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Journey through GI > Gi Patients > Flashcards

Gi Patients Flashcards

1
Q

what is dyspepsia

A

a common problem that causes pain or discomfort in your upper abdomen (dyspepsia) or behind your breastbone (heartburn).

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2
Q

what is GORD

A

gastro oesophageal reflux disease

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3
Q

what are the symptoms of dyspepsia

A 
hearburn 
fullness
upper abdominal pain or ache
nausea 
hiccups 
coughing
belching 
bloating
pain when swallowing 
difficulty swallowing
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4
Q

what symptoms of dyspepsia may indicate GORD

A

pain when swallowing

difficulty swallowing

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5
Q

what does alarm stand for

A 
age >55
loss of weight
anaemia
recurrent vomiting
malaena
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6
Q

medication causes of GORD / DYSPEPSIA

A 
calcium antagonists
nitrates
theophylline
bisphosphonates
aspirin / NSAIDs
alpha blocker
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7
Q

describe the way to manage dyspepsia

A

are there alarm signals

if yes then seek gp care

if no is there any drug side effects

if also no give lifestyl advice and advice on use of drugs

response no further

if yes advise to see gp routinely

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8
Q

what OTC medicines are available for uncomplicated dyspepsia

A

antacids

acid suppression therapy

alginates

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9
Q

What drug interactions exist with antacids

A

ciprofloxacin
digoxin

enteric coated tablets

iron

levothyroxine

tetracyclines

warfarin

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10
Q

what lifestyle advice can we give for dyspepsia or GORD

A 
smoking
alcohol
coffee
chocolate
fatty food
spicy food
weight
stress
anxiety
depression
avoid tight 
raise head of bed 
dont eat too late
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11
Q

what is GORD

A

proven disease endoscopically diagnosed oesophagitis or non erosive reflux disease

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12
Q

what should patients who have gord have

A

full dose PPI for 4 weeks to 8 weeks

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13
Q

what should we do if GORD has recurring symptoms

A

lowest dose of PPI to control symptoms

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14
Q

What do Proton Pump Inhibitors

A

inhibit gastric scretion by blocking hydrogen potassium adenosine trip

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15
Q

What cautions proton pump inhibit

A

can mask signs of gastric cancer

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16
Q

what are the side effects of proton pump inhibitors

A

gi disturbances

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17
Q

What is the role of the pharmacist

A

identify and refer patients with alarm symptoms

review the person medication and if possible avoid drugs that may cause or exacerbate symptoms

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18
Q

what are alarm signals of peptic ulcer disease

A

severe pain
hematemesis
malaena

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19
Q

what should we review medication for in peptic ulcer disease

A 
aspirin and nsaids 
corticosteroids 
bisphosphontaes
SSRIs
Cocaine
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20
Q

what type of bacteria is H plyori

A

gram negative bacteria

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21
Q

what is H plyori associated with

A

chronic gastritis

gastric ulcers

22
Q

what are some examples of proton pump inhibitors

A 
Omeprazole
Lansoprazole
Esomeprazole
Pantoprazole
Rabeprazole
23
Q

what tests can we use to identify H plyori

A

Carbon 13 Urea breath test

Stool antigen

Blood test

24
Q

How do we treat a H pylori treatment

A

triple therapy of 2x antiobiotics and a high dose PPI used BD for 1 week

if large or bleeding ulcer then PPI treatment continued until healed

need to consider previous antibiotic exposure

25
Q

when choosing a regime for H pylori treatment what is important to consider

A

when choosing a regime take into account

  • allergies
  • frequency of antibiotics
  • interactions with other medications
26
Q

what are two conditions of inflmattory bowel disease

A

ulcerative colitis

crohns disease

27
Q

what does ulcerative colitis do

A

affects the entire large intestine

28
Q

what does crohns disease do

A

can affect any part of the digestive tract from mouth to anus

29
Q

what musculo skeletal symtpom of IBD exists

A

arthritis

osteoporosis

30
Q

what dermatological symptoms of IBD exist

A

fissures
fistulas
abcesses

oral chrons disease (ulcers)

psoriasis

eryythema nodosum

31
Q

what hepatic symptoms of IBD exist

A

cholangitis
bile duct carcinoma
autoimmune hepatitis

32
Q

what ocular symtpoms of IBD exist

A

uveitis

corneal ulcers

33
Q

what metabolic of IBD exist

A

growth retardation in children

vitamin deficiencies

34
Q

what is necessary to determine the appropriate approach to treatment

A

disease location

extent

severity

35
Q

Disease severity is dependent on what

A

using a rating scale that incorporates the following

number of soft bowel movements
presence of blood in the stool
abdominal pain
cramping or discomfort
presence and severity of extra intestinal symptoms
blood results such as Hb, CRP, ESR of haematocrit

36
Q

what are the two scoring systems for Crohn’s

A

CDAI requires 7 days monitoring
Harvey bradshaw index for Crohn’s 1 day monitoring

1 scoring system for UC - Truelove and witts severity index for UC

37
Q

what is the goal of treating IBD

A

induce remission while improving QoL

following attainment of remission, treatment is tailored to maintain remission

step wise addition of medication is slightly different between 2 diseases

aim to be on lowest effective doses of medication to control disease

38
Q

What are the 3 steps of proctitis remission

A

topical aminosalicylate

if remission not achieved in 4 weeks

add oral aminosalicylate

if remission not achieved in 4 weeks

add topical or oral corticosteroid

39
Q

how can diagnose IBD

A

FBC

Imaging e.g. ct, mri, x ray

sigmoidoscopy or colonoscopy

stool sample

crp

LFTs

temperature

40
Q

describe the different parts of the gastro intestinal system

A 
stomach
duodenum
jejunum
ileum
small intestine
large intestine
41
Q

what are the different parts of the colon

A 
appendix
ascending colon
transverse colon
descending colon
sigmoid colon
rectum
42
Q

describe the ulcerative colitis pathway

A

person with exacerbation can go to 4 parts

proctitis mild to moderate which then goes to further treatment for moderate to severe uc then to maintaining remission

proctosigmoiditis and left sided UC which then goes to further treatment for moderate to severe uc then to maintaining remission

extensive ulcerative colitis mild to moderate which then goes to further treatment for moderate to severe uc then to maintaining remission

acute severe Ulcerative colitis then goes to dealing with a multidisciplinary team then given treatment options to doing surgery then to maintaining remission

43
Q

what biologics can be used to further treat moderate to severe colitis

A 
Ustekinumab
Vedolizumab
Adalimumab
Tofacitinib
Infliximab
Golimumab
44
Q

if conventional therapy cannot be tollerated what should be used instead

A

biological agent

tumour necrosis factor alpha inhibitor

45
Q

what are the two steps of uc extensive remission

A

topical and high dose aminosalicyate

stop topical aminosalicylate with an oral corticosteroid

46
Q

what are the steps of uc inducing remission

A

intravenous orticosteroids and consider surgery

if no improvement in 72 hours

add intravenous ciclosporin

if contraindicated or inappropriate infliximab

47
Q

how can we maintain remission for proctitis and proctosigmoiditis

A

topical aminosalicylate

oral and topical amino salicylate

oral amino salicylate

48
Q

what are the different steps of managine crohns disease

A

IV or oral conventional glucocorticoid
Oral aminosalicylate if cannot tolerate / decline steroids

azathioprine or mercaptopurine if >2 exacerbations per year or steroid dose cannot be tappered down

TNFa inhibitor for a planned treatment course only continued if clear evidence of ongoing disease

maintain remission with azathiprine or mercaptopurine or if contraindicated or not tollerated then use methotrexate

surgery / resection

49
Q

what are 5 aminosalicylates used for

A

induction and maintenance of remission in mild to moderate IBD especially effective in UC

50
Q

what is the active component of 5 aminosalicylates

A

mesalazine is the active component

Journey through GI (30 decks)

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