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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
Q

What do you monitor in breast-fed infants whose mother is taking balsalazide sodium?

A

Monitor for diarrhoea in infant

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26
Q

State common side effects for Sulfasalzine?

A

Taste altered, urine abnormalities, insomnia, tinnitus, yellow discolouration of bodily fluids

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27
Q

State the monitoring requirements for sulfasalazine?

A
  • FBC, white cell count, platelet count initially, and at monthly intervals during first 3 months
  • LFTs at monthly intervals for first 3 months
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28
Q

What is the monitoring requirements for budesonide when used in autoimmune hepatitis?

A
  • LFTs should be done every 2 weeks for 1 month, and then at least every 3months
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29
Q

What age is IBS common in?

A

20-30’s and is more common in women

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30
Q

What are the symptoms of IBS?

A

Abdominal pain, discomfort, diarrhoea or constipation, passage of mucus and bloating

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31
Q

State counselling points for patients with IBS?

A

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

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32
Q

State the drug treatment for IBS?

A

Alverine citrate, mebeverine and peppermint oil all OTC

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33
Q

Which drug laxative would you avoid in patients with IBS?

A

Lactulose due to it causing bloating

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34
Q

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?

A

Linaclotide

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35
Q

State drug treatment for IBS:

A

1) Antispasmodic, anti-motility, laxatives
2) Low dose TCA, amitriptyline
3) SSRI

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36
Q

What are the red flags for constipation?

A

New onset of constipation especially patients 50+
- Anaemia
- Abdominal pain
- Blood in stool
- Weight loss

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37
Q

State the counselling patient for patients with constipation?

A

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
Q

How do bulk-forming laxatives work?

A

Increases the bulk or weight of poo, which in turn stimulates bowel. Onset of action is upto 72 hours

39
Q

State three bulk-forming laxatives?

A

Sterculia, methylcellulose, Bran, Ispaghula husk

40
Q

How do stimulant laxatives work?

A

Increases intestinal motility

41
Q

Give examples of stimulant laxatives?

A

Bisacodyl, sodium picosulfate, senna, docusate, co-danthromer. Onset of action is 6-12 hours.

42
Q

Which laxative acts as a stimulant and faecal softener?

A

Docusate

43
Q

How do faecal softeners work?

A

Decreases surface tension and increases penetration of intestinal fluid into faecal mass

44
Q

State 2 side effects for liquid paraffin?

A

Anal seepage, malabsorption of ADEK fat soluble vitamins, lipoid pneumonia

45
Q

Excessive use of stimulants can cause what?

A

Hypokalaemia

46
Q

What colour does senna discolour urine?

A

Yellow-brown

47
Q

What colour does co-danthromer, co-danthrusate discolour urine

A

Red

48
Q

Which laxative can only be used in females?

A

Prucalopride

49
Q

What is the management of opioid induced constpation?

A

1) Stimulant AND osmotic laxative (or docusate)
2) Naloxegol / methylnaltrexone

50
Q

What is the management of chronic constipation?

A

1) Bulk forming
2) Osmotic laxative macrogol
3) Lactulose
4) Stimulant
5) Prucalopride in women only

51
Q

What is the management of constipation in pregnancy?

A

1) Bulk-forming
2) Osmotic
3) Biscadoyl / senna / docusate / glycerol

52
Q

Which laxative do you avoid at near term in pregnancy?

A

Senna

53
Q

What is the management of constipation in breastfeeding?

A

1) Bulk-forming
2) Lactulose or macrogol
3) Senna / bisacodyL

54
Q

What is the management of constipation in children?

A

1) Macrogol Laxative + diet modification/behavioural intervention
2) Stimulant
3) Lactulose / faecal stool softener

55
Q

What are the red flags for diarrhoea?

A

Unexplained weight loss, rectal bleeding, persistent diarrhoea, following course of antibiotics, following foreign abroad travel

56
Q

State two drugs which have diarrhoea as a side effect?

A

Metformin and Iron supplements

57
Q

What is the treatment of diarrhoea?

A

1) ORS + appropriate adequate fluid intake
2) Loperamide (also for traveller’s diarrhoea) (and first line for faecal incontinence)

58
Q

Which antibiotic is occasionally used for prophylaxis against traveller’s diarrhoea?

A

Ciprofloxacin

59
Q

Which drug is licensed as an adjunct to rehydration for the symptomatic treatment of uncomplicated acute diarrhoea in adults and children 3 months+?

A

Raecadotril

60
Q

What is the maximum amount (in mg) of loperamide an adult can take in one day?

A

16 mg

61
Q

What are the side effects of loperamide in overdose?

A

QT prolongation, torsades de pointes, cardiac arrest

62
Q

What should you monitor if a patient has been detected to have consumed large amounts of loperamide?

A

CNS depression

63
Q

What is the antidote to loperamide?

A

Naloxone

64
Q

What are the symptoms of dyspepsia?

A

Upper abdominal pain, fullness, early satiety, bloating and nausea

65
Q

What are the red flags for dyspepsia?

A

Bleeding, dysphagia, recurrent vomiting, weight loss, blood in stools, new onset dyspepsia in patients 55+ age

66
Q

Treatment for un-investigated dyspepsia?

A

1) Antacids
2) Proton pump inhibitor for 4 weeks
3) Test for H.pylori infection

67
Q

What is the treatment for investigated functional dyspepsia?

A

1) Eradication therapy
2) PPI or H2 receptor antagonist

68
Q

What do magnesium containing antacids be like?

A

Laxative

69
Q

What do aluminium containing acids be like?

A

Constipating

70
Q

Which ? containing antacid is constipating, neurotoxic and can cause encephalopathy?

A

Bismuth containing

71
Q

Which ? containing antacid can induce rebound acid secretion and can cause hypercalcaemia, alkalosis and precipitate milk-alkali syndrome?

A

Calcium containing

72
Q

State a function of simethicone?

A

Relief of hiccups in palliative care
Anti-relief foaming agent to relieve flatulence

73
Q

Which PPI do you have to take 30-60 mins before food?

A

Lansoprazole

74
Q

What do PPI increase the risk of?

A

Fractures, osteoporosis, gastric cancer, clostrium difficile, hypomagnesaemia Very low risk of subacute cutaneous lupus erythematosus

75
Q

What is the initial treatment of H.Pylori Infection?

A

One-week triple therapy with: PPI + clarithomycin + amoxicillin (or metronidazole)

76
Q

What is the test for H.Pylori?

A

C13-urea breath test

77
Q

Which H2 antagonist can be used in pregnancy?

A

Ranitidine

78
Q

Side effects of h2 receptor antagonists?

A

Headaches, rashes, dizziness, diarrhoea, depression, hallucinations, confusion

79
Q

State the common food allergens?

A

Soya, wheat, nuts, shellfish, eggs, soy, cow’s milk, tree nuts, fish

80
Q

State the licensed treatment of food allergy?

A

Chlorphenamine

81
Q

State the treatment of food-induced anaphylaxis?

A

Adrenaline/Epinepherine – know your child and adult doses!

82
Q

State the MHRA safety information for hyoscine butylbromide?

A

Injection can causes serious effects: tachycardia, hypotension, anaphylaxis (more fatal in those with CHD)

83
Q

When should PPIs not be prescribed

A

When there is alarm symptoms present as they may mask symptoms of a gi malignancy

84
Q

When should PPIs be stopped pre endoscopy

A

2 weeks before

85
Q

What are the side effects of PPi

A

Adverse effects include headache, diarrhoea, nausea, vomiting, abdominal pain, constipation, and dizziness.

86
Q

What are the rare side effects with ppi

A

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
Q

What are the long term adverse effects with PPIs

A

Osteoporosis risk, hypomagnemaesia, c diff infection risk, rebound hypersecretion

88
Q

What are the symptoms of hypomagnamaesia

A

Muscle twitches, tremor, vomititng, loss of appeitite. Can predispose hypokalaemia and hypocalcaemia

89
Q

What are the known interactions with PPI

A

Citalopram/escitalopram levels can be increased
digoxin
warfarin effects enhanced
reduced excretion of methotrexate
phenytoin effects enhanced
reduced absorption of azole antifungals

90
Q

What is the interaction between omeprazole and clopidogrel

A

antiplatelet effect reduced

PRE REG (24 decks)

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