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GI system > GI system > Flashcards

GI system Flashcards

1
Q

list 4 examples of chronic bowel disorders

A

coeliac disease
diverticular disease and diverticulitis
inflammatory bowel disease
short bowel syndrome

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2
Q

what are the 3 most common symptoms in bowel disorders?

A

ADR
abdominal pain
diarrhoea
rectal bleeding

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3
Q

what is coeliac disease?

A

autoimmune disease causes inflammation of small intestines triggered by gluten. can cause malabsorption of nutrients

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4
Q

what are the 4 symptoms of coeliac disease?

A 
ABCD
abdominal pain
bloating
constipation
diarrhoea
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5
Q

what could be a complication of malabsorption of nutrients from coeliac disease?

A

osteoporosis / bone disease

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6
Q

what are the different drug treatment options for coeliac disease?

A
  • vitamin supplements eg vit C, D and folic acid
  • osteoporosis/bone treatment
  • prednisolone [as initial treatment]
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7
Q

what is diverticular disease?

what is the prevalence for this disease?

A

diverticular [bulges] develop on small intestine

over 40 year olds

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8
Q

what are the symptoms of diverticular disease? [4]

A

abdominal pain, constipation, diarrhoea, rectal bleeding

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9
Q

what is the non-drug treatment for diverticular disease?

what is the drug treatment for diverticular disease?

A

non drug: lifestyle exercise, stop smoking, weight loss, healthy eating
drug: paracetamol, anti-spasmodics for abdominal cramps, bulk forming laxatives

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10
Q

what is diverticulitis?

what symptoms are associated with this disease

A
  • diverticula that forms becomes inflamed/ infected

- severe abdominal pains, fistula [hole], fever, malaise, rectal bleeding

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11
Q

what is the drug treatment options of diverticulitis?

A 
high fibre diet
bran supplements
bulk forming laxative
paracetamol
antibiotics
antispasmodics
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12
Q

what 2 conditions come under the umbrella term if inflammatory bowel disease?

A

crohns disease and ulcerative colitis

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13
Q

what is the difference between crohns disease and ulcerative colitis?

A

crohns disease: affects whole intestinal system from mouth to anus

ulcerative colitis: affects colon only [large intestine]

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14
Q

what age group is mostly affected by ulcerative colitis?

A

15 - 25 years

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15
Q

what are the symptoms of inflammatory bowel diseases?

A 
abdominal pain
rectal bleeding
diarrhoea
fever
weight loss
anal fissure
ulcers
anaemia
mouth ulcers
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16
Q

what are some other less common symptoms of inflammatory bowel diseases? [3]

A

skin rash
inflammation/painful joints
liver inflammation

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17
Q

what are the complications of crohns disease? [4]

A

fistula [hole]
perforation
stricture [narrowing of GI tract]
cancer

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18
Q

what are the non drug treatment of crohns? [3]

A

stress management
diet
stop smoking

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19
Q

what are some drugs that can be used to treat inflammatory bowel disease? [5]

A
  • antibiotics
  • aminosalicylates [eg mesalazine, sulphasalazine]
  • steroids eg prednisolone
  • immunosuppressants: eg methotrexate, azathioprine, mercaptopurine
  • biological therapy monoclonal antibodies: infliximab
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20
Q

the following question is related to mild to moderate ulcerative colitis:

what is the 1st line, 2nd line and then 3rd line treatment of proctitis? [rectal inflammation]

A

1st line: topical aminosalycilate
2nd line: after no improvement after 4 weeks then add oral aminosalycilate
3rd: if no improvement add oral or topical corticosteroid for 4-8 weeks

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21
Q

the following question is related to mild to moderate ulcerative colitis:

what is the 1st line and 2nd line treatment for proctosigmoiditis and left sided ulcerative colitis?

A

1st line: topical aminosaliylate

2nd line: if no improvement after 4 weeks then add high dose oral aminosalicylate

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22
Q

the following question is related to mild to moderate ulcerative colitis:

what is the 1st line treatment of extensive ulcerative colitis?

A

1st line: topical aminosalycilate and high dose oral aminosalycilate

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23
Q

what is the treatment for acute severe life threatening ulcerative colitis?

A

iv corticosteroids [eg methylprednisolone/hydrocortisone] and infliximab

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24
Q

what can be used to maintain remission in mild, moderate or severe ulcerative colitis?
what must be avoided?

A

aminosalicylates

avoid corticosteroids

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25
Q

which 2 drugs are used when remission is not being maintained with aminosalicylates or when there has been 2 or more exacerbations in a 12 month period that required treatment with corticosteroids?

A

azathioprine or mercaptopurine [unlicensed]

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26
Q

give an example of older aminosalycilates and a side effect associated with them?

A

sulfasalazine

stains contact lenses

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27
Q

give examples of newer aminosalycilates

A

mesalazine , balsalazide, olsalazine

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28
Q

what is the patient and carer advice for aminosalycilates?

A

report any bone marrow suppression / blood disorder signs and symptoms eg sore throat, bruising, bleeding

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29
Q

what must you monitor with aminosalycilates?

A

renal function before starting treatment, at 3 months and then annually

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30
Q

what are the side effects associated with amino salicylates [2]
what side effects are associated with sulfasalazine? [2]

A
  • nephrotoxicity and salicylate hypersensitivity

- yellow/orange body fluids and soft contact lenses stained

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31
Q

what is irritable bowel disease?

who does it mostly affect?

A

long term chronic condition of bowel

women. 20-30 year olds

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32
Q

what are the symptoms of irritable bowel disease?

A

abdominal pain
either constipation or diarrhoea
bloating

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33
Q

what is the non drug treatment of irritable bowel syndrome?

A
  • increase soluble fibre
  • diet lifestyle exercise
  • increase water intake
  • reduce alcohol , caffeine, fizzy drinks
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34
Q

what kinds of drugs may be used for irritable bowel disease?

A

antispasmodics, antimuscarinics [eg mebeverine, hyoscine]
loperamide [diarrhoea]
peppermint oil [bloating]
anti depressants and SSRIs [amitriptyline and fluoxetine] unlicensed but for those who do not respond to laxatives]

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35
Q

what are the causes of constipation? [5]

A 
pregnant
medications [eg codeine, opioids]
medical conditions eg IBS
little fluid intake
little fibre intake
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36
Q

what are the red flag symptoms of constipation? [5]

A 
50 years and over
anaemia
blood in stools
weight loss
abdominal pain
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37
Q

what are the different types of laxatives for constipation use?

A 
boss
bulk forming
osmotic
stimulant
softeners
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38
Q

what are some examples of bulk forming laxatives?

A

bran, isphagula husk, methylcellulose

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39
Q

what is the mechanism of action of bulk forming laxatives?

what is the onset of action?

A

increases bulk in stool

up to 72 hours

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40
Q

what are some symptoms that bulk forming laxatives can cause?

A

bloating, cramping, flatulence

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41
Q

what are some examples of stimulant laxatives?

what is the mechanism of action of them?

A
  • senna, sodium picosulfate, glycerol, bisacodyl, co-danthramer

increases intestinal motility

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42
Q

which stimulant laxative is reserved for terminally ill patients and why?

A

co-danthramer

carcinogenic and colours urine red

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43
Q

what is the onset of action of stimulant laxatives?

is this different with suppositories?

A

8-12 hours

suppositories take 20-30 mins

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44
Q

when are stimulant laxatives recommended to be taken during the day?

A

at bed time

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45
Q

what are the side effects of stimulant laxatives?

A

abdomina pain

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46
Q

what is the MHRA warning of stimulant laxatives?

what are the new restrictions associated with this warning?

A

misuse and abuse causing hypokalaemia
dietary and other laxatives 1st line before stimulant laxatives, children under 12 unable to buy otc, pack size limited to 2 short term courses

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47
Q

give an example of faecal softeners

what is their mechanism of action?

A

liquid paraffin, docusate sodium, peanut [arachis]

wets and softens the stools, increases penetration of liquid into stool

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48
Q

what are some examples of osmotic laxatives?

what is the mechanism of action?

A

lactulose and macrogols

either maintains or increases fluid in bowel

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49
Q

why is lactulose [osmotic] unsuitable for immediate relief of constipation?

A

takes up to 2 days to work

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50
Q

what is the management of short duration constipation, constipation in pregnancy and chronic constipation?

A

spc is BOS

bulk forming first, then can either add or switch to osmotic laxatives then use stimulant if no improvement

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51
Q

what is the management of opioid induced constipation, constipation with faecal impaction, constipation in children?

A

focos children

OS- osmotic and stimulant first line

52
Q

what can be used to treat opioid induced constipation in patients that have shown no response to laxatives?

A

naloxegol and methylnaltrexone

53
Q

what class of laxatives is fybogel and laxido?

A

fybogel: isphagula husk bulk forming

laxido - osmotic

54
Q

what are the 2 types of diarrhoea?

A

acute: lasting less than 14 days and symptoms improve after 2-4 days
chronic: more than 14 days

55
Q

what are the causes of diarrhoea? [4]

A

gastroenteritis [inflammation of stomach/intestines]
drug side effects
GI disorders
infection

56
Q

what is the aims of treatment for diarrhoea?

A

prevent dehydration and loss of electrolytes/nutrients

57
Q

what are the signs of dehydration?

A 
tiredness
headache
light headache
muscle cramps
sunken eyes
dry mouth
weakness
reduced urine
confusion
58
Q

what are the red flags of diarrhoea?

A
  • recent hospital/antibiotic treatment
  • weight loss
  • persistant diarrhoea
  • rectal bleeding
  • systemic illness
  • recent foreign travel
59
Q

what is the non drug and drug treatment of diarrhoea?

A

drink lots of fluid and eat as normal

loperamide and oral rehydration sachets

60
Q

what can you use as occasional prophylaxis for travellers diarrhoea?

A

ciprofloxacin

61
Q

what is dyspepsia?

A

range of upper GI symptoms that can last for 4 or more weeks

62
Q

what are the symptoms of dyspepsia?

A 
upper abdominal pain
fullness
early satiety
bloating 
nausea
63
Q

what are the red flags of dyspepsia?

A 
bleeding
difficulty swallowing [dysphagia]
weight loss
55 years or over
recurrent vomiting
64
Q

what are the lifestyle advice for dyspepsia?

A

raise head of bed bc of heartburn
stop medication that causes dyspepsia
alcohol, smoking, lifestyle diet etc

65
Q

what is the treatment options for dyspepsia?

A

life style
antacids
PPI up to 4 weeks
test for h.pylori

66
Q

what is GORD and what are the symptoms?

A

gastro oesophageal reflux disease

heart burn
acid regurgitation
dysphagia
ulceration

67
Q

what are the treatment options for gord?

A

PPI
alginates
h2 receptor antagonists
antacids

68
Q

what is the management of gord in pregnancy?

A

diet and lifestyle changes first
then antacids and alginates
then ranitidine
then omeprazole

69
Q

what is the management of GORD in infants and older children?

A

treat older children like adults

infants: change frequency and volume of feed and use feed thickener

70
Q

what is a side effect of aluminium [antacids]

and magnesium?

A

aluminium - constipating

magnesium - laxative

71
Q

when during the day is it advised to take antacids?

A

after meals and at bedtime

72
Q

why must you not take antacids together with modified release medication?

A

because it can damage the enteric coating of some modified release preparations

73
Q

which types of patients is sodium bicarbonate antacid not suitable for?

A

has high sodium content so not suitable for people with high BP, ppl on lithium and on salt restriction diets

74
Q

why can you not take antacids together with medication eg tetracyclines?

A

affect absorption, take antacids 1/2 hr before or after other medication

75
Q

name the 4 different antacids?

A 
scam
sodium bicarbonate
calcium carbonate
aluminium hydroxide 
magnesium hydroxide
76
Q

list some examples of proton pump inhibitors?

A

omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole

77
Q

list some indications of proton pump inhibitors?

A 
gastric and duodenal ulcers
GORD
dyspepsia
nsaid associated ulcers
h.pylori
zollinger ellison syndrome
78
Q

what are the 3 P’s of PPIs

A

porous bones - osteoporosis/bone fracture
possible gi infections - c.diff
prevents holes - ulcers

79
Q

what are the cautions of PPIs?

A

osteoporosis/bone fracture risk
gi infections risk increased
masks symptoms of gastric cancer
lupus risk [low risk]

80
Q

what is the MHRA advice with PPIs?

A

low risk of lupus [SCLE] when skin exposed to sun - lesions appear on skin
advice pt to not expose skin to sun

81
Q

which is the only PPI safe in pregnancy?

A

omeprazole

82
Q

what are the 2 important interactions with PPIs and explain them

A

methotrexate - omeprazole decreases clearance of methotrexate
clopidogrel - omeprazole decreases efficacy

83
Q

what drugs are used in triple therapy of H.pylori?

A

ppi
clarithromycin
amoxicillin/metronidazole

84
Q

what is the triple therapy treatment choice of H.pylori for a patient who is allergic to penicillin?

A

metronidazole, ppi, clarithromycin

PCM

85
Q

what is the triple therapy treatment choice for h.pylori for a patient who is not allergic to penicillin?

A

amoxcillin or metronidazole
clarithromycin
ppi

pac or pam

86
Q

for each PPI below, write down the doses for h.pylori eradication

omeprazoe
lansoprazole
esomperazole
pantoprazole
rabeprazole
A

omeprazole: 20-40mg twice daily
lansoprazole: 30mg twice daily
esomeprazole: 20mg twice daily
pantoprazole: 40mg twice daily
rabeprazole: 20mg twice daily

87
Q

what are some diagnostic tests used to diagnose H.pylori?

A

urea 13c breath test
stool helicobacter antigen test
lab based serology

88
Q

what are the 3 public health england advice for preventing false negatives with H.pylori?

A
  • do not test 4 weeks after antibiotic treatment
  • do not test 2 weeks after ppi treatment
  • retesting for h.pylori should be performed 4 weeks after treatment
89
Q

what are gastroprotective complexes and chelators?

what are they used for?

A

complex of aluminium and sucrose eg sucralfate

used to protect mucosa from acid pepsin attack in gastric ulcers

90
Q

what is a caution of chelators?

A

in intensive care pt can cause bezoar formation [solid indigestible mass]

91
Q

when during the day must you give chelators?

A

1 hour BEFORE meals and at bedtime

92
Q

list some examples of h2 receptor antagonists

which one is the safest in pregnancy?

A

ranitidine, cimetidine, famotidine

ranitidine

93
Q

which h2 receptor antagonist is an enzyme inhibitor and interacts with many drugs?

A

cimetidine

94
Q

what is a caution of h2 receptor antagonist?

A

masks symptoms of gastric ulcers

95
Q

what are the common side effects of h2 receptor antagonists?

A

diarrhoea, constipation, fatigue, headache, dizziness

96
Q

what is misoprostol used for?

A

healing of gastric and duodenal ulcers

termination of pregnancy

97
Q

what is the conception and contraception advice for misoprostol?

A

avoid in child bearing potential women unless pregnancy has been excluded
wear effective contraception

98
Q

what is the management of food allergies>

A

avoid the triggering food

sodium cromoglicate

99
Q

what drug can be used for symptomatic control of food allergy?

A

chlorphenamine maleate

100
Q

what drug is used for food induced anaphylaxis?

A

adrenaline

101
Q

what are some side effects of anti-muscarinic drugs?

A

cant see - blurred vision
cant pee - urinary retention
cant shit - constipation
cant spit - dry mouth

102
Q

what BMI is classed as obesity?

A

over 30

103
Q

in which patients is anti-obesity medication allowed in?

A
  • pt with bmi over 28 and risk factors

- pt with bmi over 30 who have had no results after 3 months of diet, exercise

104
Q

which drug is the only licensed drug in the uk for weight loss?
what is the dose?

A

orlistat

120mg up to 3 times a day

105
Q

when can you continue treatment in a patient with orlistat?

A

if after 3 months, weight loss exceeds 5%

106
Q

what bmi is bariatric surgery considered in?

A

bmi over 40

bmi over 35-39.9 with risk factors eg diabetes

107
Q

/what are the symptoms of anal fissure

A

bleeding
linear tear in anal mucosa
pain on defecating

108
Q

what is the drug treatment for ACUTE anal fissure [lasts less than 6 weeks]

A

bulk forming laxatives [or osmotic]
topical anaesthetics eg lidocaine
simple analgesics

109
Q

what is the drug treatment for chronic anal fissure [lasts more than 6 weeks]?

A

glyceryl trinitrate rectal ointment

oral/topical diltiazem or nifedipine

110
Q

what is haemorrhoids and what are the 2 types?

A

abnormal swelling around anus

internal: painless
external: painful or itchy

111
Q

what kinds of ppl is haemorrhoids common in?

A

pregnant women

112
Q

what is the non drug treatment of haemorrhoids?

A

dietary fibre
increase fluid intake
good anal hygiene

113
Q

what is the treatment of haemorrhoids in pregnant women?

what drugs must you avoid?

A

bulk forming laxatives. topical haemorrhoidal preparations

avoid corticosteroids and anaesthetics

114
Q

what is the drug treatment for haemorrhoids?

A

bulk forming laxative for constipation
simple analgesia
topical anaesthetic cream, corticosteroids, astringents

115
Q

how many days are topical corticosteroids allowed to be used for for haemorrhoids?

A

7 days

116
Q

what is exocrine pancreatic insufficiency?

A

reduced secretion of pancreatic enzymes into duodenum

117
Q

what are the symptoms of exocrine pancreatic insufficiency?

A

diarrhoea
abdominal cramps
fat in stool
maldigestion and malnutrition

118
Q

what is the drug treatment of exocrine pancreatic insufficiency?

A

pancreatic enzyme replacement therapy with pancreatin eg creon

119
Q

what is a stoma?

what are the 2 main types of stoma?

A

an artificial opening on the abdomen to divert the flow of urine and faeces into external pouch

colostomy and ileostomy

120
Q

what types of formulation of medication are not allowed in patients with stoma?

A

enteric coated or modified release
soluble tablets
liquids , capsules and uncoated tablets

121
Q

what ingredient in medicines is not allowed in people with stoma and why

A

sorbitol due to laxative effects

122
Q

what analgesics is the only one allowed in patients with stoma?

A

paracetamol

123
Q

what is the risk of alginates in people with stoma?

A

diarrhoea with magnesium and constipation with aluminium increased

124
Q

what is the risk of using digoxin in patients with stoma?

A

hypokalaemia risk

125
Q

why should you use diuretics with caution in patients with a stoma? which type of diuretic is best?

A

risk of potassium depletion

use potassium sparing diuretics

126
Q

which route of administration for iron is preferred in patients with a stoma?

A

im route.

oral route causes loose stools and sore skin

GI system (1 decks)

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