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A - Pre-reg Exam COPY > Gastro-intestinal system > Flashcards

Gastro-intestinal system Flashcards

1
Q

Can anti- diarrhoea’s be used in acute ulcerative colitis?

A

No- increased risk of toxic megacolon.

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2
Q

How is an acute flare up of (non severe) ulcerative colitis treated?

A

1st line- oral/rectal aminosalicylate
2nd line- ADD oral beclometasone
3rd line- ADD oral prednisolone (if becometasone fails)
4th line ADD oral Tacrolimus
5th line- Monoclonal antibodies (e.g infliximab)

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3
Q

How is an acute flare up of severe ulcerative colitis managed?

A

Medical emergency- immediate hospitalisation.

1st line- IV steroids
2nd line- IV cyclosporin or surgery
3rd line- monoclonal antibodies

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4
Q

What is the maintenance treatment for ulcerative colitis?

A

1st line- oral or rectal aminosalicylates
2nd line- azathioprine or mercaptopurine
3rd line- monoclonals: infliximab, adalimumab and vedolizumab.

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5
Q

What are some aminosalicylates?

When should treatment be discontinued?

A

Mesalasine, sulfasalazine

Can cause bone marrow suppression and blood disorders- STOP if sore throat, etc and do FBC.

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6
Q

What side effect can monoclonal antibodies cause?

A

Increased susceptibility to opportunistic infections.

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7
Q

What must be treated before starting a monoclonal antibody?

A

Screen for and treat latent TB.

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8
Q

How is irritable bowel syndrome (IBS) treated?

A

1st line: antispasmodics to relax GI smooth muscle
2nd line: low dose TCA for abdominal pain/ SSRI

Use laxatives and antidiarrhoeals as needed.

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9
Q

What is eluxadoline?

A

An antidiarrhoeal that can be used in IBS as a last resort if nothing else has worked.
Stop after 4 weeks if no benefit.
MHRA alert about risk of pancreatitis- avoid if liver disorders or cholecystectomy.

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10
Q

What issues are present with short bowel syndrome?

A

Short bowel due to large surgical resection leading to inadequate absorption in the gut.

  • Many vitamins and minerals may need supplementation especially magnesium.
  • Some drugs may need higher doses than usual
  • MR/ GR drugs are unsuitable
  • Diarrhoea is common. Treat as appropriate
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11
Q

What are some antispasmodics used in IBS?

A

alverine, mebeverine, peppermint oil.

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12
Q

What are some bulk forming laxatives?

When are they used?

A

Ispaghula husk, sterculia, methylcellulose.

Small hard stools

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13
Q

How long do bulk forming laxatives take to work?

A

72 hours.

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14
Q

When should stimulant laxatives be avoided?

A

intestinal obstruction

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15
Q

Which laxative is of benefit in hepatic encephalopathy and why?

A

Lactulose- discourages proliferation of ammonia producing organisms.

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16
Q

What class of laxatives are macrogols?

A

osmotic laxatives

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17
Q

What is linaclotide?

A

A laxative used for constipation in those with IBS

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18
Q

What is the recommended treatment for opioid induced constipation?

A

1st line: osmotic laxative (lactulose) or docusate

2nd line: stimulant laxative (eg Senna)

3rd line: naloxegol, methylnaltrexone

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19
Q

Which laxatives should be avoided in opioid induced constipation?

A

Bulk forming

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20
Q

How is chronic constipation managed?

What about if pregnant or breastfeeding?

A

1st line: bulk forming (ispaghula husk)

2nd line: osmotic (macrogol first/ lactulose)

3rd line: stimulant (bisacodyl/ senna) or docusate.

Same pathway in pregnancy/breastfeeding

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21
Q

What laxative can be used in WOMEN only when at least 2 other laxatives have failed at the maximum dose in the last 6 months.

A

Prucalopride (women only)

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22
Q

Which laxative should be avoided in pregnant women near term?

A

Senna

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23
Q

Should diet alone be used as first line management of constipation in children?

A

No - start laxatives immediately.

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24
Q

What is the MHRA alert associated with loperamide?

A

Risk of serious cardiac events with large overdoses in misuse. Including QT prolongation, cardiac arrest, torsade de pointes.

Naloxone can be used as a reversal agent.

25
Q

Which antibiotic can be used for prophylaxis of travellers diarrhoea (although it is not recommended)?

A

Ciprofloxacin

26
Q

Which patients need urgent investigation if they have recent onset of dyspepsia not responding to treatment?

A

Patients over 55 - risk of cancer

27
Q

What should be done if a patient has unexplained dyspepsia not responding to PPIs?

A

Test for H.pylori + treat if it is present

28
Q

Why are bismuth containing antacids not recommended?

A

They are neurotoxic- can cause encepalopathy and are also constipating.

29
Q

What is a common side effect of magnesium?

A

A laxative effect

30
Q

What is a common side effect of aluminium?

A

Constipation

31
Q

How do antacids work and what do they mostly contain?

A

Neutralise stomach acid.

Aluminium, magnesium, calcium

32
Q

What do alginates do?

A

Increase viscosity of stomach contents and protect oesophageal mucosa from acid reflux.

33
Q

What is simeticone?

What is it used for?

A

An antifoaming agent.

Relieves flatulence and prevents hiccups in palliative care.

34
Q

What medicines can be used for GORD in pregnancy?

A

1st line: antacids and alginates
2nd line: ranitidine
3rd line: omeprazole (if severe)

35
Q

What are the 2 main causes of peptic (stomach) ulcers?

A

NSAIDS and h.pylori.

36
Q

How is H.pylori infection treated?

A

1 week triple therapy of:
1 PPI + 2 of amox/ clarith/ metronidazole

  • Usual PPI doses: lansop 30mg BD omen 20mg BD
  • If a patient has used one of these antibiotics recently, exclude it from the regimen and use the other two.
  • Tinidazole can occasionally be used as an alternative to metronidazole
37
Q

What can be used for h. pylori eradication failure?

A

2 weeks of:

PPI + tripotassium + tetracycline + metronidazole

38
Q

What must be avoided before the test for h.pylori?

A

NO antibiotics 4 weeks before

NO anti secretory drugs (e.g PPIs) 2 weeks before

39
Q

What is the MHRA alert regarding PPIs?

A

Very low risk of subacute cutaneous lupus erythematous. Skin lesions may develop in sun exposed areas- can be treated with steroids.

40
Q

What are some side effects of PPIs?

A

Hyponatraemia, hypomagnesia, blood disorders

Risk of oseteoporosis- maintain adequate calcium and vitamin D.

41
Q

What is the difference between IBD and IBS?

A

IBD- inflammatory bowel diseases includes Crohn’s and ulcerative colitis (UC) .

IBS- irritable bowel disease- no inflammation and less damage to the bowel than IBD.

42
Q

What is the difference between Crohn’s and UC?

A

Crohn’s can occur at any part of the GIT.

Ulcerative colitis only occurs at the colon.

43
Q

How is an acute flare up of Crohn’s managed?

A

1st line: Corticosteroids (only option if its severe)
2nd line: budesonide
3rd line: aminosalicylates

You can add on azathioprine/mercaptopurine/ methotrexate to steroids if its recurrent flare ups.
Monoclonals can also be added: infliximab/ adalimumab, vedolizumab.

44
Q

What is the maintenance treatment for Crohn’s?

A

1st line: azathioprine/ mercaptopurine

2nd line: aminosalicylates

45
Q

What is the MHRA alert associated with hyoscine injections?

A

Risk of serious cardiac side effects in patients with underlying cardiac disease (e.g tachycardia, hypotension, anaphylaxis).

Have resus available.

46
Q

What are acute antimuscarinic side effects?

A

Blind as a bat- blurred vision

Dry as a bone- dry mouth

Hot as hell- hyperthermia

Mad as a hatter - confusion

Red as a beet- tachycardia and vasodilation

Full as a flask - urinary retention.

47
Q

Which medicines can be used to treat pruritis associated with liver disorders?

A
  • Colestyramine - reduces serum bile hence reduces itch
  • ursodeoxycholic acid
  • rifampicin
48
Q

Which medicine can also be used to dissolve gallstones (although gall stones are usually asymptomatic)

A

ursodeoxycholic acid

49
Q

When can orlistat be used for obesity?

A

BMI>30 or >28 and other risk factors

50
Q

When should orlistat treatment be stopped and deemed ineffective?

A

Stop after 12 weeks if weight loss has not exceeded 5% (reduce this target in patients with T2DM)

51
Q

When can bariatric surgery for obesity be considered?

A

BMI> 40 or

BMI>35 with significant disease (such as T2DM or hypertension)

52
Q

What is the main counselling points to tell patients about orlistat?

A

Take with meals. Omit dose if a meal is being skipped.

Impairs absorption of fat soluble vitamins (ADEK)- supplementation might be needed.

53
Q

Whats the maximum duration for topical corticosteroids for haemorrhoids or piles?

A

7 days

54
Q

What side effect can occur in patients with cystic fibrosis taking high doses of pancreatin?

A

Fibrosing colonopathy.

Doses shouldn’t exceed 10,000 units/kg/day of lipase

55
Q

What should be routinely assessed and supplemented if necessary in patients with pancreatic insufficiency?

A

Fat soluble vitamins (ADEK)

micronutrients (zinc and selenium)

56
Q

What is a stoma?

A

An artificial opening on the abdomen to divert flow of faeces/ urine to an external pouch located outside the body- can be temporary or permanent.

57
Q

What excipient should be avoided in patients with a stoma and why?

A

Sorbitol- laxative side effects

58
Q

What can diuretics and digoxin commonly cause in patients with a stoma?

A

Hypokalaemia- potassium supplements may be needed

59
Q

What can be used to reduce intestinal motility and decrease water and sodium losses from stoma?

A

Loperamide and codeine.

A - Pre-reg Exam COPY (15 decks)

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