Gi System 1/2 Flashcards
Short bowel syndrome nutritional deficiencies?
Vit ADEK, B12
Essential Fatty Acids
Zinc
Selenium
What to treat short bowel syndrome with- diarrhoea and high stomach output?
Loperamide and Codeine
Anal fissure symptoms?
Tear or ulcer in anal canal so:
Bleeding and pain when pooing
Anal fissure acute treatment?
Bulk forming laxatives or Osmotic laxatives
Can also use short term topical such as lidocaine
Pregnancy acute management of anal fissures?
DO NOT USE LIDOCAINE
Chronic management of Anal fissure?
GTN Rectal if 6 weeks or longer
Topical/oral Diltiazem or Nifedipine
(Low adverse effects)
Specialist: Botox
Haemorrhoids which pain relief to not use?
Opioids - cause constipation
NSAIDS - Exacerbate Rectal bleeding
Pregnancy with Haemorrhoid?
Bulk forming laxative
Haemorrhoids - HIGH RISK DURING PREGANANCY
Loperamide ages in OTC And RX?
OTC: 12yrs+
Rx: 4yrs+
Lopermaide MHRA warning?
QT PROLONGATION!!
Serious cardiac reaction with high doses
Loperamide overdose treatment?
Naloxone
Loperamide dose?
1-2 doses (2-4mg) first then one with every stool Max 8 doses (16mg) per day
IBS non drug treatment?
- Increase exercise
- Eat reg meals
- 8 cups of water atleast
- Avoid sorbitol in diarrhoea
- Reduce stress/cafeine/alcohol
- Fresh fruit 3/day
Which laxative to not use in IBS and why?
Lactulose - CAUSES BLOATING
If OTC IBS relief doesn’t work what unlicensed other drug can be used?
TCA LOW DOSE - Amitriptyline
If TCA doesn’t work —> SSRI
Unlicensed use
Impaired bile formation called what?
Cholestasis
Cholestatic pruritis treated by?
- Cholestyramine
- Ursodeoxycholic acid
- Rifampacin
Cholestasis and pregnancy?
When does it occur? Treatment?
Usually occurs late pregnancy
Treatment for Pruiritis:
Ursodeoxycholic acid
Gallstone left untreated can lead to?
Biliary Colic, Cholecystitis, Pancreatitis
Gallstone drug treatment? Mild-mod pain? Severe pain?
Mild to moderate pain -> Paracetamol/NSAID
SEVERE: IM Diclofenac
Exocrine Pancreatitis insufficiency treatment?
Pancreatic enzyme replacement (Pancreatin)
Pancreatin contains which enzymes?
Lipase
Amylase
Protease
Why should Pancreatin be taken with food/meals?
Prevents early breakdown
Pt’s who have both Cystic fibrosis and Pancreatic insufficiency?
Fibrosis colonopathy at high does can occur
Cystic fibrosis and pancreatic insufficiency maximum dose of lipase daily?
Maximum 10,000 units/kg/day
What signs or symptoms should be reported in Cystic fibrosis, pancreatic insufficiency pt?
New abdominal signs
^^^looking for fibrosing colonopathy
Monitor what in pancreatitis insufficiency?
Monitor Levels of:
Fat soluble vitamins & Micronutrients
Give supplements when needed
Which formulation of drugs should NOT be used in stoma care?
MR or Enteric coating
Insufficient effect of drug
Need quick action formulations
What can cause diarrhoea, nutrients? (Especially in stoma care)
- Sorbitol
- Magnesium Antacids
- Iron (ileostomy)
What can cause constipation, Drugs/nutrients? (Especially in stoma care)
- Opioids,
- Calcium Antacids,
- Iron (Colostomy)
What can cause Gi Irritation, Drugs? (Especially in stoma care)
Aspirin + NSAIDS
Diuretics/Laxatives can cause dehydration therefore what electrolyte imbalance?
Hyperkalaemia
Digoxin toxicity can occur in stoma care due to what reason?
Hypokalaemia occurring as fluids and Na Depletes
Therefore causing Digoxin Toxicity
