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The patient (Y2-2) > IBD > Flashcards

IBD Flashcards

1
Q

Acute diarrhoea is not infectious. True or false?

A

False - usually infectious

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2
Q

Acute diarrhoea is usually self-limiting in 3 days. True or false?

A

True

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3
Q

How does loperamide work?

A

Increases salt and water reabsorption by decreasing motility of gut longitudinal and circular muscles

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4
Q

Loperamide is an OTC medicine that can be given to children. True or false?

A

False - OTC not for children

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5
Q

Loperamide is a synthetic opioid but has no opiate activity at therapeutic doses. True or false?

A

True

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6
Q

If symptoms of overdose of loperamide occur, what drug is given?

A

Naloxone

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7
Q

Other than loperamide and oral rehydration therapy, what is available for treatment of diarrhoea?

A

Antispasmodics

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8
Q

Loperamide and antispasmodics can be used for treatment of acute diarrhoea in young children. True or false?

A

False - neither can be used in young children

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9
Q

Acute diarrhoea that is infectious is caused by a virus. True or false?

A

True - e.g. norovirus, rotavirus

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10
Q

Traveller’s diarrhoea is usually caused by a virus. True or false?

A

False - usually by a bacteria e.g. E.coli, 10% of cases are viral

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11
Q

What drug is used adjunct to oral rehydration therapy in children aged 3 months and over?

A

Racecadotril

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12
Q

What does racecadotril do?

A

It is an enkephalinase inhibitor
It reduces hypersecretion of water and electrolytes into the intestinal lumen
Given orally

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13
Q

The rotavirus is a live vaccine given IV. True or false?

A

False - given orally

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14
Q

The rotavirus vaccine should be started in children over 15 weeks old, given in two divided doses. True or false?

A

False - should not be started in children over 15 weeks

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15
Q

What is the recommended schedule for rotavirus vaccine?

A

The first dose at 2 months of age (must be given between 6 weeks-15 weeks)
The second dose 3 months of age

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16
Q

What are the warning signs of diarrhoea for referral?

A 
Symptoms for more than one week
Babies/young children
Signs of dehydration
Diarrhoea accompanied by fever
Stools are bloody or black
Severe abdominal or rectal pain
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17
Q

What causes pseudomembranous colitis?

A

Overgrowth of C.diff and release of toxin

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18
Q

How is pseudomembranous colitis managed?

A

Stop antibiotics
Fluid and electrolyte replacement
Isolation strategies, environmental control and hand hygeine

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19
Q

How is C.diff treated?

A

Metronidazole or oral vancomycin

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20
Q

Alcohol gel kills C.diff spores. True or false?

A

False

21
Q

Which drug classes should be avoided in the management of C.diff?

A

Quinolones
Cephalosporins
Clindamycin

22
Q

What area does ulcerative colitis involve?

A

The mucosa of the rectum and colon

23
Q

Which areas does Crohn’s disease effect?

A

Whole GIT from mouth to anus

24
Q

What surgical procedure provides total cure of ulcerative colitis?

A

Total colectomy

25
Q

Surgery for Crohn’s disease is curative. True or false?

A

False

26
Q

What is the general management of acute mild to moderate IBD?

A

Local application of corticosteroid or aminosalicylate

27
Q

How is diffuse inflammatory disease not responding to local therapy managed?

A

Oral treatment with aminosalicylate or corticosteroid

28
Q

How is sever inflammatory bowel disease managed?

A

Admission to hospital, IV corticosteroids and other immunsuppressive agents

29
Q

What are the monitoring parameters for IBD?

A 
Faecal calprotein
Stool frequency
Presence of blood and/or mucous in the stool
Temperature
CRP
U&Es
30
Q

Name 3 aminosalicylates that are only licensed for use in UC

A

Mesalazine
Balsalazide
Olsalazine

31
Q

What causes side effects in sulphasalazine?

A

Sulphapyridine - carrier molecule - this is not present with new analogues of aminosalicylates

32
Q

What actions are taken if there is acute relapse of UC or Crohn’s?

A

Bed rest
Low residue diet
Monitoring
Corticosteroids - hydrocortisone IV or methylprednisolone

33
Q

When are immunosuppressive agents used?

A

In patients where the disease is not responding to oral corticosteroids

34
Q

Immunosuppressants work immediately. True or false?

A

False - may take 1 or 2 months to be effective

35
Q

Name the immunosuppressants that are used for patients who do not respond to oral corticosteroids

A

Azathioprine
6-mercaptopurine
Once weekly methotrexate
Ciclosporin - UC only

36
Q

Which monoclonal antibodies are used in IBD and why?

A 
Infliximab 
Adalimumab 
Golimumab 
Vedolizumab 
Used as they have a high afftinity to alpha-TNF and so inhibit its activity
37
Q

What is the dietary advice for someone who is constipated?

A

Increase fluid intake 2L/day and increase fibre

38
Q

Name the 6 causes of constipation

A 
Lifestyle
Diet and fluid
Mechanical - tumours, strictures etc.
Systemic affecting motility - pregnancy, hypercalcaemia
Neurological - paralysis 
Drugs - opiates, diuretics, CCBs
39
Q

Type 1 and 2 of the bristol stool chart indicate diarrhoea. True or false?

A

False - indicate constipation

40
Q

What are the treatment options for constipation?

A

Bulking agents e.g. dietary fibre, isphaghula, methyl cellulose
Stimulants e.g. senna, bisacodyl

41
Q

How do bulking agents work in relieving constipation?

A

They increase faecal mass and so stimulate peristalsis

42
Q

Laxatives should be offered to any patients starting on opiates. What are some other reasons for use of laxatives?

A 
Post MI - to prevent strain
Expulsion of parasites after anthelmintic treatment
Prior to surgery 
Prior to certain X-ray procedures
In liver failure
43
Q

How do stimulants relieve constipation?

A

Increase intestinal motility - but should be avoided in intestinal obstruction

44
Q

How do osmotic agents relieve constipation?

A

Increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with

45
Q

Glycerol is a softening agent that is used orally to relieve constipation. True or false?

A

False - for rectal use only

46
Q

Name a stimulant that is used for treatment of constipation

A

Senna

47
Q

Name an osmotic agent that is used to treat constipation

A

Lactulose

48
Q

Name a softening agent used to treat constipation

A

Glycerol
Docusate
Liquid paraffin

The patient (Y2-2) (8 decks)

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