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Yr 3 Inflammatory and GI > Lower GI > Flashcards

Lower GI Flashcards

1
Q

What causes food to move from SI to caecum, colon and then into rectum?

A

Peristalsis

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2
Q

What do bacteria in large intestine produce

A

Vit. K and biotin (vit B7)

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3
Q

What is constipation

A

difficulty in opening bowel
going less than 3 times a weeks
straining more than 25% shits
Hard or pellet stools

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4
Q

What dietary factors can cause constipation

A

Low fibre
high fats
Alcohol
Caffeine
Low fluid intake

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5
Q

Name a bulking agent

A

Ispaghula husk
methylcellulose

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6
Q

Name a stimulant laxative

A

Bisacodyl
Senna
Dantron
Sodium picosulphate

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7
Q

Name a faecal softeners

A

Docusate
Glycerol
Arachis oil (enema)

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8
Q

Name a Osmotic Laxatives

A

Lactulose
Macrogols
Magnesium hydroxide and sulphate
Phosphate
Sodium citrate

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9
Q

What should you give a patient who has hard stools with faecal loading/ impaction?

A

High dose oral macrogol or stimulant
if not work- glycerol and/ or Bisacodyl supps

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10
Q

What should you give a patient who has soft stools with faecal loading/ impaction?

A

stimulant
then docusate or sodium citrate enema

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11
Q

What should you give a patient who has acute constipation?

A

lifestyle advice
bulk forming
(and/ or) osmotic: macrogol
stimulant

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12
Q

What can you give opioid induced constipation?

A

Osmotic and stimulant
Naloxegol (PAMORA drug)
AVOID BULK FORMING

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13
Q

What are lifestyle advice points for constipation?

A

30g a day fibre
good fluids
wholemeal bread
increase exercise

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14
Q

What can you give a pregnant woman who has constipation?

A

Bulk forming lax.
Can add/ switch to osmotic lax
SENNA NOT OTC FOR PREGNANCY
glycerol supp.

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15
Q

What can you give a child who has constipation

A

Macrogols and interventions
Can use stimulant lax.
Add lactulose if macrogol not tolerated

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16
Q

Name some osmotic laxatives

A

Macrogol
lactulose
Mg Hydroxide
Docusate (and a stim)

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17
Q

What is prucalopride

A

selective serotonin 5HT4 receptor agonist for constipation

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18
Q

What is linaclotide

A

drug used for constipation with IBS

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19
Q

How do Bulk-forming lax work?

A

Polysaccharides increase osmolality in gut when broken down therefore retention of water
Causes a bulkier stool
This distends colon
Promotes peristalsis

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20
Q

How do osmotic laxatives work?

A

Osmotic agents increase water retention as poorly absorbed
Absorbed into stool making softer

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21
Q

How do stimulant laxatives work?

A

Stimulates local reflexes of myenteric nerve plexus of guy
Irritate nerve endings in intestine
Motor effect-> increase propulsion/ motility

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22
Q

What does senna do? How does it work?

A

anthraquinone laxative
Combines with sugars- forms glycosides
Bond hydrolysed by colonic bacteria to release an irritant- sennosides A and B
Absorbed and has action on myenteric nerve plexus
Assumption that incr. PGE
Also decreases colonic water absorption

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23
Q

How do stool softeners work?

A

Surface wetting agents/ surfactants
Decrease surface tension allowing water to penetrate
Soften stool
Has some stim action

Arachis oil creates barrier between stool and intestine wall

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24
Q

How does a PAMORA work?

A

Competitive antagonist at intestinal mu-opioid receptors
Prevents opioid activation of intestinal mu-opioid receptors
Targets opioid induced side effects

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25
How does prucalopride work?
5HT4 receptor agonist activation increases ACh increases parasympathetic drive (rest and digest) Increases peristalsis
26
What is acute diarrhoea?
more than 3 loose stools a day for no more than 14 days
27
What causes diarrhoea
change in balance of absorption and secretion of water due to osmotic force or enterocytes secreting fluid causes activation of ion transporters- can cause cytokine secretion to produce prostaglandins which stim. secretion
28
explain the differences between invasive and non-invasive bacteria causing diarrhoea
invasive- attacks mucosal cells may contain blood and pus fever non-invasive- Bacteria produce enterotoxins that disrupt secretion watery
29
How do you diagnose diarrhoea
Accompanying symptoms Rapid set no stool formation Faecal studies Serum albumin intestinal biopsy
30
What drugs may cause diarrhoea
Antibiotics laxatives metformin antacids digoxin ferrous sulphate NSAIDs Beta blockers cholestyramine (for high lipids-bile salts)
31
What is the treatment for acute diarrhoea
Loperamide- PRESCRIBED = 4mg, 2mg after each loose stool- 5 days max. Max 16mg - GSL/OTC = 48 hrs max. Max 12g a day Bland foods- soup, bread, pasta, rice
32
What is oral rehydration therapy
Dioralytes Corrects dehydration
33
What can you give someone who is breastfeeding or pregnant for diarrhoea?
ORT and fluids Loperamide for breastfeeding AVOID IN PREG.
34
How does loperamide work?
Synthetic opioid analogue- doesn't pass BBB Binds to mu-receptors in gut wall Inhibits ACh and prostaglandin release therefore decreasing parasympathetic activity
35
What medicines should be stopped during vomiting, diarrhoea, fever, sweats etc: (sick day)
STOP ACE inhibitors (prils) ARBs (sartans) NSAIDs Diuretics Metformin
36
C. Diff infection risk factors
broad spec. antibiotic use Stay in hospital over 65
37
Treatment for c. diff
Vancomycin 125-500mg every 6hrs for 10 days
38
Symptoms of IBS
Abdominal cramps Diarrhoea/ constipation etc Flatulence acid indigestion Eating may worsen symptoms
39
How do you diagnose IBS
abdominal pain for 6 months Relief by defecation Bloating Mucus Worsened by eating etc
40
What is IBS-C
more than 25% type 1/2 less than 25% type 6/7
41
What is IBS-D
more than 25% type 6/7 less than 25% type 1/2
42
What is IBS-M
more than 25% type 1/2 and more than 25% type 6/7
43
What is IBS-U
IBS but cant be categorised
44
What is an antispasmodic? what's it used for?
IBS Smooth muscle relaxants Mebevrine / peppermint / hyoscine butyl bromide (more antimuscarinic side effects)
45
What is used to treat IBS-c
laxatives (not lactulose tho as can increase gas and worsen symptoms)
46
What is used to treat IBS-d
Loperamide but must be over 18 for GSL and diagnosed with IBS 2 weeks max
47
What is linaclotide used for
Moderate/severe IBS-C if had for over a year and other laxatives not work
48
How do antispasmodics work
Block voltage gated sodium channels Prevents build up of calcium Decreases smooth muscle cell contraction
49
How does linaclotide work
guanylate cyclase-c agonist leads to increased production of cGMP causing CTFR ion channel causing increased secretion of chloride and bicarbonate into intestine causing increased GI transit GC-C-> cGMP -> CFTR action -> increase intestinal chloride and bicarb
50
Red flags for IBS
weight loss rectal bleeding loose stools for more than 6 weeks when over 60yrs old
51
What causes diverticulosis
muscular hypertrophy causing narrowing of lumen and forms small chamber with high pressure
52
What causes diverticulitis
Faecal material collects in diverticula and causes obstruction bacterial overgrowth and vascular compromise causes increase in luminal pressure resulting in inflammation
53
Management of diverticulosis
Weight loss, smoking cessation, high fibre, bulk-forming laxatives
54
what is diverticular disease
intermittent pain in LLQ worsened by eating- relieved by shitting tender on palpitation LLQ
55
What is the management for diverticular disease
high fibre bran and bulk forming laxative lifestyle advice avoid NSAIDS and anti-motility drugs like codeine
56
What is the management for diverticulitis
co-amoxiclav or trimethoprim and metronidazole 5x a day
57
What is exocrine pancreatic insufficiency
Lack of pancreatic digestive enzymes being secreted into duodenum Lack of amylase, lipase, protease
58
What can exocrine pancreatic insufficiency be cause by
pancreatitis diabetes coeliac disease tumours cystic fibrosis
59
Symptoms of exocrine pancreatic insufficiency
malnutrition lack of growth in children low zinc conc and selenium so lowered immune function and healing muscle loss diarrhoea cramping/bloating fatty stools- steatorrhea
60
treatments of exocrine pancreatic insufficiency
creon pancrex v Pancreatic enzyme replacement

Yr 3 Inflammatory and GI (15 decks)

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