Other GI stuff Flashcards
What are signs that a patient is allergic to certain food?
- cutaneous e.g. rash, hives
- GI e.g. colic, vomiting
- Resp e.g. breathing probs
- Anaphylaxis
What are main causes of food allergy?
- peanuts
- cows milk
- soy
- hens eggs
- fish
- shellfish
How do you treat food allergy?
- sodium cromoglicate in adjunct to dietary adjustment
- chlorphenamine
- adrenaline for anaphylaxis
What can cause GI smooth muscle spasm?
- IBD
- IBS
- Bowel colic in palliative care
How do you treat GI smooth muscle spasm?
- antispasmodics
- antimuscarinics
What are examples of antimuscarinics used for GI muscle spasm?
- Atropine (rarely used)
- Dicycoverine
- Hyoscine butylbromide
- Propantheline bromide
What are side effects of antimuscarinics?
- Blurred vision
- Urinary retention
- Constipation
- Dry mouth
- Tachycardia
- Pupil dilation
- Reduced bronchial secretions
- Angle-closure glaucoma
- Confusion in elderly
- Drowsiness
Who should you be cautious in when prescribing antimuscarinics?
- pts who are susceptible to angle-closure glaucoma
- conditions causing tachycardia
- CVD e.g. arrhythmias, congestive heart failure
Who are antimuscarinics contra-indicated in?
- prostatic enlargement/urinary retention
- closed-angle glaucoma
- paralytic ileus, GI obstruction, toxic megacolon
- Myasthenia gravis
What is the difference between antimuscarinics and antispasmodics?
- musc = reduce intestinal motility
- spas = directly relaxes intestinal smooth muscle
What are examples of antispasmodics?
- Mebeverine
- Alverine (dizziness, driving warning)
- Peppermint oil (heartburn)
What is ursodeoxycholic acid used for?
- dissolution of gall stones
- primary biliary cirrhosis
How do you treat oesophageal varices?
- Treated with terlipressin
How do you treat obesity?
- orlistat
What is reduced exocrine secretions?
- reduced secretions of pancreatic enzymes
- can cause maldigestion, malnutrition, GI symptoms
What causes a reduction of exocrine secretions?
- cystic fibrosis
- chronic pancreatitis
- zollinger-ellison syndrome
What dietary advice would you give to someone with reduced exocrine secretions?
- distribute food intake between 2 main meals and 2-3 snacks
- avoid food difficult to digest
- do not consume alcohol
- avoid reduced fat diets
What would you take for reduction of exocrine secretions?
- pancreatin - amylases, lipases, proteases
- Pancreatin inactivated by gastric acid
- E/C preparations deliver higher pancreatin levels
- Pancreatin inactivated by heat (do not mix with hot food or drink)
What are side effects of pancreatin (creon)?
- N+V
- Abdominal discomfort
- Irritations
e.g. excessive doses = perianal irritation, hyperuricaemia, hyperuricosuria
Who is pancreatin contraindicated in?
- Nutrizym 22/pancrease HL in children 15 years old or under with cystic fibrosis
What counselling points are needed with pancreatin?
- ensure adequate hydration at all times with high strength preparations
What are the symptoms of anal fissure (tear in lining of anal canal)?
- bleeding
- sharp pain on defecation
- linear split in anal mucosa
How do you treat an acute anal fissure that has lasted less than 6 weeks?
- soft stools to ease pain - bulk forming or osmotic laxatives
- prolonged burning pain - short term anaesthetic (lidocaine) (apply before emptying bowel)
How do you treat chronic anal fissure that has lasted longer than 6 weeks?
- GTN rectal ointment (side effect = headache)
- OR oral/topical CCB (diltiazem/nifedipine)
What are haemorrhoids?
- swelling of anal mucosal cushion
What are the symptoms of haemorrhoids?
- pain after defecation
- bleeding
- swelling
- itchy/sore skin
What are the risk factors for developing haemorrhoids?
- pregnancy
- constipation - bulk forming laxative
What topical treatment can be used for haemorrhoids?
- local anaesthetic - lidocaine
- corticosteroids
- astringents (liquid based formula)
- lubricants
- antiseptics
How do you treat local haemorrhoid pain?
- anaesthetics - few days max
How do you treat local perianal inflammation?
- preparations with corticosteroids - max 7 days
- hydrocortisone, flucortolone, pred
What do you avoid if you have haemorrhoids?
- NSAIDs if there is rectal bleeding
- Opioids
What should you avoid if pt has a stoma?
- sorbitol preparations
People with stoma are vulnerable to water and electrolyte depletion - what should you be careful of?
- diuretics - excessive dehydration and potassium loss
- hypokalaemia - risk of digoxin toxicity
- avoid laxatives
