Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI AND SURGERY > PPT - PUD, IBD, DIARRHOEA AND CONSTIPATION > Flashcards

PPT - PUD, IBD, DIARRHOEA AND CONSTIPATION Flashcards

1
Q

What is Hartmanns solution?

A

Aka compound sodium lactate
A resuscitation isotonic/crystalloid fluid that is compositionally similar to blood
It contains sodium chloride, potassium chloride, calcium chloride dehydrate and sodium lactate in 60% water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you manage uncomplicated PUD?

A

if Helicobacter pylori is negative then proton pump inhibitors (PPIs) should be given until the ulcer is healed
if Helicobacter pylori is positive then eradication therapy should be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How quick do PPIs work?

A

2-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why are IV high dose PPIs given in PUD?

A

To prevent rebleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you manage H.pylori?

A

eradication may be achieved with a 7-day course of
a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole)
if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drugs do you give for H.pylori eradication?

A

PPI
Clarithromycin
Amoxicillin (or metronidazole if penicllin allergy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why does simvastatin interact with clarithromycin?

A

Clarithromycin is a strong inhibitor of CYP450-3A4 so concentration of simvastatin will increase, increasing the risk of myopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should the pt avoid whilst taking metronidazole?

A

Alcohol - causes a Disulfiram-like reaction
(unpleasant SE such as nausea, vomiting hot flushes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are crystalloids? Give some examples

A

Water with added salts/glucose
E.g. 0.9% sodium chloride, 5% dextrose, hartmanns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are colloids? Whats an example?

A

Fluids containing large molecules that stay in the intravascular space longer and help retain fluid in the intravascular space
E.g. human albumin solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you manage actively bleeding PUD?

A

IV PPI
Endoscopic intervention
If this fails then surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the adverse effects of PPIs?

A

Hyponatraemia and hypomagnasaemia
Osteoporosis
Microscopic colitis
Increased risk of c.diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a contraindication for statins?

A

Macrolides
Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Whats an example of bulk-forminglaxative?

A

Isphaghula husk
Bran
Methyl cellulose
Sterculia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are examples of osmotic laxatives?

A

Lactulose and macrogols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are examples of stimulant laxatives?

A

Bisacodyl
Senna
(Co-danthrusate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are examples of faecal softeners?

A

Co-danthrusate
Docusate sodium (partially)
Glycerol suppositions
Enemas containing arachis oil
Liquid paraffin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which laxatives are safe in pregnancy?

A

senna
Magnesium salts
Docusate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which laxatives are only used ib terminally il and why?

A

Bisacodyl
Co-danthramer
Co-danthrusate

These are used for terminally ill with opioid induced constipation as they contain dantron which is carcinogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you manage opioid-induced constipation?

A

Stimulant laxatives
If these fail then you can use methylnaltrexone (peripheral opioid receptor antagonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When do you use lactulose?

A

Just in hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How should you manage a pt with constipation caused by neurological disease

A

Faecal softener with regular enemas or rectal washouts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Outline the order of laxative choice for opioid-induced constipation?

A

Stimulant and osmotic
(DO NOT USE BULK FORMING)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Outline the order of laxative choice for chronic constipation?

A

Bulk forming with plenty of fluid
Osmotic laxative
Stimulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Outline the order of laxative choice for chronic constipation caused by IBS?
Softener Osmotic Stimulant Linaclotide (stop all other laxatives)
26
Outline the order of laxative choice for constipation in chronic frail/low mobility pt?
Softener Stimulant Osmotic (DON’T USE BULK FORMING AS CAN CAUSE A BLOCKAGE)
27
What drug therapies are available for diarrhoea?
Codeine phosphate Loperamide Diphenoxylate
28
How long. Do bulk forming laxatives take to work?
72 hours
29
What are SE of bulk forming laxatives?
Can worsen flatulance, bloating and cramping Intestinal obstruction if adequate fluid intake is not met
30
What SE can stimulant laxatives cause?
Often cause abdominal cramp
31
Why is lactulose good for hep;antic encephalopathy?
It produces an osmotic diarrhoea of low faecal pH, and discourages the proliferation of ammonia-producing organisms.
32
What are oral rehydration therapy options?
Di sodium hydrogen citrate with glucose Potassium chloride and sodium chloride Potassium chrlodie with sodium chloride potassium chloride with rice powder sodium chloride and sodium citrate
33
When should you avoid using loperamide?
In bloody or suspected inflammatory diarrhoea Significant abdominal pain Active UC
34
Whats the moa of loperamide?
Acts on my-opioid receptors on circular and longitudinal intestinal muscle = reduces propulsive peristalsis and increases intestinal transit time It stimulates intestinal absorption of water and electrolytes by inhibiting calmodulin
35
Whats the moa of diphenoxylate
an opiate receptor agonists that stimulate mu receptors in GI to decrease the peristalsis and constrict the sphincters. Diphenoxylate has a direct effect on circular smooth muscle of the bowel, that conceivably results in segmentation and prolongation of gastrointestinal transit time
36
How can you manage pain in IBS?
Antispasmodic agents Second line - low dose TCA
37
How can you manage constipation in IBS?
Laxatives (avoid lactulose as it increases bloating)
38
How can you manage diarrhoea in IBS?
Loperamide
39
What are examples of antispasmodic drugs used in IBS?
Alverine citrate Mebeverine hydrochloride Peppermint oil
40
How do you induce remission in mild-moderate UC?
Rectal aminosalicylates If remission is not achieved within 4 weeks - add oral aminosalicylates If remission is still not achieved add oral corticosteroid
41
How shoul you induce remission in severe colitis?
IV steroids first line Consider adding IV Ciclosporin after 72 hours if no improvement
42
How do you maintain remission in mild-moderate UC?
Rectal aminosalicylates Oral aminosalicylates + rectal aminosalicylates Oral aminosalicylate may be used first in left-sided and extensive UC
43
How do you maintain remission in UC following a severe relapse or >=2 exacerbation in the past year?
oral azathioprine or oral mercaptopurine
44
What are examples of aminosalicylates?
Masala one Olsalazine Sulfasalazine
45
What are examples of corticosteroids used in UC?
Hydrocortisone Prednisolone Budenoside
46
What are examples of anti-TNF alpha antibodies cytokine modulators used in UC?
Adalimumab Infliximab
47
What immunosuppressants are used in UC?
Azathioprine Methotrexate
48
What antibiotics are used in UC?
Metronidazole
49
What monitoring is required for corticosteroids?
Assess for osteoporosis Cushingoid features Assess for hyperglycaemia, cataracts, glaucoma
50
What monitoring is required for aminosalicylates?
Mesalazine - U&E annually Sulfasalazine - FBC & LFT every 3 months
51
What are common SE of aminosalicylates?
Headache
52
What are the SE of immunosuppressants e.g. azathioprine?
Increased susceptibility to sunburn Increased risk of cervical abnormalities Increased susceptibility to infections Potentially increased risk of lymphoma
53
What monitoring is needed for methotrexate?
U&Es, FBC and LFT every 3 months
54
Whats the main concern with biological agents such as infliximab?
Increased susceptibility to infections including TB
55
Whats the moa of azathioprine?
A prodrug that is quickly converted to 6-mercaptopurine this is then metabolised in the liver and gut to 6-thioguanine nucleotides = affects DNA in rapidly replicating cells = immunosuppression
56
What are 2 serious drug interactions with azathioprine?
Allopurinol Febuxostat (They slow the elimination of 6-MP by inhibiting xanthine oxidase)
57
What should be checked before starting azathioprine?
TPMT levels - this enzyme usually breaks down 6-mercaptopurine but this gene is subject to genetic polymorphism = some people dont have TPMT activity so azathioprine isnt broken down /cleared properly
58
What is infliximab?
A chimeric monoclonal antibody which has a high specificity for and affinity to TNF alpha This neutralises the biological activity of TNF alpha by antagonising its receptors It can also stimulate apoptosis of activates lymphocytes in gut mucosa
59
What are the side effects of azathioprine?
Bone marrow suppression Pancreatitis Increased risk of infection Leucopenia
60
What is sulphasalazine?
A combination of a sulphonamide and 5-ASA
61
What is mesalazine?
A delayed release form of 5-ASA
62
Whats the benefit of mesalazine?
It avoids the sulphapyridine side effects you get in taking sulphasalazine
63
What are common side effects of all aminosalicylates?
GI upset Headache Agranulocytosis Pancreatitis (7 times more common) Interstitial nephritis
64
What are the sulphapyridine side effects you get with sulphasalazine?
Rashes Oligospermia Headache Heinz body anaemia Megaloblastic anaemia Lung fibrosis
65
How do you induced remission in Crohn’s?
Glucocorticoids Second line - 5ASA drugs
66
How do you manage refractory crohns or fistulating crohns?
Induce remission - Infliximab Maintenance - azathioprine or methotrexate
67
How do you maintain remission in crohns?
Azathioprine or mercaptopurine (Second line - methotrexate)
68
What proportion of crohns pt will end up getting surgery?
80%
69
What are the issues with empiric antibiotic therapy for acute infective diarrhoea?
Potential side effects Most causes in UK caused by viruses ProMotion of bacterial resistance Eradication of normal flora Excess cost Most cases are self-limiting
70
Who may recieve empiric antibiotic for infective diarrhoea?
If severe disease e.g. >6 stools a day, volume depletion warranting hopsital Features suggestive of invasive bacterial infection e.g. blood/mucous stools Host factors that increase risk of complications e.g. >70 or immunocompromised
71
Which antibiotics are used for first episode of c.diff?
Oral vancomycin for 10 days
72
What are the risk factors of c.diff infections?
Second and third generation cephalosporins Clindamycin Fluoroquinolone Broad spectrum penicillins PPI >65 Prolonged hospitalisation Exposure to others with c.diff Previous history of c.diff
73
Which antibiotics are used for recurrent episodes of c.diff?
If within 12 weeks of symptoms resolution - oral fidaxomicin If >12 weeks of symptom resolution - oral fidaxomicin or oral vancomycin
74
Which antibiotics are used for life-threatening of c.diff?
Oral vancomycin and IV metronidazole

GI AND SURGERY (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions