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NMR > GI PROBS U23 > Flashcards

GI PROBS U23 Flashcards

1
Q

what is the oral mucosa made up of?

A

external stratified squamous epithelium and inner

connective tissue separated by basement membrane

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2
Q

what is oral dysplasia?

A

disease condition where the epithelial region is affected so the drugs used should have the capacity to retain themselves in this epithelial region.

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3
Q

in what condition are the basal cells and connective tissue adjacent to it affected?

A

oral lichen planus

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4
Q

what is another name for oral thrush?

A

acute pseudo-membranous candidiasis

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5
Q

who is oral thrush common in?

A

those with xerostomia, HIV infection, DM, neutropenia, dentures, taking broad spectrum AB, breastfeeding infants, taking inhaled CSs, taking immunosuppressant drugs

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6
Q

name four other less common forms of oral candida infection

A

acute atrophic erythematous candidiasis, denture stomatitis. chronic hyperplastic candidiasis, angular chelitis

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7
Q

when are ulcers a cause for concern?

A

when they dont heal within 3 weeks

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8
Q

what are the three types of apthous ulcers?

A

minor (less than 10mm), major (>10mm) and herpetiform (1-2mm)

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9
Q

which apthous ulcer can last up to 2 weeks and how does it feel?

A

major apthous ulcer - painful and difficulty eating

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10
Q

what are causes of apthous ulcers?

A

oral trauma, changes in hormone levels, after stopping smoking, lack of iron, stress, medications and food like chocolate, strawberries, nuts etc

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11
Q

in which people are apthous ulcers more common in?

A

inflammatory bowel disease, HIV, systemic lupus erythematosus and behcets diseases and systemic infections (but these ulcers arent generally the apthous type)

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12
Q

Management of apthous ulcers (non medical)

A

avoid spicy/hot foods, use a straw to drink liquids, relaxation techniques, soft tooth brush, change in formulation of medication if that is what is causing the ulcers, warm saline mouthwash

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13
Q

what is Difflam?

A

Benzydamine spray - used for ulcer management

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14
Q

what is choline salicylate?

A

bonjela - shouldnt be used in under 16s due to the risk of reyes syndrome

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15
Q

which drugs can cause xerostomia?

A

anti-histamines, anti-muscuranics, anti-psychotics, TCAs

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16
Q

which drugs can cause stomatitis?

A

NSAIDs, methotrexate, doxorubicin

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17
Q

what drug induced reaction can anti-malarials e.g. chloroquine cause?

A

pigmentation - discolouration of oral mucosa appears bluish-black to brown

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18
Q

which drug is associated with staining teeth?

A

minocycline

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19
Q

which drugs cause gingival hyperplasia?

A

phenytoin, CCB, cyclosporine, sodium valproate

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20
Q

what part of the body is most commonly involved in ACEI-induced drug reaction?

A

lips - angioedema

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21
Q

how long can H2-receptor antagonists be taken for OTC?

A

max 2 weeks then you would need a prescription

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22
Q

which antacids can cause constipation?

A

calcium, aluminium and bismuth salts

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23
Q

which antacids may be unsuitable for people with HF or HTN?

A

magnesium salts - many products contain and increasing content of sodium

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24
Q

what is domperidone?

A

prokinetic - that stimulates GI peristalsis licensed for nausea, heartburn and dyspepsia

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25
Q

which drug reduces surface tension of the mucus coated gas bubbles in the stomach so small bubbles can coalesce?

A

simeticone - acts as a defoaming agent

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26
Q

when does dyspepsia need to be referred to a doctor?

A

persistent dyspepsia > 2 weeks despite a course of treatment

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27
Q

what does uninvestigated dyspepsia mean?

A

endoscopy does not need to be carried out - no alarm symptoms

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28
Q

managing dyspepsia ? advice for pts

A

advice of weight reduction, avoid known participants such as alcohol, chocolate, recognise CBT and psychotherapy may reduce dyspeptic symptoms in short term, for ppl who need long term management advise to reduce use of prescribed medication

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29
Q

what is treatment for persistent uninvestigated dyspepsia?

A
  • full dose PPI for 4 weeks
  • if no response offer test for the presence of bacterium H. pylori and treat the infection if test is positive “test and treat”
  • leave a 2 weeks wash out period after PPI use before testing for H pylori with a breath test or stool antigen test
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30
Q

when are PPIs effective?

A

when taken 30- 60 mins before a meal as they only inhibit actively secreting pumps

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31
Q

what allows once daily dosing of PPIs? And when is twice daily dosing recommended?

A

prolonged duration of action but twice daily dosing is recommended in barrettes oesophagus when a pH above 4 is required or in oesophagitis

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32
Q

what is the main stimulus to proton pump activity?

A

meals

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33
Q

when does GORD occur?

A

anti-reflux mechanisms fail, allowing acidic gastric

contents to make contact with the lower oesophageal mucosa.

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34
Q

when can pressure in the stomach rise higher than the lower oesophageal sphincter can withstand?

A

during pregnancy,

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35
Q

what are common causes of drug induced oesophagitis?

A

taking medicine at night or without water

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36
Q

which drugs are the cause of drug induced oesophagitis in more than 50% of the time?

A

Antibacterials such as doxycycline, tetracycline and

clindamycin

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37
Q

what are examples of smooth muscle relaxants that may worsen or cause symptoms of GORD?

A

Examples are nitroglycerins, antimuscarinics, beta-adrenoceptor agonists, aminophylline, and benzodiazepines.

38
Q

who should alendronate and oral ibandronate not be given to?

A

patients with abnormalities of the oesophagus - due to risk of oesophageal reactions

39
Q

what dosage instructions should you adhere to according to MRHA in response to oral bisphosphonates?

A
  1. tablets should be swallowed whole with 200ml of water on an empty stomach after getting up
  2. stay fully upright for at least 30 mins-1hr after taking the tablet
40
Q

interventions for GORD?

A

full dose PPI for 4-8 weeks if symptoms recur after initial treatment offer PPI at lowest dose - if inadaquate response to PPI then offer H2RA therapy

41
Q

what are the classic symptoms of peptic ulcer disease ?

A

upper abdo pain occuring 1-3hrs after a meal and then relieved by food/antacids

42
Q

what is H. pylori?

A

spiral shaped gram negative bacteria found in gastric antrum

43
Q

risk factors for H. pylori?

A

low social class, overcrowding and bed sharing.

44
Q

what H. pylori associated with?

A

H. pylori infection is associated with about 90% of duodenal ulcers, 70% of gastric ulcers, as well as gastric cancer.

45
Q

how do NSAIDs cause ulcers?

A

o Prostaglandins are needed to produce a protective
mucus layer to line the stomach.
o Inhibiting the formation of prostaglandins (by using
an NSAID, e.g. during treatment for an inflammatory
condition) increases the risk of gastric irritation and
ulceration

46
Q

which NSAID is associated with the lowest risk of NSAID associated ulcers?

A

ibpfn

47
Q

what is the major systemic action of NSAIDs that contribute to the formation of ulcers?

A

reduction in mucosal PGs production

48
Q

what are risk factors for NSAID ulcers?

A
  1. > 65years
  2. prev. peptic ulceration
  3. high dose NSAID or using multiple NSAIDs
  4. short term hx of NSAID use < 1 month
  5. using CSs or anticoag aswell as NSAIDs
  6. having CVD
49
Q

why are selective COX-2 inhibitors known to be safer than non-selective NSAIDs?

A

COX-1 inhibit PG formation whereas COX-2 do not as they are used for inflammation

50
Q

who should COX-2 inhibitors be avoided in?

A

those who need low-dose aspirin or those with established heart or cerebrovascular disease

51
Q

what is misoprostol?

A

gastroprotectant

52
Q

how would you diagnose a peptic ulcer?

A

endoscopy
and Endoscopy should be undertaken in patients >55 years with persistent dyspepsia and risk factor (eg NSAID use) or in patients of any age with alarm features.

53
Q

first line treatment for H.pylori?

A

One week triple therapy, twice daily.
• Proton Pump Inhibitor (PPI), amoxicillin and
clarithromycin/metronidazole.

54
Q

what is sucralfate?

A

mucousal protectant - polymerizes below ph 4 to give a sticky gel that adheres to the bases of ulcer crates

55
Q

treatment of NSAID associated ulcer

A

Stop NSAID if possible, full dose PP for 4-8 weeks, H pylori eradicaton where test is positive
people of high risk who NSAID is needed use gastroprotectant OR use COX-2 (if not using low dose aspirin or CVD risk)

56
Q

what would you recommend for people continuing to take NSAIDs when the ulcer has healed?

A
  1. offer trial of use ‘as needed’ basis
  2. substitute NSAID with pctml/other analgesic
  3. low dose ibpfn (1.2g daily)
57
Q

what is gastroenteritis?

A

stomach and intestines become inflamed - due to viral or bacterial infection, D+V are main symptoms

58
Q

what is the most common bacteria in the UK causing gastroenteritis?

A

campylobacter

59
Q

what parasites can cause gastroenteritis?

A

cryptosporidium, giardia, entamoeba histolytica

60
Q

where is the toxin bacillus cereus commonly found?

A

mainly found in reheated rice

61
Q

this toxin is usually found in reheated meat dishes

A

clostridium perfringens

62
Q

what toxin is found in underocooked red kidney beans?

A

toxin phytohaemagglutin

63
Q

what is HUS caused by?

A

E.coli - occurs mostly in children and elderly

64
Q

what ethnic group is IBD more common in?

A

caucasians

65
Q

what mutations have been identified in crohns?

A

NOD2 - gene is thought to code for an intracellular receptor for bacterial cell wall components, expressed in monocytes and Paneth cells

66
Q

which IBD makes non-smokers more prone?

A

UC

67
Q

pathology in CD?

A

CD can affect any part of the intestine, common areas are the terminal ileum, the colon and the
anorectal area.
‘skip lesions’, mucosa is ulcerated and there is inflammation throughout the deeper layers, granulomas, consisting of lymphocytes and
macrophages, thickening of the intestinal wall and fibrosis, flare-ups may be precipitated by smoking, oral
contraceptives, NSAIDs and bacterial infections

68
Q

in the long term what does UC predispose an individual to?

A

Longterm, UC predisposes to colon cancer, and is associated with primary sclerosing cholangitis (damage and scarring of the bile ducts).

69
Q

in which IBD is the absorption of vitamin B12 and bile salts reduced resulting in anaemia and gall stones?

A

CD

70
Q

when in inflixmab used in IBD?

A

Management of severe active Crohn’s disease and severe UC in patients which has not responded to corticosteroid and a conventional drug that affects the immune system

71
Q

what is the mechanism of action of metronidazole?

A

Is a 5-nitroimidazole. Diffuses into organism where the nitro group is reduced. During this reduction process, chemically reactive intermediates are formed that inhibit DNA synthesis and /or damage DNA, impairing its function

72
Q

what drug is used to treat of mild/moderate UC and maintenance of remission, treatment of active Crohn’s disease?

A

sulfasazaline

73
Q

mechanism of azathioprine?

A

Azathioprine is metabolised to 6-mercaptopurine by the liver. Mechanism unclear, but the active metabolites inhibit purine ribonucleotide synthesis, which may inhibit T cell function

74
Q

what is loperamide and what age is it indicated for?

A

anti-motility drug for diarrhoea and for >12 years

75
Q

name bulk forming laxatives and how long do they take to work?

A

methylcellulose and 2-3 days for constipation

76
Q

what are senna and biscodyl examples of?

A

stimulant laxative - can take with stool softener such as docusate sodium

77
Q

what is mebeverine an example of?

A

anti-spasmodics - + alverine

78
Q

who is bismuth salicylate contraindicated in and why?

A

those with a sensitivity to aspirin OR under 16s as coverted to salicylate (aspirin)

79
Q

what 4 drugs can commonly cause constipation?

A

codeine, amitryptiline, aluminium and calcium ant-acids

80
Q

how can mycophenolate cause diarrhoea?

A

Can cause colitis - this form of injury could be related to either direct toxicity or an “innocent by-stander” phenomenon secondary to the alteration of the immunologic microenvironment of the colon caused by the mycophenolate

81
Q

what drugs cause diarrhoea through suppression of gastric acid secretion, leading to changes in bacterial flora which could cause diarrhoea – some links to C diff associated diarrhoea?

A

ranitidine and omeprazole

82
Q

what is the lifecycle of a threadworm?

A

live for 5-6 weeks then die and can survive up to 2 weeks outside the body

83
Q

treatment for threadworms?

A

under 3 months - only hygeine measures

and mebendazole for over 2 years and over 6 months can under 2 can take this medicine buty unlicensed

84
Q

in the Uk what age group is sent stool testing kits for CRC?

A

60-75 years - every 2 years

85
Q

what staging system of CRC is commonly used by doctors in the UK?

A

TMN
T - size of tumour
M- - whether its spread
N - presence of nodes

86
Q

what chemotherapy drugs are commonly used for CRC?

A

fluorouracil, irinotecan, capecitabine, oxaliplatin

87
Q

what is irinotecan?

A

chemotherapy drug used in CRC

88
Q

which CRC chemothaerapy drug is commonly given with vitamin folinic acid?

A

fluorouracil

89
Q

which type of CRC accounts for 95%?

A

adenocarcinomas

90
Q

what is mesalazine?

A

aminosalicylate

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