- Empiric treatment:
- -_____(sometimes change in H20 and electrolyte imbalance is the cause of diarrhea)
- -_____ – Increase colonic transit time (anti-motility) and Increase _____ water absorption (anti-secretory)
- _____ (does not cross BBB so no addiction potential), has _____ effects
- _____ + _____ (Lomotil), CNS effects at higher doses - _____ - Rifaximin (Salix), also used in IBS as has anti-inflammatory and antibacterial properties
Gastroenteritis Antibiotic prophylaxis foods Oral rehydration solutions Opioid agonists fecal Loperamide anticholinergic Diphenoxylate atropine Antibiotics
constipation
- 74% nursing home residents
- _____, lack of _____, or use of certain medications (_____, _____, _____, _____, _____ and Supplements like _____/_____)
- Underlying ds- Stroke, Parkinson’s disease, Diabetes, Spinal cord injury, Multiple sclerosis, Hypothyroidism etc
- Most pts use OTC remedies and don’t report
- Discomfort, bloating, hemorrhoids or fecal impaction
- Mistaken belief: everyone should move their bowels each day, can lead to dangerous _____ overuse
- Bowel movements _____/wk may be normal and healthy for some
Diet physical activity Opioids CCBs diuretics antidepressants antacids iron/calcium laxative 3
management
- Bulk forming – Absorb _____ and _____ to increase _____ pressure (increase in peristalsis)
- Stimulants – Stimulate _____ in intestinal smooth muscle, increase mucosal permeability (moves fluids into lumen)
- Osmotics – Increase _____ (stimulate peristalsis by increasing intraluminal pressure)
- Wetting agents – _____ to ease passage (act like detergents and soften stools by reducing _____, thus allowing intestinal fluids, fatty substances to penetrate fecal mass)
water expand intraluminal enteric nerves fluid volume Moisten surface tension
bulk forming
- _____
- _____
stimulants
- _____
- _____
osmotic
- _____
- _____
- _____ (_____)
- _____
wetting agents
- _____
- _____
Psyllium, Methylcellulose
Bisacodyl Senna, Castor oil
Mag hydroxide Lactulose, Glycerin Polyethylene glycol (PEG)
Milk of Magnesia
Docusate
Mineral oil
OPIOID RECEPTOR ANTAGONISTS – µ (peripheral)
- _____
- Used in short term tt of opioid induced constipation without affecting _____ or precipitating _____
Methynaltrexone
analgesia
withdrawls
laxative abuse
- Eating disorders – _____ (binge eating followed by purging)
- Quick weight control – _____ (boxing, wrestling)
- _____ – something is wrong if they don’t move their bowels every day
Bulimia
Combat sports
Older adults
antiemetics
-_____ – Benzodiazepines like lorazepam
-_____ – Antipsychotics like _____, Prochlorperazine
-D2 antagonists in CTZ and peripheral pro-kinetic action – _____ and _____
-_____ – Ondansetron, Granisetron
_____ is highly selective, high-affinity, non cardiotoxic and safe in children
-_____ – Meclizine, Cinnarizine, Cyclizine, Dimenhydrinate, Promethazine and Diphenhydramine
-_____ – Hyoscine( Scopolamine as a transdermal patch)
-Corticosteroid combination and neurokinin 1 (NK1) receptor antagonist – Aprepitant
-Partial_____ – Nabilone and Dronabinol
GABA agonist DA antagonists Promethazine Metoclopramide Domperidone 5HT3 antagonist Granisetron H1 antagonists Muscarinic antagonists CB1 agonist
CELIAC DISEASE (GLUTEN SENSITIVE ENTEROPATHY)
- Autoimmune disorderof _____ intestinein genetically predisposed (HLA DQ2, DQ8, or both)
- An inflammatory reaction to dietary gluten resulting in production of _____ that may produce _____ of the _____ (villous atrophy)
- Intestinal manifestations- _____, flatulance and weight loss.
- _____- iron deficiency anemia(palor), decreased bone mineral density, dermatitis herpetiformis, neuropathy and muscle wasting
- Left untreated- low _____ (vitamin D def) and risk for _____
- Women- risk of _____, spontaneous abortions, preterm deliveries, and LBW
small autoantibodies shortening villi diarrhea Extraintestinal BMD fractures infertility
treatment
- _____-free diet (Dietary education should focus on identifying hidden sources of gluten, planning balanced meals, reading labels, food shopping, dining out, and dining during travel)
- 5% of patients are refractory to a gluten-free diet
- Refractory patients –
- -_____
- -_____
- -Remission may be induced by the _____ and maintained with _____ and _____.
- Dermatitis herpetiformis – _____ skin ointment, _____ or potent topical Steroids (_____ or _____) or very potent (_____)
Gluten Corticosteroids Immuno-modulators anti-TNF alpha antibody Infliximab Prednisolone Azathioprine Dapsone Salfasalazine Betamethasone valerate dipropionate Clobetasol propionate
