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GI system Flashcards

1
Q

State the 3 symptoms associated with coeliac disease?

A

Diarrohoea, abdominal pain and bloating

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2
Q

State the only effective treatment for coeliac disease?

A

Strict, life-long gluten-free diet

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3
Q

What is the drug treatment of choice for the confirmed cases of refractory coeliac disease while awaiting specialist advice?

A

Prednisolone

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4
Q

State the symptoms of diverticular disease?

A

Marked lower abdominal pain, malaise, fever, diverticula inflamed and infected, large rectal bleeds.

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5
Q

What is the recommended treatment for symptomatic diverticular disease?

A

High fibre diet (bulk-forming drugs but evidence is lacking)

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6
Q

What is the treatment of uncomplicated diverticulitis?

A

Low residue diet and bowel rest
Antibiotics are only given when patients are immunocompromised / signs of infection

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7
Q

What is the treatment of complicated / severe diverticulitis?

A

Intravenous antibacterials (gram negative organisms / anaerobes) and bowel rest

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8
Q

What surgery is required for patients with diffuse peritonitis?

A

Urgent sigmoid colectomy

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9
Q

State the two-side effect associated with sulfasalazine?

A

Blood disorders and lupus-like syndrome

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10
Q

What should be co-prescribed with methotrexate and why?

A

Folic acid, usually dosage once weekly, why because to avoid methotrexate toxicity

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11
Q

State the symptoms of crohn’s disease?

A

Diarrhoea, abdominal pain, fever, weight loss, rectal bleeding

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12
Q

What is the monotherapy treatment of crohn’s disease?

A

1) Prednisolone or methylprednisolone or IV hydrocortisone (to reduce remission / within first 12 months)
2) Budesonide (distal ileal, ileocaecal or right sided colonic disease)
3) Sulfasalazine / mesalazine§

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13
Q

What is the add-on treatment of Crohn’s disease?

A

1) Azathioprine or mercaptopurine 2) Methotrexate

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14
Q

In patients who are deficient to thiopurine methyltransferase what drug can be added to their Crohn’s treatment?

A

Methotrexate

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15
Q

Specialist treatment of Crohn’s disease?

A

1) Adalimumab or infliximab 2) Vedolizumab

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16
Q

Which two drugs can be used to treat diarrhoea associated with crohn’s disease without colitis?

A

Loperamide or codeine

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17
Q

Which drug is licensed for relief of diarrhoea associated with crohn’s disease?

A

Colestyramine

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18
Q

Which is the treatment of fistulating crohn’s disease?

A

Metronidazole or/and ciprofloxacin

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19
Q

What ages is ulcerative colitis most common in?

A

15-25

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20
Q

What are the complications associated with ulcerative colitis?

A

Secondary osteoporosis
Increased risk of colorectal cancer
Toxic megacolon
Venous thromboembolism

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21
Q

Why is it a risk of using loperamide for relief of diarrhoea in patients with ulcerative colitis?

A

Increases risk of toxic megacolon

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22
Q

State some side effects for aminosalicylates?

A

Blood disorders, lupus-like syndrome, cough, gi discomfort, leucopenia, skin reactions

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23
Q

State one patient and carer advice for patients taking aminosalicylates?

A

To report any unexplained bruising, bleeding, purpura, fever, sore throat, malaise (blood disorders)

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24
Q

What is the monitoring requirement for aminosalicylates?

A

Monitor Renal function before treatment, 3 months and then annually

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25
What do you monitor in breast-fed infants whose mother is taking balsalazide sodium?
Monitor for diarrhoea in infant
26
State common side effects for Sulfasalzine?
Taste altered, urine abnormalities, insomnia, tinnitus, yellow discolouration of bodily fluids
27
State the monitoring requirements for sulfasalazine?
- FBC, white cell count, platelet count initially, and at monthly intervals during first 3 months - LFTs at monthly intervals for first 3 months
28
What is the monitoring requirements for budesonide when used in autoimmune hepatitis?
- LFTs should be done every 2 weeks for 1 month, and then at least every 3months
29
What age is IBS common in?
20-30’s and is more common in women
30
What are the symptoms of IBS?
Abdominal pain, discomfort, diarrhoea or constipation, passage of mucus and bloating
31
State counselling points for patients with IBS?
Increase physical activity - Advised to eat more regularly - Limit fresh fruit consumption to no more than 3 portions a day - Fluid intake mostly water should be increased to 8 cups a day - Sorbitol should be avoided in patients with diarrhoea - Probiotics can be used for 4 weeks
32
State the drug treatment for IBS?
Alverine citrate, mebeverine and peppermint oil all OTC
33
Which drug laxative would you avoid in patients with IBS?
Lactulose due to it causing bloating
34
What can be prescribed if patients who have not responded to laxatives from different classes and who have had constipation for past 12 months for patients with IBS?
Linaclotide
35
State drug treatment for IBS:
1) Antispasmodic, anti-motility, laxatives 2) Low dose TCA, amitriptyline 3) SSRI
36
What are the red flags for constipation?
New onset of constipation especially patients 50+ - Anaemia - Abdominal pain - Blood in stool - Weight loss
37
State the counselling patient for patients with constipation?
Dietary fibre, increase in fluid and exercise advised - Fruits high in fibre and sorbitol and fruit juices high in sorbitol can help prevent and treat constipation - Note: laxative abuse may lead to hypokalaemia
38
How do bulk-forming laxatives work?
Increases the bulk or weight of poo, which in turn stimulates bowel. Onset of action is upto 72 hours
39
State three bulk-forming laxatives?
Sterculia, methylcellulose, Bran, Ispaghula husk
40
How do stimulant laxatives work?
Increases intestinal motility
41
Give examples of stimulant laxatives?
Bisacodyl, sodium picosulfate, senna, docusate, co-danthromer. Onset of action is 6-12 hours.
42
Which laxative acts as a stimulant and faecal softener?
Docusate
43
How do faecal softeners work?
Decreases surface tension and increases penetration of intestinal fluid into faecal mass
44
State 2 side effects for liquid paraffin?
Anal seepage, malabsorption of ADEK fat soluble vitamins, lipoid pneumonia
45
Excessive use of stimulants can cause what?
Hypokalaemia
46
What colour does senna discolour urine?
Yellow-brown
47
What colour does co-danthromer, co-danthrusate discolour urine
Red
48
Which laxative can only be used in females?
Prucalopride
49
What is the management of opioid induced constpation?
1) Stimulant AND osmotic laxative (or docusate) 2) Naloxegol / methylnaltrexone
50
What is the management of chronic constipation?
1) Bulk forming 2) Osmotic laxative macrogol 3) Lactulose 4) Stimulant 5) Prucalopride in women only
51
What is the management of constipation in pregnancy?
1) Bulk-forming 2) Osmotic 3) Biscadoyl / senna / docusate / glycerol
52
Which laxative do you avoid at near term in pregnancy?
Senna
53
What is the management of constipation in breastfeeding?
1) Bulk-forming 2) Lactulose or macrogol 3) Senna / bisacodyL
54
What is the management of constipation in children?
1) Macrogol Laxative + diet modification/behavioural intervention 2) Stimulant 3) Lactulose / faecal stool softener
55
What are the red flags for diarrhoea?
Unexplained weight loss, rectal bleeding, persistent diarrhoea, following course of antibiotics, following foreign abroad travel
56
State two drugs which have diarrhoea as a side effect?
Metformin and Iron supplements
57
What is the treatment of diarrhoea?
1) ORS + appropriate adequate fluid intake 2) Loperamide (also for traveller’s diarrhoea) (and first line for faecal incontinence)
58
Which antibiotic is occasionally used for prophylaxis against traveller’s diarrhoea?
Ciprofloxacin
59
Which drug is licensed as an adjunct to rehydration for the symptomatic treatment of uncomplicated acute diarrhoea in adults and children 3 months+?
Raecadotril
60
What is the maximum amount (in mg) of loperamide an adult can take in one day?
16 mg
61
What are the side effects of loperamide in overdose?
QT prolongation, torsades de pointes, cardiac arrest
62
What should you monitor if a patient has been detected to have consumed large amounts of loperamide?
CNS depression
63
What is the antidote to loperamide?
Naloxone
64
What are the symptoms of dyspepsia?
Upper abdominal pain, fullness, early satiety, bloating and nausea
65
What are the red flags for dyspepsia?
Bleeding, dysphagia, recurrent vomiting, weight loss, blood in stools, new onset dyspepsia in patients 55+ age
66
Treatment for un-investigated dyspepsia?
1) Antacids 2) Proton pump inhibitor for 4 weeks 3) Test for H.pylori infection
67
What is the treatment for investigated functional dyspepsia?
1) Eradication therapy 2) PPI or H2 receptor antagonist
68
What do magnesium containing antacids be like?
Laxative
69
What do aluminium containing acids be like?
Constipating
70
Which ? containing antacid is constipating, neurotoxic and can cause encephalopathy?
Bismuth containing
71
Which ? containing antacid can induce rebound acid secretion and can cause hypercalcaemia, alkalosis and precipitate milk-alkali syndrome?
Calcium containing
72
State a function of simethicone?
Relief of hiccups in palliative care Anti-relief foaming agent to relieve flatulence
73
Which PPI do you have to take 30-60 mins before food?
Lansoprazole
74
What do PPI increase the risk of?
Fractures, osteoporosis, gastric cancer, clostrium difficile, hypomagnesaemia Very low risk of subacute cutaneous lupus erythematosus
75
What is the initial treatment of H.Pylori Infection?
One-week triple therapy with: PPI + clarithomycin + amoxicillin (or metronidazole)
76
What is the test for H.Pylori?
C13-urea breath test
77
Which H2 antagonist can be used in pregnancy?
Ranitidine
78
Side effects of h2 receptor antagonists?
Headaches, rashes, dizziness, diarrhoea, depression, hallucinations, confusion
79
State the common food allergens?
Soya, wheat, nuts, shellfish, eggs, soy, cow’s milk, tree nuts, fish
80
State the licensed treatment of food allergy?
Chlorphenamine
81
State the treatment of food-induced anaphylaxis?
Adrenaline/Epinepherine – know your child and adult doses!
82
State the MHRA safety information for hyoscine butylbromide?
Injection can causes serious effects: tachycardia, hypotension, anaphylaxis (more fatal in those with CHD)
83
When should PPIs not be prescribed
When there is alarm symptoms present as they may mask symptoms of a gi malignancy
84
When should PPIs be stopped pre endoscopy
2 weeks before
85
What are the side effects of PPi
Adverse effects include headache, diarrhoea, nausea, vomiting, abdominal pain, constipation, and dizziness.
86
What are the rare side effects with ppi
Subacute cutaneous lupus erythematosus (SCLE), Severe cutaneous adverse reactions (SCARs) including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) have been reported very rarely, and rarely with omeprazole treatment.
87
What are the long term adverse effects with PPIs
Osteoporosis risk, hypomagnemaesia, c diff infection risk, rebound hypersecretion
88
What are the symptoms of hypomagnamaesia
Muscle twitches, tremor, vomititng, loss of appeitite. Can predispose hypokalaemia and hypocalcaemia
89
What are the known interactions with PPI
Citalopram/escitalopram levels can be increased digoxin warfarin effects enhanced reduced excretion of methotrexate phenytoin effects enhanced reduced absorption of azole antifungals
90
What is the interaction between omeprazole and clopidogrel
antiplatelet effect reduced

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