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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
when choosing a regime for H pylori treatment what is important to consider
when choosing a regime take into account - allergies - frequency of antibiotics - interactions with other medications
26
what are two conditions of inflmattory bowel disease
ulcerative colitis | crohns disease
27
what does ulcerative colitis do
affects the entire large intestine
28
what does crohns disease do
can affect any part of the digestive tract from mouth to anus
29
what musculo skeletal symtpom of IBD exists
arthritis | osteoporosis
30
what dermatological symptoms of IBD exist
fissures fistulas abcesses oral chrons disease (ulcers) psoriasis eryythema nodosum
31
what hepatic symptoms of IBD exist
cholangitis bile duct carcinoma autoimmune hepatitis
32
what ocular symtpoms of IBD exist
uveitis | corneal ulcers
33
what metabolic of IBD exist
growth retardation in children | vitamin deficiencies
34
what is necessary to determine the appropriate approach to treatment
disease location extent severity
35
Disease severity is dependent on what
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
what are the two scoring systems for Crohn's
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
what is the goal of treating IBD
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
What are the 3 steps of proctitis remission
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
how can diagnose IBD
FBC Imaging e.g. ct, mri, x ray sigmoidoscopy or colonoscopy stool sample crp LFTs temperature
40
describe the different parts of the gastro intestinal system
``` stomach duodenum jejunum ileum small intestine large intestine ```
41
what are the different parts of the colon
``` appendix ascending colon transverse colon descending colon sigmoid colon rectum ```
42
describe the ulcerative colitis pathway
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
what biologics can be used to further treat moderate to severe colitis
``` Ustekinumab Vedolizumab Adalimumab Tofacitinib Infliximab Golimumab ```
44
if conventional therapy cannot be tollerated what should be used instead
biological agent | tumour necrosis factor alpha inhibitor
45
what are the two steps of uc extensive remission
topical and high dose aminosalicyate stop topical aminosalicylate with an oral corticosteroid
46
what are the steps of uc inducing remission
intravenous orticosteroids and consider surgery if no improvement in 72 hours add intravenous ciclosporin if contraindicated or inappropriate infliximab
47
how can we maintain remission for proctitis and proctosigmoiditis
topical aminosalicylate oral and topical amino salicylate oral amino salicylate
48
what are the different steps of managine crohns disease
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
what are 5 aminosalicylates used for
induction and maintenance of remission in mild to moderate IBD especially effective in UC
50
what is the active component of 5 aminosalicylates
mesalazine is the active component

Journey through GI (30 decks)

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