Laxatives - Bulk forming - Ispaghula husk (Fibrogel)

Question 1

There are 4 basic layers of the GIT. Organise them with the closest layer to the lumen 1st:

1 - mucosa
2 - serosa
3 - muscularis externa also known as muscularis propria
4 - submucoas

Answer 1

1 - mucosa
4 - submucoas
3 - muscularis externa also known as muscularis propria
2 - serosa

Question 2

The mucosa contains 3 separate layers. Which of the following is NOT a layer of the mucosa?

1 - muscularis mucosa
2 - submucosal nerve plexus
3 - lamina propria
4 - epithelial layers

Answer 2

2 - submucosal nerve plexus

• muscularis mucosa = break up food
• lamina propria = blood and lymph vessels
• epithelial layers = absorbs and secretes mucus and GIT secretions

Question 3

Which of the following is NOT contained within the dense submucosal layer?

1 - arteries
2 - veins
3 - submucosal nerve plexus
4 - lamina propria

Answer 3

4 - lamina propria

Question 4

Which 2 of the following are the functions of the submucosa plexus contained within the submucosal layer of the GIT?

1 - peristalsis of the GIT
2 - control of blood vessels
3 - secretion of mucus
4 - GIT secretions

Answer 4

2 - control of blood vessels
4 - GIT secretions

Question 5

In the 3rd layer of the GIT is the muscularis externa, contains smooth muscle. There are 2 layers of smooth muscle, an inner circular layer and an outer longitudinal layer. Together these perform peristalsis. Which of these layers is responsible for stopping food move backwards, and which is responsible for moving food forward?

Answer 5

• stopping food moving backwards = INNER CIRCULAR LAYER
• moving food forward = OUTER LONGITUDINAL LAYER

Question 6

The 3rd layer of the GIT is the muscularis externa, containing an inner circular and an outer longitudinal layer os smooth muscle. This is separated by what?

1 - submucosal nerve plexus
2 - lamina propria
3 - myenteric nerve plexus
4 - muscularis mucosa

Answer 6

3 - myenteric nerve plexus

Question 7

According to NICE, diarrhoea is the abnormal passage of loose or liquid stools. Which 2 of the following are needed in a patient to be diagnosed with acute diarrhoea?

1 - >3 times/day daily and/or a volume of stool >200g/day
2 - >10 times/day and/or stool volume >500g/day
3 - <14 days in duration
4 - >14 days in duration

Answer 7

1 - >3 times/day daily and/or a volume of stool >200g/day

3 - <14 days in duration

• chronic diarrhoea is >4 weeks

Question 8

Which of the following are included in the definition of constipation?

1 - <3 bowel movements/wk
2 - excessive straining
3 - abdominal pain or bloating
4 - all of the above

Answer 8

4 - all of the above

Question 9

Which of the following are included in the definition of chronic constipation?

1 - <3 bowel movements/wk
2 - excessive straining
3 - abdominal pain or bloating
4 - symptoms present in 12 weeks of the last 6 months
5 - all of the above

Answer 9

5 - all of the above

Question 10

What is the bulk forming agent that we need to know?

1 - ispaghula husk
2 - senna
3 - glycerol suppositories
4 - docusate sodium

Answer 10

1 - ispaghula husk

Question 11

Ispaghula husk is the bulk forming laxative that we need to know about. How does it improve bowel movements?

1 - contains dietary fibre
2 - draws water in forming a gel like structure in stool making it larger
3 - stool is softer and more moist
4 - all of the above

Answer 11

4 - all of the above

• all of these increase stool size and peristalsis contractions, making stool easier to pass

Question 12

Which of the following is ispaghula husk indicated in the use of?

1 - diarrhoea
2 - constipation
3 - IBS
4 - IBD

Answer 12

2 - constipation

• given orally so it mixes with stool
• MUST maintain fluids and normally consume with 150ml of liquid

Question 13

Which of the following is ispaghula husk contraindicated in the treatment of?

1 - faecal impaction
2 - intestinal obstruction
3 - reduced gut motility
4 - sudden change in bowel habit that has persisted more than two weeks
5 - undiagnosed rectal bleeding
6 - all of the above

Answer 13

6 - all of the above

Question 14

Which of the following is NOT an adverse event of ispaghula husk?

1 - abdominal distension/ flatulance
2 - hepatic failure
3 - gastrointestinal disorders
4 - hypersensitivity (conjunctivitis, bronchospasm, rhinitis, skin reactions)

Answer 14

2 - hepatic failure

• it contains allergens so important to ask about allergies