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pre reg Thammis cards > GI system (medium) > Flashcards

GI system (medium) Flashcards

1
Q

what are the symptoms of celiacs and how would you manage this

A

diarrhoea = loperamide
bloating/ abdominal pain = simeticone

avoid gluten

malnutrition = vitamin D, calcium and another vitamin (under specialist)

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2
Q

how would you treat refractory coeliacs

A

prednisolone

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3
Q

what is the difference between diverticulosis and diverticulitis

A

diverticulosis = small pouches in colon but asymptomatic

diverticulitis = small pouched in colon with symptoms: abdominal pain, diarrhoea, constipation, rectal bleed

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4
Q

what is acute diverticulitis

A

when pouches of the colon become inflamed or infected

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5
Q

what is complicated diverticulitis

A

when abscess, perforation, fistulas, sepsis and haemorrhage occur

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6
Q

management of diverticular disease

A

increase fibre
bulk-forming laxatives
paracetamol for pain if needed

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7
Q

complications of crohns disease

A

fistulas
anaemia/ malnutrition
colorectal/ bowel cancers
growth failure/ delayed puberty in children
arthritis, joint pain, eyes, liver, skin conditions

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8
Q

non- drug management of crohns

A

smoking cessation

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9
Q

what can be used to treat diarrhoea in crohns disease

A

loperamide
codeine
colestyramine

avoid in UC !!

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10
Q

how to treat the first acute exacerbation of crohns disease

A

1st line: glucocorticoid therapy (prednisolone, IV hydrocortisone, Methylpred)

2nd line: budesonide (used for distal, ileal, ileococcal, right sided disease)

3rd line: aminosalicylates = mesalazine, sulfasalazine (not as effective but less SE)

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11
Q

treatment for acute exacerbation if more than 2 flare ups in a year

A

1st line: azathioprine or mercaptopurine

2nd line: Methtorexate (used if TPMT deficient/ intolerant to 1st line)

severe: monoclonal antibody (specialist) - adalimumab or infliximab (2nd line Vedolizumab)

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12
Q

maintenance therapy for crohns disease

A

1st line: azathioprine or mectaptopurine

2nd line: MTX (only if used for acute exacerbation/ intolerant to 1st line/ low TPMT)

corticosteroid/ budesonide should NOT be used

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13
Q

maintenance therapy for crohns after surgery

A

1st line: azathioprine + metronidazole

or azathioprine alone if metronidazole not tolerated

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14
Q

management in Crohns disease with symptomatic fistulas/ won’t heal and the maintenance management

A

metronidazole +/- ciprofloxacin

metronidazole only used for 1 month due to risk of peripheral neuropathy

maintenance management:
azathioprine or mercaptopurine
mAb if above not tolerated/ low TPMT: infliximab

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15
Q

complications fo ulcerative colitis

A

osteoporosis
colorectal cancer
VTE
toxic megacolon

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16
Q

1st line for acute UC

A

topical aminosalicylate (suppositories or enema)

in extensive colitis: topical aminosalicylate + high dose oral aminosalicylate

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17
Q

2nd line management for acute UC in proctitis, proctosigmoiditis, and extensive colitis

A

proctitis: oral aminosalicylates
proctosigmoiditis: oral aminosalicylates OR switch to high dose oral aminosalicylates + 4-8 weeks of oral corticosteroids

extensive colitis: high dose oral aminosalicylates + 4-8 weeks of oral corticosteroids
if oral aminosalicylates CI use oral corticosteroids

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18
Q

3rd line management of crohns proctitis and proctosigmoiditis

A

proctitis: topical or oral corticosteroid for 4-8 weeks
proctosigmoiditis: oral aminosalicylates + oral corticosteroid for 4-8 weeks

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19
Q

which anti-diarrhoea medication should be avoided in UC? what may this cause

A

loperamide,
codeine

toxic megacolon

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20
Q

what are the 1st, 2nd and 3rd line management of crohns disease in an emergency/ life threatening situation

A

1st line: IV hydrocortisone or methylprednisolone + surgery assessment

2nd line: IV cyclosporin OR surgery

3rd line/ no improvement of symptoms after 72 hours: IV ciclosporin + IV steroids OR surgery

use infliximab if ciclosporin CI

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21
Q

maintenance treatment for UC:

proctitis/ proctosigmoiditis, left sided/ extensive, >2 flares in 1 year

A

proctitis/ proctosigmoiditis: rectal +/- oral aminosalicylates

left sided/ extensive: low dose oral aminosalicylates

> 2 flares in 1 year: oral azathioprine or mercaptopurine
if no improvement give mAb

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22
Q

what are the monitoring parameters for aminosalicylates

A

nephrotoxic: monitor kidneys before starting, at 3 months then annually
hepatotoxic: monitor liver monthly for first 3 months

blood disorders: monthly for first 3 months - stop if signs of blood dyscrasia

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23
Q

counselling of aminosalicylates

A

CI: salicylate hypersensitivity

counselling: may colour bodily fluids orange/ yellow

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24
Q

what are the 4 categories/ drugs of IBS treatment OTC 1st line

A

antispasmodics: mebeverine, alverine, peppermint oil
laxatives: NOT lactulose

loperamide

antimuscarinics: hyoscine butyl bromide (Avoid in cardiac disease), atropine

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25
Q

2nd line treatment for IBS pain

A

low dose TCA: amitriptyline (UL)

SSRI if TCA doesnt work

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26
Q

management for short bowel syndrome (Shortened bowel due to surgery)

A

replacement of vitamins due to lack of absorption: vitamin AB12DEK, essential fatty acids, selenium and zinc

diarrhoea/ high output stoma: loperamide and codeine

27
Q

what are the red flags of constipation

A

BAAWN

Blood in stools
anaemia
abdominal pain
weight loss
new onset of constipation if over 50 years old
28
Q

what medications may cause constipation

A

opioids
iron preparations,
aluminium
clozapine

29
Q

what are stimulant laxatives, how long does it take to work and what are the CI

A

Senna, docusate, co-danthromer, bisacodyl…

6-12 hours to work

CI: intestinal obstruction

co-dantrhomer and co-danhtrusate are carcinogenic and only used in palliative care - can cause red urine

30
Q

what are the bulk forming laxatives, how long does it take to work, what are the CI/ counselling

A

ispaghula husk, methyl cellulose, sterucilra

takes 2-3 days to work

CI: opioid induced - causes facecal impaction

counselling: need to have adequate hydration

31
Q

osmotic laxatives and how long it takes to work

A

lactulose, MgOH, macrogols

2-3 days

32
Q

stool softeners, how long it takes to work

A

docusate, glycerol, liquid paraffin

works quickly
docusate enema can take 5-20 minutes

avoid liquid paraffin due to anal seepage, lipid pneumonia on aspiration and GIT issues

33
Q

what laxative is used for opioid induced constipation

A

osmotic + stimulant

if no response: naloxegol

AVOID: BULK FORMING

34
Q

what laxatives can be used in pregnancy and breastfeeding

A

dietary/ lifestyle
1st line: bulk forming
2nd line: osmotic- lactulose
3rd line: bisacodyl or Senna but avoid Senna near term

35
Q

what laxatives can be used in children

A

1st line: dietary + Macrogol
2nd line: add or switch to stimulant

if stool hard use lactulose or docusate

36
Q

what laxatives are used in faecal impaction (hard and soft stools)

A

hard stools: macrogols first then stimulant

soft stools: stimulant

persistant: rectal bisacodyl +/- glycerol

37
Q

management of travellers diarrhoea

A

adequate rehydration
loperamide
avoid if suspected infection

38
Q

management of diarrhoea of faecal incontinence

A

loperamide

39
Q

licensing of loperamide, counselling and treating overdose

A

OTC >12 years
counselling: take 1-2 doses first then 1 with every loose stool (max 8 tablets per day

overdose reversal: naloxone

40
Q

referral symptoms for dyspepsia and GORD

A

over 55
GI bleed
unexplained weight loss
dysphagia

41
Q

treatment of uninvestigated dyspepsia

A

PPI for 4 weeks

if this doesnt work test for H pylori and treat if positive

42
Q

treatment of functional (investigated dyspepsia)

A

if H pylori - treat

if no cause:
PPI or H2 antagonist for 3 weeks

43
Q

diagnosis of H pylori

A

urea breath test (13C) or stool helicobacter test

stop PPI for 2 weeks prior to tets
stop antibiotics 4 weeks prior to test

44
Q

treatment of h pylori

A

triple therapy BD for 7 days

PPI
amoxicillin 1g BD 
clarithromycin 500mg BD
Metronidazole 400mg BD 
(choose 2/3 antibiotics but usually amoxicillin unless penicillin allergy)
45
Q

what drugs can cause GORD

A

Alpha/ beta blockers, bisphosphonates, anticholinergics, benzodiazepines, NSAIDs, TCAs, nitrates, corticosteroids

46
Q

treatment of uninvestigated GORD

A

PPI for 4

if no improvement check for H pylori and treat if positive

47
Q

treatment of confirmed GORD

A

PPI 4-8 weeks

if no response -> H2 antagonist

48
Q

management of GORD in pregnancy

A

antacids or alginates

omeprazole and ranitidine can be used (UL)

49
Q

side effects of aluminium, magnesium and calcium antacids

A

aluminium: cosntipation
magnesium: diarrhoea
calcium: induces rebound acid secretion

50
Q

interactions of antacids

A

antacids should not be taken with other drugs as it may impair the absorption (bisphosphonates, tetracyclines, ciprofloxacin)

high sodium content- avoid in hypertension/ lithium/ CVD/ renal failure

increased concentration when given with MTX, phenytoin, warfarin and digoxin

51
Q

MHRA warning of PPIs

A

risk of subacute cutaneous lupus erythematous

52
Q

risks and side effects of omperazole

A

fractures/ osteoporosis
C.diff
may mask symptoms of gastric cancer

53
Q

interactions of H2 antagonsits

A

reduces absorption of azalea antifungals

54
Q

what is cholestatsis and the symptoms of cholestasis

A

cholestasis: impaired bile flow/ formation

jaundice, dark urine, fatigue, pale, pruritus

55
Q

treatment of cholestatic pruritus

A

colestyramine
ursodeoxycholic acid
rifampicin

56
Q

intrahepatic cholestatic pruritus In pregnancy

A

in late pregnancy can impact the foetus

treatment: ursodeoxycholic acid

57
Q

treatment of asymptomatic and symptomatic gallstones

A

asymptomatic: no treatment
symptomatic: sugrery

drug management while waiting for surgery:

  • analgesia- paracetamol or NSAID
  • severe pain: iM diclofenac or IM opioid if diclofenac not suitable
58
Q

acute management of anal fissures

A

bulk forming/ osmotic laxatives to ease passage

show term topical preparation with anaesthetic (lidocaine) or analgesic: AVOID in pregnancy

59
Q

chronic management of anal fissures

A

if 6 weeks or longer -> use rectal GTN
topical or oral diltiazem/ nifedipine can be used -> less SE
specialist: botulinum toxin A
surgery if needed

60
Q

management of haemorrhoids

A

pain: analgesia (avoid opioid or NSAIDs)
bulk-forming: help with passing stool
pain/ itching: topical anesthetics (lidocaine) for a few days, corticosteroids up to 7 days, lubricant, antiseptics

pregnancy: bulk forming laxatives, do not use topical haemorrhoid preparation

61
Q

treatment of exocrine pancreatic insufficiency

A

PANCREATIN- replace pancreatic enzymes

in CF patients use high dose

monitor level of fat soluble vitamins and micronutrients and supplement as needed

62
Q

what drugs/ excipients should be avoided in stomas.

what preparations are better for stoma care

A

avoid: sorbitol, EC/ MR tablets, NSAIDs, opioids, laxatives (ileostomy)

use quick acting medication: liquids, uncoated tablets

63
Q

management of stoma care: GI irritation, diarrhoea, constipation, acid secretion

A

GI irritation: Aspirin + NSAIDs

constipation: use bulk forming if needed or low dose stimulant if this doesn’t work
diarrhoea: loperamide and codeine

pre reg Thammis cards (8 decks)

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