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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
2nd line treatment for IBS pain
low dose TCA: amitriptyline (UL) SSRI if TCA doesnt work
26
management for short bowel syndrome (Shortened bowel due to surgery)
replacement of vitamins due to lack of absorption: vitamin AB12DEK, essential fatty acids, selenium and zinc diarrhoea/ high output stoma: loperamide and codeine
27
what are the red flags of constipation
BAAWN ``` Blood in stools anaemia abdominal pain weight loss new onset of constipation if over 50 years old ```
28
what medications may cause constipation
opioids iron preparations, aluminium clozapine
29
what are stimulant laxatives, how long does it take to work and what are the CI
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
what are the bulk forming laxatives, how long does it take to work, what are the CI/ counselling
ispaghula husk, methyl cellulose, sterucilra takes 2-3 days to work CI: opioid induced - causes facecal impaction counselling: need to have adequate hydration
31
osmotic laxatives and how long it takes to work
lactulose, MgOH, macrogols 2-3 days
32
stool softeners, how long it takes to work
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
what laxative is used for opioid induced constipation
osmotic + stimulant if no response: naloxegol AVOID: BULK FORMING
34
what laxatives can be used in pregnancy and breastfeeding
dietary/ lifestyle 1st line: bulk forming 2nd line: osmotic- lactulose 3rd line: bisacodyl or Senna but avoid Senna near term
35
what laxatives can be used in children
1st line: dietary + Macrogol 2nd line: add or switch to stimulant if stool hard use lactulose or docusate
36
what laxatives are used in faecal impaction (hard and soft stools)
hard stools: macrogols first then stimulant soft stools: stimulant persistant: rectal bisacodyl +/- glycerol
37
management of travellers diarrhoea
adequate rehydration loperamide avoid if suspected infection
38
management of diarrhoea of faecal incontinence
loperamide
39
licensing of loperamide, counselling and treating overdose
OTC >12 years counselling: take 1-2 doses first then 1 with every loose stool (max 8 tablets per day overdose reversal: naloxone
40
referral symptoms for dyspepsia and GORD
over 55 GI bleed unexplained weight loss dysphagia
41
treatment of uninvestigated dyspepsia
PPI for 4 weeks if this doesnt work test for H pylori and treat if positive
42
treatment of functional (investigated dyspepsia)
if H pylori - treat if no cause: PPI or H2 antagonist for 3 weeks
43
diagnosis of H pylori
urea breath test (13C) or stool helicobacter test stop PPI for 2 weeks prior to tets stop antibiotics 4 weeks prior to test
44
treatment of h pylori
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
what drugs can cause GORD
Alpha/ beta blockers, bisphosphonates, anticholinergics, benzodiazepines, NSAIDs, TCAs, nitrates, corticosteroids
46
treatment of uninvestigated GORD
PPI for 4 if no improvement check for H pylori and treat if positive
47
treatment of confirmed GORD
PPI 4-8 weeks if no response -> H2 antagonist
48
management of GORD in pregnancy
antacids or alginates omeprazole and ranitidine can be used (UL)
49
side effects of aluminium, magnesium and calcium antacids
aluminium: cosntipation magnesium: diarrhoea calcium: induces rebound acid secretion
50
interactions of antacids
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
MHRA warning of PPIs
risk of subacute cutaneous lupus erythematous
52
risks and side effects of omperazole
fractures/ osteoporosis C.diff may mask symptoms of gastric cancer
53
interactions of H2 antagonsits
reduces absorption of azalea antifungals
54
what is cholestatsis and the symptoms of cholestasis
cholestasis: impaired bile flow/ formation | jaundice, dark urine, fatigue, pale, pruritus
55
treatment of cholestatic pruritus
colestyramine ursodeoxycholic acid rifampicin
56
intrahepatic cholestatic pruritus In pregnancy
in late pregnancy can impact the foetus treatment: ursodeoxycholic acid
57
treatment of asymptomatic and symptomatic gallstones
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
acute management of anal fissures
bulk forming/ osmotic laxatives to ease passage | show term topical preparation with anaesthetic (lidocaine) or analgesic: AVOID in pregnancy
59
chronic management of anal fissures
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
management of haemorrhoids
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
treatment of exocrine pancreatic insufficiency
PANCREATIN- replace pancreatic enzymes in CF patients use high dose monitor level of fat soluble vitamins and micronutrients and supplement as needed
62
what drugs/ excipients should be avoided in stomas. what preparations are better for stoma care
avoid: sorbitol, EC/ MR tablets, NSAIDs, opioids, laxatives (ileostomy) use quick acting medication: liquids, uncoated tablets
63
management of stoma care: GI irritation, diarrhoea, constipation, acid secretion
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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