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Pradeepa's notes > Gastro-Intestinal System > Flashcards

Gastro-Intestinal System Flashcards

1
Q

coeliac disease

A

-occurs in small intestine
-associated with gluten; wheat, barley, rye
->causes immune response = intestinal mucosa
-may cause malabsorption of nutrients
-

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2
Q

coeliac disease aim

A

-avoid gluten
-manage symptoms; diarrhoea, bloating, abdominal pain
-avoid malnutrition; give vit D, calcium + other nutrients (supervision)

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3
Q

diverticular disease

A

small pouches but asymptomatic

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4
Q

diverticulitis

A

small pouches but symptomatic

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5
Q

diverticulitis symptoms

A

abdominal pain
constipation
diarrhoea
rectal bleed

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6
Q

acute diverticulitis

A

pouches inflamed/infected

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7
Q

acute diverticulitis symptoms

A

severe abdominal pain
fever
significant rectal bleed

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8
Q

complicated acute diverticulitis

A

abscess, perforation, fistula, obstruction, sepsis, haemorrhage

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9
Q

diverticular disease + diverticulitis tx

A

-fibre bulking forming laxatives
-paracetamol PRN

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10
Q

Crohns disease

A

affects whole GIT assoc with thickened wall, extending through all layers with deep ulceration

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11
Q

complications caused by crohns disease

A

-intestinal strictures or fistulae
-anaemia + malnutrition
-colorectal + small bowel cancer
-growth failure + delayed puberty
-extra-intestinal manifestation; arthritis, joints, eyes, liver + skin abnormalities

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12
Q

acute crohns disease 1st falre up in 12 month period tx

A

-monotherapy with either; prednisolone, methylprednisolone/IV hydrocortisone
-if pt - distal ileal, ileocecal or right sided disease use budesonide if normal tx x work
-aminosalicylate may be used (sulfasalazine/mesalazine)
->less effective but less side effects

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13
Q

acute crohns disease 2+ flare up in 12 month period tx

A

-add azathioprine or mercaptopurine
-methotrexate may added if azath/merca is CI
severe; monoclonal antibodies

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14
Q

crohns disease maintenance

A

-stop smoking
-monotherapy of azathioprine or mercaptopurine
-methotrexate can be used if used in induction or can not tolerate aza/merc
-after surgery
->azathioprine + metronidazole
->azathioprine alone if metronidazole x tolerated

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15
Q

fistulating crohns disease

A

-when fistula develops between intestine + perianal skin, bladder + vagina
-can be left alone if asymtomatic

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16
Q

fistulating crohns disease
tx (not fully healed)

A

-metronidazole +/- ciprofloxacin
-metronidazole usually for ONE month no longer three due to perianal neuropathy
-maintenance; azathioprine/mercaptopurine (infliximab if x response)
-tx; must be at least ONE yr

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17
Q

ulcerative colitis

A

can affect region from rectum to whole colon
-common age 15-25yr

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18
Q

ulcerative colitis symp

A

bloating
diarrhoea
defecation urgency
abdominal pain

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19
Q

ulcerative colitis complications

A

colorectal cancer
secondary osteoporosis
VTE
toxic megacolon

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20
Q

ulcerative colitis different types (continous)

A

-proctitis
-proctosigmoiditis
-distal/left sided
-extensive colitis
pancolitis

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21
Q

tx ulcerative colitis acute (mild-moderate)

A

-distal rectal preparation (suppository or enema)
->foam preparation used if pt = difficulty retaining liquid enema
-extended systemic medication needed
-diarrhoea avoid loperamide or codeine as it can cause toxic megacolon
->only initiate under specialist advice

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22
Q

proctitis tx

A

1)topical aminosalicylates
2) + oral aminosalicylates (if no impr in 4WK)
3) still no improv topical/oral corticosteroids 4-8wk

-pt = oral aminosalicylates if preferred but less effective
-if aminosalicylates = CI then corticosteroids

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23
Q

proctitis acute (mild-moderate) tx

A

-proctosigmoiditis + left sided UC
1)topical aminosalicylates
2) + high dose aminosalicylates if no improv after 4wk or
2) switch to high oral dose of aminosalicylates + 4-8wk of of topical corticosteroids
3)start topical tx + offer oral aminosalicylate + 4-8wk of oral corticosteroid

-pt - high dsoe of aminosalicylates if perferred byt less effective if CI then topical//oral cortiocsteorids for 4-8wk

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24
Q

extensive UC tx

A

1) topical aminosalicylates + high dose aminosalicylates
2) no change after 4wk -> stop topical aminosalicylates + offer high dose oral aminosalicylates + oral corticosteroids 4-8wk

-if CI = corticosteroids 4-8wk

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25
Q

UC acute (severe) tx

A

-life-threatening - medical emergency
-IV hydrocortisone or methylprednisolone -> assess need for surgery
-if IV steroids = CI -> IV ciclosporsin/surgery
-if symp x improve in 72hr = IV steroid + IV ciclosporin -> surgery
-if ciclosporin CI then infliximab

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26
Q

UC tx maintenance

A

-oral aminosalicylates
->CI = corticortosteroids
->more effect as OD but more s/e
-procititis / proctosigmoiditis = rectal +/- oral aminosalicylates
-.oral can be given
-left sided/extensive - low dose oral aminosalicylate
-2+ flares - 12months; oral azathioprine/erc
->give monoclonal antibodies if no effect

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27
Q

aminosalicylates

A

sulfasalazine
balsalazine
mesalazine
olsalazine

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28
Q

aminosalicylates monitoring

A

-nephrotoxic - monitor before initiation3mtannually
-hepatotoxic - monitor monthly for 1st 3MT
-blood disorder: monitor monthly 1st 3MT
->blood count + stop if signs of blood dyscaria
-CI in salicylate hypersensitivity
-sulfasalazine; stains contact lenses = orangey/yellow

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29
Q

irritable bowel syndrome

A

common chronic, relapsing + often life-long assoc with abdominal pain, diarrhoea, constipation, urgency, incomplete defaecation + passing mucus
- more common women 20-30

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30
Q

irritable bowel syndrome what excacerbates it

A

caffeine
alcohol
milk
large meals
fried food
stress

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31
Q

irritable bowel syndrome non-drug tx

A

-excerise
-eat regular meals
-less fresh fruit = TDS
-less insoluble fibre
-8 cups of water
-less caffeine, alcohol + fizzy
-avoid sorbitol = diarrhoea
-less stress

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32
Q

irritable bowel syndrome drug tx

A

OTC
-antispasmodics = aiverine, mebeverine, peppermint oil
-laxatives = if constipation x lactulose - bloating
-loperamide = diarrhoea
-antimuscarinic = hyoscine butylbromide avoid in coeliac disease

2nd line for pain x otc work
- amitriptyline = unlicensed
- SSRI if TCS = X work

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33
Q

short bowel syndrome

A

-shortened bowel due to large surgical resection
-need to ensure adequate absorption of nutrients + fluids

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34
Q

short bowel syndrome nurtritional deficiences

A

-replace vit A, B12, D, E, K, essential fatty acids, zinc, selenium

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35
Q

short bowel syndrome diarrhoea and high output stoma

A

-loperamide + codeine less intestinal motility

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36
Q

constipation

A

infrequent difficult stools

37
Q

constipation risk factors

A

women
elderly
pregnancy

38
Q

constipation red flags

A

-blood in stools
-anaemia
-abdominal pain
-weight loss
-new onset in over 50yr+

39
Q

constipation non-drug tx

A

-inc dietary fibre
-adequate fluid intake
-exercise
-review medications

40
Q

constipation bulkforming laxatives

A

-methylcellulose, ispagula husk, sterculia
-small hard stools inc faecal mass, stimulating psitalsis
-2-3DY to work
-inc fluid intake so no intestinal blockage

41
Q

constipation stimulant laxative

A

-bisacodyl, sodium picosulfate, senna, docusate, glycerol
-stimulating colonical nerves - peristalsis
- 6-12HR to work
-avoid in intestinal obstruction
-co-danthramer + co-danthrustate used in terminal illness due to cacinogenicity (red urine)

42
Q

constipation faecal softners

A

-liquid paraffin, docusate, glycerol
-inc water retention to stools
-quick acting = docusate enema = 5-20mins
-liquid paraffin - avoid in anal seepage, granulomatous disease of GIT, lipid pnuemonia on aspiration

43
Q

constipation osmotic laxatives

A

-lactulose, macrogol
-inc fluid to large bowel - persistalsis
-2/3 DY to work
-faecal softening properties

44
Q

constipation short duration

A

-bulk forming + good hydration - osmotic

45
Q

constipation chronic

A

-bulk forming + good hydration
-if still hard stools add/change to macrogol (lactulose 2nd line)
-if still no change after 6MT = procalopride
-withdraw lactulose slowly when improvement

46
Q

constipation faecal impaction

A

-hard stools = macrogol + stimulant once softened
-soft stools = stimulant
-rectal bisacodyl +/ or glycerol if still there

47
Q

constipation opioid induced

A

-osmotic + stimulant
-naloxegol if x work
-avoid bulk forming

48
Q

constipation pregn + BF

A

-dietary + lifestyle - fibre supplements e.g. bran, wheat
-bulk forming- lactulose
-bisacodyl/senna x use senna near term

49
Q

constipation children

A

-1st line = dietary advice + macrogol if no faecal impaction -> stimulant
-if stool = hard -> lactulose/docusate

50
Q

loperamide drug tx

A

-acute usually w/o meds
-oral rehydration sachets
-severe dehydration x drink - hosp for IV fluids
-if rapid control is needed/travellers - loperamide
-> avoid bloodly/suspected inflammatory
-loperamide = 1st line = faecal incontinence

51
Q

loperamide

A

-12+ otc
-4+ pom
-1-2 doses (2-4mg) at first then one every loose stool max 8 doses
-serious cardiac reactions (QT prolongation) inc doses
-naloxene tx overdose

52
Q

dyspepsia

A

-upper abdominal pain, heartburn, gastric reflux, bloating, N+V

53
Q

dyspepsia red flags/urgent referral

A

-GI bleeding
-55+
-unexplained weight loss
-dysphagia

54
Q

dyspepsia tx

A
  • uninvestigated dyspepsia
    -> PPI 4WK if x work then test for h.pylori
    -functional dyspepsia
    -> test for h.pylori
    -> x infected 3WK of PPI/h2 receptor antagonist
55
Q

helicobater pylori infection

A
  • most common cause of peptic ulcer
    -urea 13C breath test/stool helicobacter antigen test (SAT)
    ->PPI stopped 2wk before test
    ->antibiotics should be stopped 4WK before test
56
Q

h.pylori triple therapy

A

-PPI +2x antibiotics
-PPI = BD
-Amoxicillin - 1g BD
-Clarithromycin - 500mg BD
-metronidazole = 400mg BD
-7DY tx

57
Q

GORD

A

-Increased with
->fatty foods
->pregn
->hiatus hernia
->FH
->stress, anxiety
->obesity
->S/E meds (ablocker, bblocker, CCB, anticholingeric, benzo, bisphosphates, corticosteroids, NSAIDs, nitrates, TCA)
->smoking + alcohol

58
Q

GORD lifestyle advice

A

-1st line
-healthy eating
-weight loss (obese)
-avoid triggering food
-smaller meals
-evening meals 3-4hr before sleep
-raising head of bed
-smoking cessation
-less alcohol consumption

59
Q

GORD tx

A

-medication review
-uninvestigated GORD - 4WK PPI + test for h.pylori
-confirmed GORD= tx 4WK of PPI

60
Q

GORD pregn tx

A

-lifestyle + dietary
-antacid / alginate
-omeprazole/ranitidine

61
Q

antacids

A

-mg containing antacids = laxative
-Aluminium containing = constipating
-Ca containing = induces rebound acid secretion
-simeticone added to antacids to relieve flatulence

62
Q

antacid + aliginate

A
  • inc viscosity of stomach content
    -forms viscous gel that floats on surface of stomach
63
Q

antacid interactions

A

-inc stomach pH (inc alkali) - enteric coated caps damage before reaching intestine
-Na+ content of anatacid x take with Li+ in hypertension lower NA+ = co-magaldrox
-antacid x other drugs - impairing absorption
->bisphophonates, tetracyclines, ciprofloxacin

64
Q

PPI

A

omeprazole, esomeprazole, lansoprazole, rabeprazole

65
Q

PPI MHRA warning

A

-low rise of subacute cutaneous lupus erythematosus

66
Q

PPI RISKS

A

-inc risk of factures/oestoprosis - due to hypomagnaesmia
-high risk of c.diff
-masks symptoms of gastric cancer
-interaction - esomeprazole, clopidogrel (use lansoprazole)
-inc conc of methotrexate, phenytoin, warfarin, digoxin

67
Q

h2 receptor antagonist

A

ranitadine
cimetidine (cyp450 inhibitor)
famotidine
nizatidine

68
Q

h2 receptor antagonist s/e

A

-may mask gastric cancer symptoms so rule out symptoms of cancer before tx
- diarrhoea
- headaches
- dizziness
- rash
- tiredness

69
Q

h2 receptor antagonist interaction

A

reduces absorption of azole antifungals

70
Q

cholestatis

A

impaired bile formation or flow = fatigue, pruritus, dark urine, pale, jaundice

71
Q

cholestatic pruritus

A

relieved by cholestyramine, uroseodeoxycholic acid, rifampicin

72
Q

intrahepatic cholestasis in pregnancy

A

during late pregnancy - adverse fetal outcomes
-tx of puritis assoc = uroseodeoxycholic acid

73
Q

gallstones

A

-hard mineral or fatty deposits forming stones in gallbladder bile duct
-majority = assymptomatic
-irritated/blocked gallbladder = pain, infection + inflammation

74
Q

untreated gallstones

A
  • complications bililary colic cholecystitis, cholastits, prancreatin
    -if symptoms = surgical removal
75
Q

gallstones tx

A

-mild-moderate pain = paracetamol/NSAIDs
-severe = IM diclofenac

76
Q

anal fissures

A

-tear/ulcer in anal canal causing bleeding + pain on defecation

77
Q

anal fissures acute tx

A

-ensure stools = passing easily
->bulk-forming/osomotic laxative
->short term topical = local anaesthetic (lidocaine) or anagesia

78
Q

anal fissures chronic tx

A

-6wk + GTN rectal (high headache s.e)
-topical/oral diltiazem/nifedipine (less s/e)
-specialist = botulinum toxin type A
-surgery - when no response to drug tx

79
Q

haemorrhoids

A

swelling of vascular mucosal + cushions around anus (high risk during pregnancy)
-internal = painless
-external = itchy/painful

80
Q

haemorrhoids tx

A

-maintain easy stools to minimise straining; inc dietary fibre + fluid or bulk-forming laxative
-pain = paracetamol (opioids -> constipation, NSAIDs exacerbate rectal bleeding)
-pain + itching: topical preparations (anaesthetics, corticosteroids, lubricants, antiseptics)
->topical anesthetics (lidocaine few days)
->topical corticosteroids no more than 7DY
-pregnancy: bulk-forming no topical tx only soothing if needed

81
Q

pancreatic insufficiency

A

less secretion of pancreatic enzymes into duodenum can be due to pancreatic, CF, pancreatic tumors, coeliac disease, GI resection, may lead to maldigestion + malnutrition

82
Q

exocrine pancreatic insufficiency

A

tx
-pancreatic enzyme replacement - pancreatin
->lipase, amylase, protease - digests fats, carbs, protein so it can be absorbed
->take snacks + meals to prevent early breakdown
-if CF then fibrosing colonpathy at high dose pancreatin
->no more than 10000 units/kg/day of lipase
->report any new abdominal pain
-lvls of fat soluble vits + micronutrients = monitored
->give supplements PRN

83
Q

Stoma care

A

artifical opening on abdomen to divert flow of faeces on urine into an external pouch located outside body

84
Q

Stoma care preparation

A

EC/MR not suitable less effect so use forms = quick action = liquids, caps, uncoated/ soluble tabs

85
Q

Stoma care diarrhoea

A

sorbitol, mg+ antacids, iron (ileostomy)

86
Q

Stoma care constipation

A

opioids, Ca+ antacids, iron (colostomy)

87
Q

Stoma care GI irritation + bleed

A

aspirin + NSAIDs

88
Q

Stoma care diuretics/laxatives

A
  • dehydration = hypokal use K+ sparing diuretics or k+ supplements
    -liquid form k+ preferred to MR
    -fluids + NA deplation - hypoka inc digixon toxity

Pradeepa's notes (12 decks)

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