Diarrhoea, constipation and GI care Flashcards

Question

List 3 other treatments other than atimicrobials

Answer 1

Probiotics Restore gut microbiome Role uncertain in prevention and treatment Faecal Microbiota Transplant (FMT) Transplant from healthy donor Some evidence to support this Clinical trial stage Intravenous Immunoglobulin Severe or recurrent cases of colitis where other treatments failed

Answer 2

Passage of hard stools less frequently than normal Typically less than three bowel movements in one week

Answer 3

``` Symptoms include: Abdominal discomfort and distension Abdominal cramping Bloating Nausea Difficulty passing stool ``` Affects people of all ages More common in: Women, particularly if pregnant Older people

Answer 4

Functional (idiopathic) No anatomical or physiological cause known Secondary Induced by particular condition or medicine

Answer 5

``` Non-medical factors which pre-dispose to constipation include Inadequate fluid intake Inadequate dietary fibre Dieting Changes in lifestyle Suppressing the urge to defecate ```

Answer 6

``` Coeliac disease Depression Diabetes GI obstruction Irritable bowel syndrome Parkinson’s disease Hypercalcaemia Hypokalaemia Hypothyroidism ```

Answer 7

Medications that can cause constipation include: Antacids containing aluminium and calcium Antihypertensives – diuretics, calcium channel blockers Antidepressants – tricyclics and some monoamine oxidase inhibitors Antimuscarinics – procyclidine, oxybutynin Antiparkinsonian medicines – levodopa, dopamine agonists, amantadine *Opioid analgesics* Iron

Answer 8

``` Bowel habit Examination Try to identify cause Check for red flags including; Unexplained weight loss Rectal bleeding Family history of colon cancer or IBD Signs of obstruction ```

Answer 9

Aims: Restore normal frequency defecation Achieve regular, comfortable defecation Avoid laxative dependence Relieve discomfort

Answer 10

``` Non-pharmacological: Consider primary cause Diet – increasing dietary fibre Ensuring adequate fluid intake Lifestyle measures including exercise ``` ``` Laxatives: Bulk-forming Stimulant Osmotic Faecal-softening ```

Answer 11

Increase faecal mass through water binding to stimulate peristalsis Take several days for full effect Maintain good fluid intake as they laxatives pull in water Can be used long-term in people prone to constipation Examples include: Ispaghula husk (fybogel) Methylcellulose (also acts as softener)

Answer 12

Increase intestinal motility via muscle contractions Work within a few hours (advise to take before bedtime, should work by morning) Can cause abdominal cramps due to increased peristalsis Avoid prolonged use – can lead to diarrhoea, fluid and electrolyte imbalance Examples include: Senna Dantron (terminally ill patients only) Bisacodyl

Answer 13

Work within colonic lumen to retain and draw water into intestine by osmosis to help soften and pass the stool Patient must maintain good fluid intake Macrogel powders –1-3 days to work Lactulose (semi-synthetic disaccharide) – 2-3 days to work (dose is lower than the dose given in liver disease) Phosphate enema or suppository – 15-30 minutes to work Magnesium hydroxide – 3-6 hours to work

Answer 14

Stimulate peristalsis by increasing faecal mass: act to lower surface tension and allow water and fats to penetrate faeces Docusate sodium acts as faecal softener and stimulant – works within 1-3 days Glycerol suppository – works within one hour Arachis (peanut) oil enema – works within 30 minutes. Not to be used if nut allergy

Answer 15

Faecal Impaction Haemorrhoids Rectal prolapse Anal fissures

Answer 16

An autoimmune condition affecting the small intestine. Has a genetic predisposition aspect and has environmental triggers Body’s immune system attacks itself when gluten is eaten (adverse reaction to gluten) The reaction is not an allergic reaction and does not cause anaphylactic shock (so its not an allergy or intolerance) Affects 1% of Northern Europeans and Northern Americans

Answer 17

Serology IgA tTG vs IgA EMA (parts of the immune system) Endoscopy for small intestinal biopsy 2nd part of duodenum At least 4 large biopsies – well orientated Repeat biopsy on gluten-free diet Gluten challenge (>10g per day, 6/52)

Answer 18

Not every patient has symptoms Vary person to person from mild – severe ``` Include: Headaches Diarrhoea Abdominal pain Lethargy ``` The symptoms may last from a few hours to a few days

Answer 19

Long term malabsorption and osteoporosis Refractory coeliac disease Ulcerative jejunitis Enteropathy associated T cell lymphoma Autoimmune disease -T1DM, Autoimmune thyroid disease The longer you continue eating gluten the more your risk of triggering another autoimmune disease.

Answer 20

There is no cure and the treatment is a life long gluten-free diet All fresh meat, fish, cheese, eggs, milk, fruit and vegetables are gluten-free Specially-manufactured wheat starch is used in the gluten-free diet The Crossed Grain symbol is internationally recognised by those who have to follow a gluten-free diet.

Answer 21

``` Taste- poor compliance in adolescents Expensive Difficult to eat out No agreed international consensus on permissible levels Range of symptoms with ingestion Nutritional aspects Low fibre Low vitamin D High calories ```

Answer 22

As of 4th December 2018, the prescribing of gluten-free (GF) foods on the NHS in England will be restricted to bread and mixes only

Answer 23

Its a chronic condition of at least 6 months of abdominal pain and bowel symptoms (diarrhoea, constipation or combination of both) Cause unclear and can differ patient to patient Poorly understood Treatment aimed at symptomatic relief

Answer 24

Number of different medications can be used No “gold standard” as symptoms vary Treatments include: Dietary changes and exercise Antispasmodics for cramping pain e.g. mebeverine, hyoscine, peppermint oil Anti-diarrhoeal e.g. Loperamide Laxatives e.g. bulk-forming, stimulant, osmotic Probiotics

Answer 25

Smooth muscle relaxants Mebeverine is commonest prescribed drug for IBS in the UK Modified release capsule – 200mg twice daily Tends to be well tolerated Peppermint oil capsules can also be used – taken three times daily

Diarrhoea, constipation and GI care Flashcards

(49 cards)