1. Gastro-intestinal system (conditions) Flashcards

Question

Define toxic megacolon (2)

Answer 1

1. Acute form of colonic distention | 2. Very dilated colon accompanied by abdominal distention, sometimes fever, abdominal pain, or shock

Answer 2

Red/ purple discolored spots on the skin that do not blanch on applying pressure. To be watched out for with aminosalicylates (mesazalazine/ sulfasalazine) as may be a sign of blood dyscrasias

Answer 3

Morbid general state resulting from the presence of abnormal material in the blood.

Answer 4

1. A common chronic relapsing and often life long condition 2. Mainly affects those between 20-30 years 3. More common in women 4. Symptoms usually relieved by defaecation

Answer 5

1. Abdominal pain/ discomfort 2. Disordered defaecation 3. Passage of mucus 4. Bloating

Answer 6

1. Diet+lifestyle changes (no more than 3 fresh fruit per day, increase fluid to at least 8 cups a day, avoid sorbitol if diarrhoea) 2. Antispasmodic drugs 3. Laxative 4. Linaclotide (constella) if have not responded to laxatives from the different classes + have had constipation >12mths 5. Loperamide 1st line for relief of diarrhoea 6. Low dose TCA (unlicensed) for abdo pain/ dscomfort as 2nd line if no response 7. SSRI if no response to TCA 8. Psychological intervention if no relief of IBS>12mths

Answer 7

1. Shortened bowel due to large surgical resection (with or without stoma formation) 2. May require medical management to ensure adequate absorption of nutrients and fluid 3. Absorption of oral medication is also often impaired 4. Oral intake influences the volume of stool passed so reducing food intake will lessen diarrhoea, but will also exacerbate the problems of undernurtition. 5. Many drugs incompletely absorbed by patients with SBS and need to be prescribed in much higher doses than usual (levothyroxine, warfarin, oral contraceptives)

Answer 8

1. May require replacement of vitamins+ minerals depending on the extent and position of the bowel resection (A, B12, D, E, K, essential fatty acids, zinc, selenium). May need PN. 2. Magnesium deficiency is common and is treated with supplemention 3. Oral rehydration salts as diarrhoea common. Again, may need PN to allow them to eat less if extent of diarrhoea unacceptable. 4. Antimotility drugs (loperamide+codeine). Loperamide preferred as ot sedative+ does not cause dependence/ fat malabsorption. Could also use co-phenotrope (but this crosses BBB). 5. Colestyramine- can be used in patients with an intact colon+ <100cm ileum resected. Used to bind to unabsorbed bile salts+reduce diarrhoea. Monitor for evidence of fat malabsorptoin/ fat soluble vitamin deficiencies. 6. Omeprazole to reduce gastric acid secretion>> reduce jejunostomy output. If less than 50cm of jejunum, give IV. 7. Octreotide reduces ileostomy diarrhoea+large volume jejunostomy output by inhibiting pro-secretory substances. Unlicensed+not much evidence. 8. Growth factors eg teduglutide. Can be used to facilitate intestinal adaptation after surgery in patients with short bowel syndrome,enhancing fluid, electrolyte and micronutrinet absorption. 9. Enteric coated+ M/R preparations unsuitable for patients with SBS, particularly if ileostomy 10. Do not use soluble tablets/ uncoated tablets/ liquid formulations 11. Before prescribing liquid, prescriber should consider osmolarity, excipient content+ voume required. Hyperosmolar liquids some excipients can result in fluid loss.

Answer 9

1. Length of small intestine available for drug absorption 2. Small intestine has high area+ blood flow and so most important site for drug absorption 3. Gastric emptying+ gastric transit time also affect drug handling

Answer 10

1. Defacation that is unsatisfactory because of infrequent stools, difficult stool passage, or seemingly incomplete deecation 2. Commonly seen in women, elderly + during pregnancy 3.

Answer 11

1. New onset, especially in patients over 50, or accompanying anaemia, abdominal pain, weight loss or overt or occult blood in stool should provoke URGENT investigation because of the risk of maligancy/ other serious bowel disorder 2. Increase in dietary fibre, adequate fluid intake, exercise. Increase fibre intake gradually to prevent flatulence and boating. May take as long as 4 weeks to see effects of high fibre. Sorbitol can help treat. 3. Start with bulk forming laxative, ensuring adequate fluid intake 4. If stools remain hard, add or switch to osmotic axative 5. If stools soft/ difficult to pass/ person complains of inadequate emptying - add stimulant laxative 6. If opioid induced recommend osmotic/ docusate + stimulant. AVOID BULK FORMING. 7. If faecal impactation: depends on stoo lconsistency. If hard - high dose of oral macrogol. If this doesn't work/ stool is soft - oral stimulant drug. 8. If response inadequate, bisacodyl (or glycerol if stools hard) 9. Alternatively docusate/ sodium citrate enema 10. If response still insufficient, a sodium acid phosphate with sodium phosphate or arachis oil retention enema may be necessary 11. If chronic consitaopn and 2 laxatives from different classes have been tried at the highest tolerated dose for at least 6 months, use of prucalopride in WOMEN only should be considered 12. Advise gradually reducing+stopping laxatives once patient producing soft, formed stool without straining at least 3 times/ week

Answer 12

These laxatives increase the bulk of the stools, distend the colon, and augment peristalsis. Opioids prevent peristalsis of the increased bulk which worsens abdominal pain and can contribute to bowel obstruction.

Answer 13

1. The abnmormal passing of loose/ liquid stools with increased frequency/ volume/ both. 2. Acute if <14 days

Answer 14

1. Prompt investigation if any red flags: unexplained weight loss, rectal bleeding, persistent, systemic illness, recent hospital treatment, antibiotics, foreign travel (other than to Western Europe/ North America/ Australia/ New Zealand) 2. Aim is to prevent/ reverse fluid+ electrolyte depletion 3. Most eisodes will settle without need for any treatment 4. ORT is the mainstay of treatment 5. If unable to drink/ severe dehdration - IV fluids 6. Loperamide = 1st line treatment for patients when rapid control of symptoms is needed. It can be used for travellers diarrhoea, but should be avoided in bloody/ suspected inflammatory diarrhoea+ significant abdominal pain. 7. Ciprofloxacin is occaisionally used for prophylaxis against travellers diarrhoea but routine use is NOT recommended.

Answer 15

1. Describes a range of upper GI symptoms which are typically prsent for 4 or more weeks 2. Symptoms can be attributed to an underlying cause e.g GORD but the majority of patients are likely to have functional dyspepsia, where an underlying cause cannot be identfiied ad endoscopy findings are normal 3. Dyspepsia symptoms in pregnancy are commonly due to GORD

Answer 16

1. Upper abdominal pain/ discomfort 2. Heartburn 3. Gastric reflux 4. Bloating 5. Nasuea and/ or vomiting

Answer 17

1. URGENT endoscopic investigation if patient has dysphagia, significant GI bleed, over 55+ unexplained weight loss+ symptoms of upper abdominal pain, reflux or dyspepsia 2. Lifestyle measures: healthy eating, weight loss, trigger food avoidance, smaller meal, evening meal 3-4h before bed, smoking cessation, alcohol consumption 3. Review drugs that can cause dyspepsia (alpha blockers, antimuscarinics, aspirin, benzodiazepines, beta blockers, bisphosphonates, CCBs, corticosteroids, nitrates, NSAIDs, theophyllines, TCAs) 4. Antacids and/ or alginates may be used for short term symptom control but long term continuous use is not recommended 5. When univestigated - take PPI for 4wk+ test for H.pylori 6. When functional (no cause) - test for Hpylori infection and treat if positive. If not not infected with Hpylori, PPI/ H2RA should be taken for 4 weeks.

Answer 18

1. Gastric or duodenal ulceration 2. Which is a breach in the epithelium of the gastric or duodenal mucosa 3. Most commonly caused by NSAID use and Hpylori infection 4. Smoking, alcohol consumption and stress may also contribute to the development of peptic ulcer disease 5. Complications of peptic ulcer disease = gastric outlet obstruction and potentially life threatening GI perforation and haemorrhage

Answer 19

1. Upper abdominal pain = the main symptom | May also experience..nausea, indigestion, heartburn, loss of appetite, weight loss and bloated feeling

Answer 20

1. >65 2. High dose NSAID 3. Other drugs that increase risk of GI s/es e.g aticoags, corticosteroids, SSRIs 4. Serious comorbidity 5. Heavy smoker 6. Excessive alcohol consumption 7, Previous adverse reactions to NSAIDs 8. Prolonged requirement for NSAIDs

Answer 21

1. URGENT endoscopic investigation if dysphagia, significant acute GI bleeding or those aged 55 and over with unexplained weight loss and symptoms of abdo pain/reflux/ dyspepsia 2. Lifestyle: healthy eating, weight loss, avoid trigger food, raising head of bed, smoking cessation, eating evening meal 3-4h before bed, reducing alcohol consumption 3. Review drugs that induce peptic ulcers e.g. NSAIDs, aspirin, bisphosphonates, immunosuppressive agents, KCl, SSRIs + recreational drugs 4. Test for Hpylori 5. If positive for Hpylori and no NSAID use, eradicate the Hpylori infection 6. If related to NSAID use, use PPI/ H2 receptor antagonist for 8 weeks, followed by eradication if patient is +ve for Hpylori 7. If negative for Hpylori and no history of NHSAID use, use a PPI/ H2 receptor antagonist for 4-8 weeks 8. If +ve for Hypylori, review patient 6-8 weeks after starting eradication treatment+retest 9. If ulcer healed, need to r/v NSAID. use. Gastroprotection should always be co-prescribed and PPI is the preferred option. 10 . Patients with peptic ulcer disease who are on long term treatment should receive an annyal review of their symptoms and treatment, encourage stepdown if apporpriate.

Answer 22

1. NSAIDS 2. Aspirin 3. Bisphosphonates 4. Immunosuppressive agents 5. Potassium chloride 6. SSRIs 7. Recreational drugs e.g. crack cocaine

Answer 23

Disease in which tumours cause the stomach to produce too much acid, resulting in peptic ulcers

Answer 24

1. A chronic conditions 2. Where there is reflux of gastric contents (acid, bile, pepsin) back into the oesophagus 3. Causing symptoms of heartburn and acid regurgitation 4. May be erosive/ non erosive 5. Risk factors: consumption of trigger foods, pregnancy, hiatus hernia, family hx, stress, anxiety, obesity, drugs, smoking, alcohol, straining 6. Complications: oesophagitis, ulceration, haemorraheg, stricture formation, anaemia, aspiration pneumonia, Barrett's oesophagus

Answer 25

1. Heartburn 2. Acid regurgitation Less commonly: chest pain, hoarseness, cough, wheezing, asthma, dental erosions

Answer 26

1. URGENT endoscopic investigation if ALARM 2. Lifestyle 3. Review drugs that may cause GORD 4. Long term continuous use of antacids not recommended 5. If endoscopy confirmation of GORD = PPI for 4-8 weeks 6. If no response to PPI, offer H2 receptor antagonist 7. Severe oesphagitis - PPI for 8 weeks 8. If patient pregnant: lifestye advice, antacid/ alginate. If ineffective -omeprazole/ ranitidine

Answer 27

1. Alpha blockers 2. Anticholinergics 3. Benzos 4. Beta blockers 5. Bisphosphonates 6. CCBs 7. Corticosteroids 8. NSAIDs 9. Nitrates 10. Theophyllines 11. TCAs

Answer 28

1. One of the most common causes of peptic ulcer disease 2. 95% of duodenal and 70-80% of gastric ulcers associated with it 3. Associated with acute and chronic gastritis, gastric cancer and gastric mucosa associated lymphoid tissue lymphoma 4. Bacteria colonise only in the mucus layer of the stomach. Weakens the protective mucus coating of the stomach and duodenum. This allows acid to go through to the sensitive lining beneath.

Answer 29

1. Infection doesn't usually cause symptoms. 2. The most common symptom is abdominla pain. 3.Usually dull, gnawing aching, comes and goes for several days/ weeks. Can occur 2-3h after meals. Wakes you up in the night. Relieved by eating and antacid medications.

Answer 30

1. Must confirm presence before starting eradication treatment (test and treat) 2. PHE guidance on when to test 3. Treatyment: triple therapy 4. PPI+ 2 antibacterials 5. If no pen allergy: PO 1st line for 7 days - PPI+ amoxilciin and either clarithromycin/ metronidazole 6. If pen allergy: PO 1st line for 7 days - PPI+ clarithromycin and metronidazole

Answer 31

1. An adverse IMMUNE response to a food 2. Commonly cutaneous and GI reactions 3. Less frequently: respiratory reactions+anaphylaxis 4. Distinct from intolerance as this is not immunological 5. Common allergens: cow's milk, hen's eggs, soy, weheat, peanuts, tree nuts, fish, shellfish

Answer 32

1. Strict avoidance 2. Sodium cromoglicate licensed as an adjunct to dietary avoidance in patients with a food allergy 3. Chlorphenamine maleate is licnesed for the symptmomatic control of food allergt 4. Igf food induced - adrenaline/ epinephrine is 1st line immediate treatment

Answer 33

The intestinal smooth muscle relaxant properties of antimuscarinic and other antispasmodic drugs may be useful in IBS Alverine citrate, mebeverine Hcl and peppermint oil are believed to be direct relaxants of intestinal smooth muscle+may relieve pain in IBS

Answer 34

Lack of movement somewhere in the intestines that leads to a buildup and potential blockage of food material. May lead to intestinal obstrutcion. May happen after surgery.

Answer 35

1. Impairment of bile formation and/ or bile flow

Answer 36

1. Fatigue 2. Pruritis 3. Dark urine 4. Pale stools 5. Jaundice 6. Signs of fat soluble vitamin deficiencies

Answer 37

1. Colestyramine for pruritis 2. Ursodeoxycholic acid for pruritis 3. Rifampicin (unlicensed) for pruritis 4. If previous therapy ineffective/ not tolerated- sertraline/ for prurtitis 5. Ursodeoxycholic acid is effective for the treatment of pruritis associated with intrahepatic cholestasis in pregnancy

Answer 38

Usually occurs in late preganncy and associated with adverse fetal outcomes No evidence that ursodeoxycholic acid used in late prgenancy affects birth weight in infant/ risk of preterm delivery. There is limited data about the effect of fetal exposure during the 1st trimester.

Answer 39

1. Cholelithiases 2. Occur when hard mineral or fatty deposits form in the gallbladder 3. Majority of patients = asymptomatic 4. Symptoms occur when stones irritate the gallbladder and block part of the biliary system 5. When stones irritate the gallbaldder/ block part of the biliary system, if left untreated, can lead to biliary colic, acute cholecystits, cholangitis, pancreatitis and obstructive jaundice

Answer 40

1. Usually asymptomatic 2. When the stones irritate the gallblader/ block part f the bilirary system... - pain - infection - inflammation

Answer 41

1. Asymptomatic need o treatment 2. Treatment of symptomatic: surgical removal by laparoscopic cholecystectomy 3. Analgesia to control pain - IM diclofenac if severe/ intramuscular opioid 4. No evidence to support use of ursodeoxycholic acid use in this way

Answer 42

1. Gallstones 2. Inborn errors of primary bile acid synthesis 3. Primary biliary cholangitis

Answer 43

1. A group of dieases in which the liver does not produce enough primary bile acids due to enzyme deficiencies. 2. These acids are the main components of the bile and include cholic acid and chenodeoxycholic acid

Answer 44

1. Helps emulsify lipids in food - charge prevets fat droplets coated with bile from reaggregating into larger fat particles 2. Dispersion of fat into micelles provides a greater increased surface area for pancreatic lipase which actually digests the triglycerides and is able to reach the fatty core through gaps between the bile salt 3. Triglyceride broken down into 2 ftty acids + monoglyceride, which are absorbed 4. Since bile increases the absorption of fats, it is an oimproitant part of the absorption of fat soluble substances 5. Is also a route of excretion for bilirubin, a byproduct of RBCs recycled by the liver 6. Alkali - neutralizes excess stomach acid before it enters the duodenum 7. Bile salts also act as bactericides

Answer 45

``` May present with 1. Cholestasis (interruption or suppression of the flow of bile from the liver) > pruritis, fatigue, jaundice 2. Fat-solube vitamin malabsorption 3. Liver disease 4. Progressive neurological disease 5. Rickets 6. Susceptibility to bleeding 7. Night blindness Exact presentation depends on the specific enzyme deficiency ```

Answer 46

1. Cholic acid licensed for treatment if due to inborn deficiency of 2 specific liver enzymes. Acts by replacing some of the missing bile acids, therefore relieving some of the symptoms of the disease 2. Chenodeoxcholic acid licensed if due to a deificency of one specific enzyme in the bile acid synthesis pathwaywhen presenting as cerebrotendinous xanthomatosis. 3. Ursodeoxycholic acid (unlicensed) has been used but absence of evidence.

Answer 47

1. Chronic cholestatic disease which develops due to progressive destruction of small and intermediate bile ducts within the liver 2. Subsequently evolving to fibrosis+cirrhosis "In primary biliary cholangitis the immune system mistakenly attacks the bile ducts. It's not clear why this happens. The bile ducts become damaged and injured."

Answer 48

1. Does not always cause symptoms 2. Bone and joint aches 3. Fatigue 4. Pruritis 5. Dry eyes and mouth 6. Pain and discomfort in the UPPER RIGHT SIDE of the tummy

Answer 49

1. Ursodeoxycgholic acid is recommended, including for those with asymptomatic disease. It slows disease progression but the effect on overall survival is unceratin. 2. Liver transplantation can be considered in patients with advanced primary biliary cholangitis.

Answer 50

1. Varcies = swollen veins in oesophagus/ stomach 2. Formed when blood flow through the liver is compromised 3. Veins can bleed 4. Because the lower third of the oesophagus is drained eventually into the portal vein. These become distended in associated with portal HTN. At high gradients, blood flowing through the hepatic portal system is redirected from the liver into areas with lower venous pressures.

Answer 51

1. Banding | 2. Vasopressin analogue for bleeding

Answer 52

1. A BMI>30kg/m2, but shoul dbe interpreted with caution 2. Men with a waist circumference>/= to94cm (90 for Asian)+ Women with WC >/= 80cm - at increased risk of obesity related health problems. If >102cm(M) or 88cm (F) very high risk.

Answer 53

1. Consider underlying causes e.g. hypothyroidism 2. Review meds that may cause weight gaine.g atypical antipsychotics, sulfonylureas, TCAs 3. Engage in a sustainable weight management programme which includes strategies to change behaviour, increase physical activity and improve diet and eating behaviour 4. Drug treatment should NEVER be used as the sole element of treatment 5. Only consider drug for those with a BMI>30kg/m2 in whom diet, exercise and behaviour changes fails to achieve a realistic reduction in weight 6. Consider prescribing a vitamin and mineral supplement if concern about inadequate micronutrient intake 7. Orlistat is the only drug currently available in the UK that is recommended specifically for the management of obesity - acts by reducing the absoprtion of dietary fat 8. Treatment with orlistat may be used to maintain weight loss rather than to continue to lose weight 9. Consider discontinuation after 12 weeks if weight loss has not exceeded 5% since the start of treatment 10. Drugs which produce a feeling of satiety e.g methylcellulose and streculia have been used (unlicensed_ in an attempt to control appetite, but little evidence for their efficacy 11. Various centrally acting appetite suppressants have been used in the management but have been withdrawn/ no longer recommended due to serious safety concerns/ addictive potential 12. Bariatric surgery if BMI>40kg/m2 or betwene 35-39.9kg/m2 +significant disease

Answer 54

1. Atypical antipsychotics 2. Beta adrenoceptor blocking drugs 3. Insulin (T2DM) 4. Lithium carbonate/ citrate 5. Sodium valproate 6. Sulfonylureas 7. Thiazolidinediones 8. TCAs

Answer 55

1. Alpha blockers 2. Antimuscarinics 3. Aspirin 4. Benzodiazepines 5. Beta blockers 6. Bisphosphonates 7. CCBs 8. Corticosteroids 9. Nitrates 10. NSAIDs 11. Theophyllines 12. TCAs

Answer 56

1. An anal fissure is a tear/ ulcer in the lining of the anal canal, immediately within the anal margin

Answer 57

1. Bleeding on defacation 2. Peristent pain on defacation 3. Linear split in the anal mucosa

Answer 58

1. If acute, present for <6 weeks: focus on ensuring that stools are soft and easily passed 2. Bulk forming laxatives recommended (osmotic as an alternative) if acute <6 wks 3. Short term use of a topical preparation containing a local anaesthetic e.g lidocaine or simple analgesia may be offeredfor prolonged burning pain following defecation. 4. If inadequate, refer to hospital 5. If chronic (>6 weeks) and associated pain - gve GTN ointment (unlicensed). Limited evidence suggests strnegth used does not influence effectiveness but that higher strength potentially increases the incidence of side effects. Healing effects good but headache incidence high. Recurrence of fissure after treatment common. 6. Alternative to GTN is diltiazem or nifedipine which have lower incidence of ADRs than topical. 7. If no response, may refer to specialist for local injection of botulinum toxin type A (unlicensed indication) 8. Surgery an effective option for the management of chronic, but reserved for those who do not respond

Answer 59

1. Haemorrhoids (piles) are abnormal swellings of the vascular mucosal anal cushions around the anus 2. Internal haemarrhoids arise above the dentate line a 3. Usually pianless unless they become strangulated 4. External haemorrhoids originate below the dentate line 5. External can be itchy or painful 6. Women are predisposed to developing haemorrhoids during pregnancy

Answer 60

1. Bright red blood after pooing 2. Itchy anus 3. Feeling like you still need a poo after going to th etoilet 4. Slimy mucus in underwear after wiping bottom 5. Lumps around anus 6. Pain around anus

Answer 61

1. Lifestyle: increase fibre and fluid intake to keep stools soft and easy to pass (minimise straining) - advice about perianal hygiene is helpful to aid healing and reduce irritation and itching 2. Treat constipation with bulk forming laxative 3. Simple analgesic for pain relief 4. Avoid opioids as constipating 5. Avoid NSAIDs if active bleeding 6. Topical preparations (combinations) offer symptomatic relief of local pain and itching but evidence does not suggest that any preparation is more effective than any other 7. If topical preparation contains local anaesthetic may only be used for a few days as may cause sensitization to the anal skin. Local anaesthetics can be absorbed through the rectal mucosa and very rarely may cause increased irritation - excessive application should be avoided 8. Topical preparations containing corticosteroids may improve local inflammation but no data suggesting they reduce haemorrhoidal swelling, bleeding or protrusion 9. Topical corticosteroids are suitable for occaisional short term use (no more than 7 days) after exclusion of infections. Long term use can cuase ulceration/ permanent damage. 10. Treatments from specialists include various non drug procedures e.g rubber band ligation 11. Pregnancy: Bulk forming laxatives are not absorbed and are therefore safe in pregnancy. If topical, give soothing. DO NOT GIVE local anaesthetics or corticosteroids.

Answer 62

1. Characterized by reduced secretion of pancreatic enzymes into the duodenum (1st part of the small intestine) 2. Can result from chronic pancreatitis, CF, obstructive pancreatic tumours, coeliac disease, Zollinger-Ellison syndrome+ GI/ pancreatic surgical resection

Answer 63

1. Maldigestion 2. Malnutrition 3. Low circulating levels of micronutrients, fat soluble vitamins and lipoproteins 4. GI symptoms e.g diarrhoea, abdo cramps and steatorrhea

Answer 64

Excess fat in faeces. Bulky, difficult to flush. Pale and oily appearance. Foul smelling.

Answer 65

1. Pancreatic enzyme replacement therapy with pancreatin is the maintsay of treatment for exocrine pancreatic insufficiency 2. Pancreatin contains 3 main groups of digestive enzymes: lipase, amylase and protease 3. These enzymes respectively digest fats, carbohydrates and proteins into their basic components so that they can be absorbed and utilised by the body 4. Pancreatin should be administered with meals and snacks 5. Dose should be adjusted to lowest effective dose according to symptoms of maldigestion and malabsorption 6. Fibrosing colonopathy has been reported in patients with CF taking high dose pancreatic enzyme replacemen therapy (>10,000 units/ kg/ day). Peak age for development = between 2-8 years 7. Manufacturers advise that total dose in CF patients should not >10,000 units/kg/day of lipase 8. Advise that if patient taking pancreatin develops new abdo symptoms patient should be reviewed to exclude the possibility of colonic damage 9. Limited evidence that acid suppression may improve the effectiveness of pancreatin. PPIs or H2RAs may be trialled in patients who continue to experience symptoms despite high doses of pancreatin. 10. Levels of fat soluble vitamins and micronutrients should be routinely assessed and supplementation advised whenever necessary 11. Dietary advice should be provided 12. Food intake should be distributed between 3 main meals per day and 2 or 3 snacks. 13. Avoid foods hard to digest eg legumes and high fibre food. Avoid alcohol completely. Reduced fat diets not recommended. 14. MCT enriched preparations offer no advantage over a normal balanced diet.

Answer 66

A form of long segment colonic disease. Gradual fusiform stenosis of the lumen resulting from submucosal widening due to the deposition of mature collagen.

Answer 67

1. A stoma is an artificial opening on the abdomen 2. To divert the flow of faeces/ urine into an exterrnal pouch located outside of the body 3. May be temporary or permanent 4. Colostomy/ ileostomy most common 5. Gastrostomy, jejunostomy, duodenostomy or caecostomy may also be perfomed

Answer 68

1. Enteric coated and M/R drugs UNSUITABLE, especially in patients with an ileostomy as there may not be sufficient release of active ingredient 2. Soluble tablets, liquids, capsules or uncoated tablets are more suitabe due to their quicker dissolution 3. If solid dose form given, contents should be checked for any remnants 4. Avoid drugs with sorbitol as an excipient as laxative 5. Avoid opioid analgesics due to constipation 6. Avoid NSAIDs due to risk of gastric irritation and bleeding>monitor output for blood 7. Tendency for diarrhoea (mg) or constipation (calcium) with antacids may be increased 8. PPIs and somatostatin analogues (e.g. ocretotide) often used to reduce the risk of increased stoma output due to increased gastric acid secretion 9. Loperamide+ codeine reduce intestinal motility and decrease water and sodium output from an ileostomy. 10. Loperamide circulates through the enterohepatic circulation which is disrupted in patients with SBS so high doses may be required. 11. Patients with a stoma are particularly susceptible to hypokalemia if taking digoxin. Potassium supplements/ K+ sparing diuretic may be advisable with monitoring for early signs of toxicity. 12. Diuretics should be used in caution in patients with an ileostomy or urostomy as they may become excessively dehydrated and potassium depletion may occur. 13. Usually advisable to to use a K sparing diuretic 14. Iron preparations may cause loose stools and sore skin in stoma patients. Use IM iron if this is an issue. Avoid M/R preps. 14. Avoid laxatives in patients with an ileostomy. Colostomy patients may suffer constipation and should be treated with dietary advice. Bulk forming drugs can be tried and if insufficient can give stimulant used with caution. 15. For K supplements, liquid formulations are preferred to M/R formulations. The daily dose should be split to avoid diarrhoea.

1. Gastro-intestinal system (conditions) Flashcards

(92 cards)