GASTRO-INTESTINAL SYSTEM Flashcards

Question

GALLSTONES What is it?

Answer 1

Hard mineral/fatty deposits forming stones in the gallbladder bile duct

Answer 2

When does it occur? Late-> adverse fetal outcomes Treatment? Ursodeoxycholic acid

Answer 3

1st LINE? Cholestyramine 2nd LINE? Ursodeoxycholic Acid 3rd LINE? Rifampicin (unlicensed, careful in LD, hepato?)

Answer 4

Impaired bile formation/flow-> fatigue, pruritus, dark urine, pale, jaundice

Answer 5

``` FAMOTIDINE Age? 16+ Duration? 2 weeks max Indication? Hearbturn/dyspepsia/prevention, sleep L, etc Dose? 10mg single, MAX. 20mg OD ```

Answer 6

Reduced absorption of -azole antifungals Cimetidine- CYP450 enzyme inhibior

Answer 7

``` Diarrhoea Headache Dizziness Rash Tiredness ```

Answer 8

Gastric cancer

Answer 9

Famotidine Ranitidine Cimetidine Nizatidine

Answer 10

Clopidogrel+Omeprazole (Lansoprazole instead) | Methotrexate+Omeprazole (increased levels of methotrexate)-> PPI acts as enzyme inhibitor?

Answer 11

Increased risk of..? Fractures/Osteoporosis (hypomagnesaemia) C. Difficile Can mask symptoms of? Gastric cancer

Answer 12

Low risk of subacute cutaneous lupus erythmeatosus, crazy

Answer 13

OMEPRAZOLE ESOMEPRAZOLE LANSOPRAZOLE RABEPRAZOLE

Answer 14

Increases stomach ph (>>alkali) so enteric-coated capsules are...? Damaged before reaching intestine Impairs absorption of other drugs..? Bisphosphonates (risderonate, alendronate, zolendronic acid), High sodium content, don't take with or in..? Lithium/Hypertension Low-sodium antacid- example? Co-magaldrox

Answer 15

MAGNESIUM? LAXATIVE effect ALUMINIUM? CONSTIPATING effect CALCIUM? Induces rebound acid secretion SIMETICONE? relieves flatulence ALGINATES+ANTACIDS? Increases viscosity of stomach content -Forms a viscous gel ('raft') that floats on the surface of the stomach contents

Answer 16

If that's an L? antacid/alginate If above is also an L? omeprazole/ranitidine

Answer 17

Uninvesigated GORD? 4 weeks of PPI (same as dyspepsia) Confirmed GORD? 4-8 weeks of PPI

Answer 18

``` Healthy eating Weight loss (obese) Avoid trigger foods Smaller meals Evening meal 3-4hrs before bed Raise head of bed Smoking cessation Reduce alcohol consumption ```

Answer 19

``` Consuming fatty foods Pregnancy Hiatus Hernia Family History Stress/anxiety Obesity Smoking Alcohol Some drugs: e.g. a/b-blockers, CCBs, benzos (use lowest effective dose OR STOP) ``` Nitrates- loosens up sphincter between windpipe/stomach, more acid? Mad

Answer 20

H. PYLORI TREATMENT? PPI+2 ANTIBIOTICS PPI: BD (Omeprazole 20-40 | Lansoprazole 30) Amoxicillin: 1000mg BD (other 2 in pen allergy) Clarithromycin: 500mg BD Metronidazole: 400mg BD 7 DAYS TREATMENT 3 COMBOS? PAC OR PAM OR PCM PPI+bismuthsubsalicylate+metronidazole+tetracycline

Answer 21

How do you test for H. pylori? Urea (13C) breath test OR Stool Helicobacter Antigen Test (SAT) 2 conditions? PPIs should've been stopped 2 weeks before test & Antibiotics should've been stopped 4 weeks before test

Answer 22

FUNCTIONAL DYSPEPSIA TREATMENT? Can't identify underlying cause TEST FOR? H. pylori- treat if + NOT INFECTED? 4 weeks of PPI/H-2 receptor antagonist, e.g. cimetidine/famotidine, etc

Answer 23

UNINVENSTIGATED DYSPEPSIA TREATMENT? PPI for 4 weeks TEST FOR? H. pylori if PPI didn't work, treat if positive (PPI+ 2 antibacterials)

Answer 24

UNINVENSTIGATED & FUNCTIONAL

Answer 25

GI bleeding 55 years+ Unexplained weight loss Dysphagia

Answer 26

Upper abdominal pain/heartburn/gastric reflux/bloating/nausea/vomiting

Answer 27

OTC AGE? 12 years+ Diarrhoea w/ IBS?- 18 years+ PRESCRIPTION AGE? 4 years+ HOW TO TAKE IT? 1-2 doses (2-4mg), then 1 w/ every loose stool, max. 8 doses (16mg) per day MHRA WARNING? Serious cardiac reactions (QT prolongation) w/ high doses HOW TO TREAT OVERDOSE? Naloxone

Answer 28

Loperamide

Answer 29

Use loperamide BUT avoid in... BLOODY/SUSPECTED inflammatory diarrhoea

Answer 30

Hospital-> IV fluids ASAP

Answer 31

1st LINE? Dietary advice+macrogol (if no faecal impaction) L? Stimulant STILL HARD STOOLS? Lactulose/Docusate

Answer 32

1st LINE? Diet+lifestyle, fibre key! 2nd LINE? Bulk-forming, e.g. ISPAGHULA HUSK. L? Lactulose Still an L? Bisacodyl/senna (don't use senna near birrth)?

Answer 33

1st LINE? OSMOTIC+STIMULANT L? NALOXEGOL AVOID? BULK-FORMING (peristalsis already slow mate!)

Answer 34

HARD STOOLS? Macrogol & once softened? Stimulant L? Rectal glycerol ONLY OR glycerol+bisacodyl SOFT STOOLS? Stimulant L? Rectal bisacodyl

Answer 35

Bulk-forming+good hydration Still hard stools? Add/change to Macrogol/Lactulose Still no change after 6 months? Prucalopride Withdraw lactulose slowly when patient improves by the way!

Answer 36

Bulk-forming+good hydration. L? Osmotic

Answer 37

Examples? Lactulose, Macrogol How does it work? Increases amount of fluid in the large bowel-> peristalsis How long? 2-3 days

Answer 38

Anal seepage Risks of: Granulomatous disease of GI tract Lipoid pneumonia on aspiration

Answer 39

Examples? Liquid paraffin, docusate, glycerol How it works? Increases water penetration into stool Quickest-acting? GLYCEROL SUPPOSITORY THE QUICKEST!

Answer 40

CO-DANTHRAMER (red urine) CO-DANTHRUSATE (orange urine) limited use due to carcinogenicity..

Answer 41

Examples? Senna, Sodium Picosulfate, Bisacodyl, docusate, glycerol How it works? Stimulates intestinal motility How long? Takes 6-12hrs to work Avoid in? Intestinal obstruction

Answer 42

Examples? Methylcellulose/Ispaghula Husk/Sterculia How it works? Small, hard stools- increases faecal mass, stimulates peristalsis How long? 2-3 days to work Advice? Take w/ plenty of water to prevent intestinal blockage

Answer 43

BULK STIMULANT FAECAL SOFTENERS OSMOTIC

Answer 44

``` FIBRE WATER EXERCISE + Review possibly medications-causing? E.g. opioids, aluminium?, CLOZAPINE (BIG RED FLAG!) intestinal peristalsis? ```

Answer 45

``` Blood in stool Anaemia Abdominal pain Weight loss New onset constipation> 50 years ```

Answer 46

Infrequent, difficult stools

Answer 47

LOPERAMIDE/CODEINE TO REDUCE INSTETINAL MOTILITY

Answer 48

Vitamins A, B12, D, E, and K, essential fatty acids, zinc, and selenium

Answer 49

Shortened bowel due to large surgical resection. Need to ensure adequate absorption of nutrients+fluid!

Answer 50

2nd LINE? TCA: Amitriptyline Alternative? SSRIs [UNLICENSED]

Answer 51

LAXATIVES: if constipated (X lactulose, can cause bloating) ANTISPASMODICS: alverine, mebeverine & peppermint oil LOPERAMIDE: if experiencing diarrhoea ANTIMUSCARINICS: hyoscine BUTYLbromide (avoid in cardiac disease) hyscoine BUTYLbromide- IBS, your BUTT hyoscine HYDRObromide- ship, water, motion sickness, HYDRO

Answer 52

``` Exercise Regular meals Reduce fresh fruit-3/day Reduce insoluble fibre Drink >/= 8 cups of water Reduce caffeine/alcohol/fizzy drinks Avoid sorbitol if you have diarrhoea Reduce stress ```

Answer 53

COFFEE/ALCOHOL/MILK LARGE MEALS FRIED FOODS STRESS

Answer 54

Common/chronic/relapsing/life-long-> abdomina pain/diarrhoea/constipation/urgency/incomplete defaecation/passing mucus

Answer 55

AMIONOSALICYLATES CONTRAINDINCATED IN SALICYLATE HYPERSENSITIVITY. Obvs... SULFASLAZINE COLOURFUL SIDE-EFFECT? Stains contact lenses orangey-yellow

Answer 56

NEPHROTOXIC? Monitor before, at 3 months & /year HEPATOTOXIC? Monitor at monthly intervals for first 3 months BLOOD DISORDERS? Monitor at monthly intervals for first 3 months Perform blood count+stop drug ASAP if signs of blood dyscrasia

Answer 57

PROCTITIS/PROCTOSIGMOIDITIS? RECTAL AND/OR ORAL AMINOSALICYLATE LEFT-SIDED/EXTENSIVE? LOW-DOSE ORAL AMINOSALICYLATE 2+ FLARES IN 12 MONTHS? ORAL AZATHIOPRINE/MERCAPTOPURINE (Give monoclonal antibodies if no effect)

Answer 58

Cos of side-effects AMINOSALICYLATES>CORTICOSTEROIDS

Answer 59

1st LINE? IV hydrocortisone/methylprednisolone-> need for surgery? 2nd LINE? IV cyclosporin/surgery Symptoms not helped within 72hrs? IV steroid+IV ciclosporin OR surgery Alternative to Ciclosporin? Infliximab

Answer 60

1st LINE? TOPICAL AMINOSALICYLATE+HIGH-DOSE ORAL AMINOSALICYLATE 2nd LINE? NO CHANGE AFTER 4 WEEKS? STOP TOPICAL AMINOSALICYLATE, GIVE: HIGH-DOSE ORAL AMINOSALICYLATE+4-8 WEEKS ORAL CORTICOSTEROID NOTE: Aminosalicylates contraindicated? Consider ORAL (ONLY) corticosteroid 4-8 weeks.

Answer 61

1st LINE? TOPICAL AMINOSALICYLATE 2nd LINE? ADD-ON HIGH-DOSE ORAL AMINOSALICYLATE if no improvement after 4 weeks OR SWITCH TO HIGH-DOSE ORAL AMINOSALICYLATE+4-8 WEEKS OF TOPICAL CORTICOSTEROIDS 3rd LINE? STOP TOPICAL TREATMENT, GIVE: ORAL AMINOSALICYATE+4-8 WEEKS OF ORAL CORTICOSTEROIDS NOTE: Aminosalicylates contraindicated? Consider topical/oral corticosteroid 4-8 weeks.

Answer 62

1st LINE? Topical aminosalicylate (sulfasalazine, mesalazine...) 2nd LINE? Oral aminosalicylate (if no improvement after 4 weeks) 3rd LINE? Topical/oral corticosteroid for 4-8 weeks NOTE: Aminosalicylates contraindicated? Consider topical/oral corticosteroid 4-8 weeks.

Answer 63

AVOID LOPERAMIDE/CODEINE-> can cause toxic megacolon (as gastric emptying is slowed down, build-up) Only use on advice of a specialist!^

Answer 64

AVOID LOPERAMIDE/CODEINE-> can cause toxic megacolon (as gastric emptying is slowed down, build-up) Only use on advice of a specialist!^

Answer 65

DISTAL-RECTAL? Suppositories/Enemas-> foam preps used if patient has difficulty retaining liquid enema EXTENDED? Systemic medication

Answer 66

1. Proctitis 2. Proctosigmoiditis 3. Left-sided 4. Extensive colitis 5. Pancolitis

Answer 67

MOST COMMON AGE? 15-25years ``` COMPLICATIONS? Colorectal cancer Secondary osteoporosis Venous thromboembolism Toxic megacolon ```

Answer 68

Can affect region from rectum-whole colon- blood diarrhoea/defecation urgency/abdominal pain

Answer 69

ASYMPTOMATIC? Let it be TO IMPROVE SYMPTOMS? Metronidazole AND/OR Ciprofloxacin (Metronidazole- ~1 month, NOT >3 months due to peripheral neuropathy) MAINTENANCE? Azathioprine OR Mercaptopurine (Infliximab if response L) Treatment >/= 1 year by the way

Answer 70

When a fistula develops between intestine & perianal skin/bladder/vagina

Answer 71

LOPERAMIDE CoDeine (CD) UC, you can't by the way! COLESTYRAMINE

Answer 72

STOP SMOKING+NUTRITION KEY MONOTHERAPY? Azathioprine OR Mercaptopurine -Alternative? Methotrexate POST-SURGERY? Azathioprine+Metronidazole (3 months) OR Aazathioprine alone

Answer 73

Add-on 1st LINE? Azathioprine OR Mercaptopurine 2nd LINE? Above an L-> add-in Methotrexate SEVERE? Monoclonal antibodies

Answer 74

1st LINE? Prednisolone/methylprednisolone/IV hydrocortisone (monotherapy) Patient has distal ilea/ileocaecal/right-sided disease? Budesonide -Alternative? Aminosalicylates (sulfasalazine/mesalazine)-> less side-effects, less effective

Answer 75

INTESTINAL FISTULAE ANAEMIA/MALNUTRITION COLORECTAL/SMALL BOWEL CANCER GROWTH FAILURE/DELAYED PUBERTY IN CHILDREN EXTRA-INTESTINAL MANIFESTATION: arthritis/joints/eyes/liver/skin abnormalities

Answer 76

Affects whole GI-tract- thickened wall, all layers, deep ulceration

Answer 77

DIVERTICULAR DISEASE/ACUTE DIVERTICULITIS? Paracetamol- ongoing abdominal pain Bulk-forming laxatives- constipation COMPLICATED? SURGERY ASAP AVOID NSAIDs by the way-> higher risk of diverticular perforation

Answer 78

DIVERTICULOSIS? small pouches but asymptomatic (no treatment needed) DIVERTICULAR DISEASE? small pouches but symptomatic- abdominal pain, constipation, diarrhoea, rectal bleeding ACUTE DIVERTICULITIS? when pouches become inflamed/infected- severe abdominal pain, fever, significant rectal bleeding COMPLICATED ACUTE DIVERTICULITIS? abscess, perforation, fistula, obstruction, sepsis, haemorrhage

Answer 79

MANAGE SYMPTOMS? diarrhoea/bloating/abdominal pain AVOID MALNUTRITION? give vitamin D, calcium+other nutrients (supervised)

Answer 80

Occurs in small intestine Asscoiated w/ gluten/wheat/barley/rye -Causes immune response in intestinal mucosa (JUST AVOID GLUTEN) May cause malabsorption of nutrients

Answer 81

COELIAC DISEASE CROHN'S ULCERATIVE COLITIS

Answer 82

START BULK FORMING

Answer 83

GP BRUH BLOOD DISORDER/DYSCRASIA

Answer 84

The antidiarrhoeal drugs, loperamide hydrochloride and codeine phosphate, reduce intestinal motility and decrease water and sodium output from an ileostomy. Loperamide hydrochloride circulates through the enterohepatic circulation, which is disrupted in patients with a short bowel.

Answer 85

Aminosalicylates and budesonide are not appropriate for severe presentations or exacerbations.

Answer 86

B12 absorption lacking

Answer 87

Recommend the use of Lactulose – Ms B is suffering from constipation so she needs a laxative if dietary measures have been ineffective. PeptoBismol & Milk of Magnesia -for indigestion;

Answer 88

Bismuth oxide

Answer 89

Myalgia Other side-effects? Diarrhoea, GI discomfort, hypertriglyceridaemie (aggravation), hypoprothrombinaemia associated with Vit K deficiency, vomiting

Answer 90

They should stop taking the Clindamycin immediately and go and get an urgent appointment with their doctor

Answer 91

``` DARK URINE/ABDOMINAL DISCOMFORT SOB SORE THROAT BRUISING MOUTH ULCERS ```

Answer 92

FAECAL CALPROTECTIN, | normal in IBS, raised in IBD

Answer 93

Thyroid test

Answer 94

Hydrogen breath test- detects intestinal bacterial overgrowth or lactose/fructose intolerance

Answer 95

Vitamin C is key!

Answer 96

folic acid (give with methotrexate, separate day, etc)

Answer 97

theophylline!

Answer 98

it does not need to be reported

Answer 99

inflammation, infection/arthritis/ lupus?

Answer 100

ANAL FISSURE