GI TRACT Flashcards
A 45 years old female presents to the emergency dept with h/o intermittent nausea and dyspepsia. The endoscopy shows a large ulcer in the greater curvature of the stomach and at the biopsy, some “spiral rod-shaped” bacteria are seen. This clinical presentation is typical of which type of disease?
Acute gastritis ulcer secondary to Helicobacter pylori (H.Pylori) infection.
In peptic ulcer disease, GI bleed is consequence of _________________________________
Chronic gastritis
Glucocorticoids NAC
N. glucocorticoids are used for the treatment of mild to moderate IBD, they are receptors antagonists, A.they bind to glucocorticoids receptor in the cell membrane and alter gene transcription, C. anti-inflammatory effects in IBD, the main one is prednisolone, given PO or PR. S/E immunosuppression, hyperglycemia, easy bruising, striae, weight gain (Cushingoid appearance), cataracts.
NAC OF 5-ASA DRUGS
N.5- amino-salicylic acid is an active component that is released in the colon and not absorbed.
A. ANTI-inflammatory effect at the intestinal level, example Sulfasalzine and Mesalazine
C. useful in maintenance therapy not effective during relapses, s/e diarrhea, intestinal nephritis.
infliximab and adalimumab are biologic therapies for IBD, describe NAC and pharmacokinetics of infliximab
N.monoclonal antibodies against TNF.
A.they absorb and remove TNF from the system, which is the key cytokine for the auto-immune response in IBD
C. severe IBD treatment, also RA and PA
Pharmacokinetics. given IV, half-life 10 days, reduces hospital admissions and QOL, s/e immunosuppression and infusion reaction, very expensive drug.
pyramid of treatment of IBD
- 5-ASA drugs
- glucocorticoids
- immunomodulators (azathioprine/methotrexate)
- biologic agents (infliximab)
- surgery
Chron disease is confined to the ________ intestine and it is ______________ causing presence of ______ lesions where inflamed parts alternate with healthy parts of the bowel. While Ulcer disease is a ________ which spreads _______ from the rectum and it is confined to the _____________ of the intestinal epithelium. Because of its aetiology Chron disease is more associated with ________, ___________, and _________ disease. Other symptoms common to CD and UD are:rectal bleeding, ________, ________, _________, _______, ______ these last are considered ___________ manifestation more in CD.
Small, discontinuous, skip lesions, retrograde, backward, surface, weight loss and growth failure and perianal, abdominal cramps, diarrhea, mouth ulcers, fever/arthritis, extraintestinal.
_________ and ____________ are among anti-diarrhoeal opioid drugs, they don’t penetrate the _____ so they are best choice. ________ relative selective for GIT so best agent for traveller’s diarrhoea.
Codeine and loperamide, blood brain barrier, loperamide.
Describe the anti-motility agents.
Muscarinic receptor antagonists like atropine, not usually used because of side effects on other systems.
Opioids (drugs derived from opium-like morphine related drugs), bind to opioid receptors along the GIT and CNS resulting in anticholinergic effects such as increased tone and rhythmic contractions but reducing propulsive activity, a longer gut transit results in excessive water/electrolyte absorption, from gut lumen and decreased enzyme secretion.
What are the treatment goals in case of diarrhea?
- Support the fluid/electrolyte balance
- Include anti-motility agents
- Use anti-infective agents (usually diarrhea is a coping mechanism of the body to get rid of a parasite)
Which drugs can cause constipation and which product reduces their side effects?
Opioids can cause constipation, a new product METHYLNALTREXONE is a peripheral acting opioid antagonist that doesn’t cross the BBB so it doesn’t cause opioids withdrawal.
Stimulant laxatives increase ______ and ___________ secretion into the ____________ and consequently they increase__________. ____________ and ___________ are two examples of stimulant laxatives.
Water and electrolytes, gut lumen, peristalsis, senna and sodium picosulfate
___________ is the most commonly used ______________, it acts like a ______________ producing softer faeces. It has fewer side effects but it is less__________. Little use in ________________.
Dulcolax(Docusate sodium), faecal softener, detergent, potent/effective, chronic constipation
Osmotic laxatives consist of __________ which increases the volume of fluid in the bowel lumen by _______________ and results in acceleration of material from the _______________ intestine. Causes abnormally ____________ to enter the large intestine, causing bowel distention and abdo cramps.
___________ is a _____________ disaccharide of fructose and ___________. Colonic bacteria convert it into __________ which are poorly_____________. Describe side effects.
Poorly absorbed solutes, osmosis, small to a large, large volume of fluid, Lactulose, semisynthetic, galactose, sugars, absorbed.
s/e abdo cramps, flatulence, diarrhea, electrolytes disturbances.
Bulk forming laxatives contain ____________________ that cannot be broken down by the normal digestive processes in the upper GIT. They ___________ in the gut lumen and therefore ____________________. Examples are ______________. They are used for treatment of ___________________. They have no _____________, the disadvantage is that __________________.
Polysaccharides, retain water, promote peristalsis, methylcellulose and ispaghula husk, no side effects, they might take several days to work.
