Gi Patients Flashcards
what is dyspepsia
a common problem that causes pain or discomfort in your upper abdomen (dyspepsia) or behind your breastbone (heartburn).
what is GORD
gastro oesophageal reflux disease
what are the symptoms of dyspepsia
hearburn fullness upper abdominal pain or ache nausea hiccups coughing belching bloating pain when swallowing difficulty swallowing
what symptoms of dyspepsia may indicate GORD
pain when swallowing
difficulty swallowing
what does alarm stand for
age >55 loss of weight anaemia recurrent vomiting malaena
medication causes of GORD / DYSPEPSIA
calcium antagonists nitrates theophylline bisphosphonates aspirin / NSAIDs alpha blocker
describe the way to manage dyspepsia
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
what OTC medicines are available for uncomplicated dyspepsia
antacids
acid suppression therapy
alginates
What drug interactions exist with antacids
ciprofloxacin
digoxin
enteric coated tablets
iron
levothyroxine
tetracyclines
warfarin
what lifestyle advice can we give for dyspepsia or GORD
smoking alcohol coffee chocolate fatty food spicy food weight stress anxiety depression avoid tight raise head of bed dont eat too late
what is GORD
proven disease endoscopically diagnosed oesophagitis or non erosive reflux disease
what should patients who have gord have
full dose PPI for 4 weeks to 8 weeks
what should we do if GORD has recurring symptoms
lowest dose of PPI to control symptoms
What do Proton Pump Inhibitors
inhibit gastric scretion by blocking hydrogen potassium adenosine trip
What cautions proton pump inhibit
can mask signs of gastric cancer
what are the side effects of proton pump inhibitors
gi disturbances
What is the role of the pharmacist
identify and refer patients with alarm symptoms
review the person medication and if possible avoid drugs that may cause or exacerbate symptoms
what are alarm signals of peptic ulcer disease
severe pain
hematemesis
malaena
what should we review medication for in peptic ulcer disease
aspirin and nsaids corticosteroids bisphosphontaes SSRIs Cocaine
what type of bacteria is H plyori
gram negative bacteria
what is H plyori associated with
chronic gastritis
gastric ulcers
what are some examples of proton pump inhibitors
Omeprazole Lansoprazole Esomeprazole Pantoprazole Rabeprazole
what tests can we use to identify H plyori
Carbon 13 Urea breath test
Stool antigen
Blood test
How do we treat a H pylori treatment
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
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
what are two conditions of inflmattory bowel disease
ulcerative colitis
crohns disease
what does ulcerative colitis do
affects the entire large intestine
what does crohns disease do
can affect any part of the digestive tract from mouth to anus
what musculo skeletal symtpom of IBD exists
arthritis
osteoporosis
what dermatological symptoms of IBD exist
fissures
fistulas
abcesses
oral chrons disease (ulcers)
psoriasis
eryythema nodosum
what hepatic symptoms of IBD exist
cholangitis
bile duct carcinoma
autoimmune hepatitis
what ocular symtpoms of IBD exist
uveitis
corneal ulcers
what metabolic of IBD exist
growth retardation in children
vitamin deficiencies
what is necessary to determine the appropriate approach to treatment
disease location
extent
severity
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
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
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
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
how can diagnose IBD
FBC
Imaging e.g. ct, mri, x ray
sigmoidoscopy or colonoscopy
stool sample
crp
LFTs
temperature
describe the different parts of the gastro intestinal system
stomach duodenum jejunum ileum small intestine large intestine
what are the different parts of the colon
appendix ascending colon transverse colon descending colon sigmoid colon rectum
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
what biologics can be used to further treat moderate to severe colitis
Ustekinumab Vedolizumab Adalimumab Tofacitinib Infliximab Golimumab
if conventional therapy cannot be tollerated what should be used instead
biological agent
tumour necrosis factor alpha inhibitor
what are the two steps of uc extensive remission
topical and high dose aminosalicyate
stop topical aminosalicylate with an oral corticosteroid
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
how can we maintain remission for proctitis and proctosigmoiditis
topical aminosalicylate
oral and topical amino salicylate
oral amino salicylate
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
what are 5 aminosalicylates used for
induction and maintenance of remission in mild to moderate IBD especially effective in UC
what is the active component of 5 aminosalicylates
mesalazine is the active component
