Chapter 1: GI System Flashcards
(15 cards)
Coeliac disease is an autoimmune condition which is associated with chronic inflammation of the small intestine. Which dietary protein activates an abnormal immune response in the intestinal mucosa which can lead to malabsorption of nutrients?
Gluten - which is present in wheat, barley, rye
Treatment for coeliac disease
The management is aimed at eliminating symptoms such as diarrhea, bloating, and abdominal pain. This is done by life-long, strict, gluten-free diet.
Patients who have coeliac disease are at an increased risk of of malabsorption of key nutrients - these include?
Calcium and Vitamin D - their risk of osteoporosis and the need for active treatment of bone disease should form part of the ongoing management of coeliac disease. supplementation may be required if dietary intake is insufficient.
(Patients with coeliac disease should NOT self-medicate with OTC vitamins or mineral supplements. Initiation of supplements should be discussed with a healthcare professional first.
Diverticulosis is an asymptomatic condition characterized by the presence of diverticula. What is diverticula?
Diverticula are small pouches protruding from the walls of the large intestine. It is age dependent, with majority of patients aged 40 years and over.
What us Diverticular disease?
It is a condition where diverticula are present with symptoms such as abdominal tenderness and/or mild, intermittent lower abdominal pain with constipation, diarrhoea, or occasional large rectal bleeds.
What is acute diverticulitis?
This is when diverticula suddenly become inflamed or infected. Signs and symptoms include constant lower abdominal pain (usually severe) together with features such as fever, a sudden change in bowel habits and significant rectal bleeding, lower abdominal tenderness, or a palpable abdominal mass.
What is complicated acute diverticulitis?
Diverticulitis associated with complications such as abscess, bowel perforation and peritonitis, fistula, intestinal obstruction, haemorrhage, or sepsis
Non-drug management of diverticulitis?
- Patients /family/carers should be provided with info on diet and lifestyle changes
- Patients with diverticulosis or diverticular disease should be advised to eat a healthy, balanced diet including whole grains, fruit and vegetables
- In patients with constipation and on a low fibre diet, a gradual increase of dietary fibre may minimise flatulence and bloating
- Patients increasing dietary fibre should be advised to drink an adequate amount of fluid, especially if dehydration is a risk
- Advice should also be given about the benefits of exercise, weight loss (if overweight or obese), and Smoking cessation, in reducing the risk of symptomatic disease and acute diverticulitis.
How long can it take to see benefits from increasing fibre with diverticular disease?
Several weeks for benefits of increasing fibre and if high fibre diet is tolerated then continue it for life.
Drug treatment for diverticulosis?
As diverticulosis is an asymptomatic condition, specific treatments are not recommended. Bulk-forming laxatives can be considered for patients with constipation.
Drug treatment for diverticular disease?
- Antibacterials are not recommended for patients with diverticular disease
- Bulk-forming laxatives should be considered when a high-fibre diet is unsuitable, or for patients with persistent constipation or diarrhoea
- Consider the use of simple analgesia such as paracetamol in patients with ongoing abdominal pain, and antispasmodics in those with abdominal cramps. Non-steroidal anti-inflammatory drugs and opioid analgesics are not recommended as their use may increase the risk of diverticular perforation.
Drug treatment for Acute diverticulitis?
- Offer simple analgesia such as paracetamol to patients with acute diverticulitis who are systemically well. Consider a watchful waiting and a no antibacterial prescribing strategy, and advise patients to re-present if symptoms persist or worsen.
- Refer patients with suspected complicated acute diverticulitis and uncontrolled abdominal pain for same-day hospital assessment. Those presenting with significant rectal bleeding should be referred to hospital urgently.
- Treatment with aminosalicylates or prophylactic antibacterials are not recommended to prevent recurrent acute diverticulitis.
Drug treatment for acute diverticulitis?
- For patients who are systemically unwell, immunosuppressed, or have significant comorbidities, an antibacterial prescribing strategy should be offered.
- Oral antibacterials should be offered to patients who are systemically unwell but do not meet the referral criteria for suspected complicated acute diverticulitis.
- Oral first line: co-amoxiclav
- Second line: Cefalexin
Inflammatory bowel disease includes?
Crohn’s and Ulcerative colitis
IBD: Aminosalicylates,
