Flashcards in Chronic bowel disorders Deck (38)
What is coeliac disease ?
autoimmune condition associated with chronic inflamation of small intestine unable to absorb nutrients
What causes coeliac disease ?
intolerance to gluten
Where is dietary protein gluten found ?
in cereals wheat, barley and rye
What are the symptoms of coeliac disease ?
diarrhoea, abdominal pain, bloating
Why the patients who have coeliac disease should be assessed for the risk of osteoporosis ?
higher risk of malabsorption of key nutrients: vitamin D and calcium
What is the difference between diverticula and diverticulitis ?
Diverticula: small bulges or pockets that develop in the lining of large intestine. Pain in the lower tummy
Diverticulitis when the pockets become inflamed or infected.
No symptoms: diverticulosis
What are the symptoms of diverticular ? Fiber can predispose to diverticular ( aim for 30g fiber a day )
tummy pain, usually in your lower left side, that tends to come and go and gets worse during or shortly after eating (pooing or farting eases it)
constipation, diarrhoea, or both
occasionally, blood in your poo
What is the treatment for suspected uncomplicated acute diverticulitis ?
Oral first line: Co-amoxiclav.
Alternative in penicillin allergy or co-amoxiclav unsuitable: cefalexin (caution in penicillin allergy) with metronidazole, or trimethoprim with metronidazole, or ciprofloxacin (only if switching from intravenous route with specialist advice) with metronidazole.
Inflammatory bowel disease is a term used to describe which two conditions ?
Ulcerative colitis and chrons disease
What is ulcerative colitis ?
mucosal inflammation and ulcers restricted to colon and rectum
What are the symptoms of ulcerative colitis ?
Symptoms alternate between acute-flares up and remission
-bloody diarrhoea ( may contain mucus or pus)
-abdominal pain, urgent need to defecate
What happens in acute flares up of ulcerative colitis ?
mouth ulcers, arthritis, sore skin, weight loss, fatigue
What are the long term complications of ulcerative colitis ?
secondary osteoporosis (corticosteroid medication, dietary change )
which drugs are contraindicated during acute flares up of ulcerative colitis ?
loperamide, codeine : paralytic illeus= increased risk of toxic megacolon
Would you use oral or rectal inflammation for extensive colitis ? ( proximal)
IF colitis has affected rectum ( proctitis ), treatment oral or rectal ?
Left-sided colitis ( distal), would you consider enemas or suppositories ?
What choice of preparations would be most appropriate in proctosigmoditis ?
Proctosigmoditis: inflamation of rectum and sigmoid colon
For mild-to-moderate first presentation or inflammatory exacerbation of proctitis, proctosigmoiditis, or left-sided ulcerative colitis, what drug treatment is recommended ?
-Aminosalicylates — mesalazine and sulfasalazine, (suppository or enema) initially, and orally if remission is not achieved within four weeks.
-Corticosteroids — monotherapy with a time-limited course of corticosteroids may be used for induction of remission if aminosalicylates are ineffective.
-Calcineurin inhibitors — tacrolimus or ciclosporin may be added to oral corticosteroids to induce remission in people with mild to moderate disease if there is an inadequate response to oral corticosteroids after 2–4 weeks.
-Immunosuppressive drugs — the thiopurines (azathioprine, mercaptopurine) or methotrexate (second-line) may be considered to maintain remission if there are two or more inflammatory exacerbations in a 12-month period that require treatment with oral corticosteroids, or if remission cannot be maintained by aminosalicylates.
Thiopurines may increase the risk of which type of cancer ?
thiopurines may increase the risk of non-melanoma skin cancer, and people should be monitored for skin cancer and given appropriate sun protection advice.
What treatment is indicated for extensive ulcerative colitis ?
A topical aminosalicylate and a high-dose oral aminosalicylate are recommended as first-line treatment for patients with a mild-to-moderate initial presentation or inflammatory exacerbation of extensive ulcerative colitis. If remission is not achieved within 4 weeks, stop topical aminosalicylate treatment and offer a high-dose oral aminosalicylate and 4 to 8 weeks of an oral corticosteroid. An oral corticosteroid for 4 to 8 weeks should be considered for patients in whom aminosalicylates are unsuitable.
Name all aminosalicylates that can be used in IBD ? ( inflammatory bowel disease?
What are the side effects of aminosalicylates ?
salicylates hypersensitivity: itching and hives
yellow/orange bodily fluids with sulfasalazine: contact lenses may be stained.
What is the interactions between mesalazine and lactulose ?
lactulose lowers stool PH in the intestines: this prevents sufficient release of the active ingredient in E/C or M/R preparations.
What are the symptoms of IBS ?
lower abdominal pain/colic
What can aggravate IBS ?
stress, depression, anxiety, lack of dietary fibre.
commonly affects women between 20-30 years.
Which drug classes can be used to treat IBS ?
antispasmodics, antimuscarinics, laxatives, anti motility drugs, antidepressants
Which antispasmodics can be used in IBS to help with GI spasms ?
peppermint oil ( s/e: heartburn, local irrational of mouth, oesophagus)
Which antimuscarinics can be used in IBS to help with GI spasms?