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Nafisa Pre Reg > Gastro- intestinal system > Flashcards

Gastro- intestinal system Flashcards

1
Q

What are the two main types of inflammatory bowel diseases?

A

Crohn’s disease and Ulcerative colitis.

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2
Q

What are the potential side effects of aminosalicylates?

A

Blood disorders

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3
Q

Give an example of an aminosalicylate

A

Mesalazine

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4
Q

What symptoms should patients using aminosalicylates report immediately? (4)

A
  • Unexplained bleeding and bruising
  • purpura
  • sore throat
  • malaise
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5
Q

What action should be taken if there is suspicion of a blood dyscrasia in a patient using aminosalicylates?

A

A blood count should be performed

and the drug should be stopped immediately.

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6
Q

What advice should be given to patients if they need to switch to a different brand of mesalazine?

A

Patients should be advised to report any changes in symptoms.

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7
Q

What demographic group is most commonly affected by Irritable Bowel Syndrome (IBS)?

A

People aged between 20 and 30, mostly women

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8
Q

What are the common symptoms of Irritable Bowel Syndrome (IBS)? (3)

A
  • Abdominal pain or discomfort
  • disordered passage of mucus
  • bloating
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9
Q

What dietary and lifestyle recommendations are important for self-management of IBS?

A

A high-fiber diet and exercise

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10
Q

Name types of antispasmodics used in the management of IBS (6)

A
  • Alverine
  • mebeverine
  • peppermint oil
  • dicycloverine
  • hyoscine
  • propantheline
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11
Q

In which condition should all antispasmodics be avoided?

A

Paralytic ileus

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12
Q

What is the main cause of Clostridium difficile infection?

A

Colonization of C. difficile in the colon, often following antibiotic therapy.

(usually Ampicillin, Amoxicillin, Co-Amoxiclav, Cephalosporins, Clindamycin and Quinolones)

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13
Q

Name some antibiotics that can increase the risk of Clostridium difficile infection (6)

A
  • Amoxicillin
  • ampicillin
  • co-amoxiclav
  • second- and third-generation cephalosporins
  • clindaymycin
  • quinolones
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14
Q

What are the treatment options for Clostridium difficile infection?

A
  • Metronidazole
  • vancomycin
  • fidaxomicin
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15
Q

What potential complication can arise from excessive laxative use?

A

Hypokalaemia

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16
Q

What are the side effects associated with light liquid paraffin? (2)

A
  • Anal seepage of paraffin and consequent anal irritation after prolonged use
  • lipoid pneumonia
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17
Q

What is the main aim in treating diarrhea?

A

To reverse fluid and electrolyte depletion

(especially important in infants, frail, and elderly)

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18
Q

What are commonly used antimotility drugs in uncomplicated diarrhea?

A

Loperamide

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19
Q

Is routine prophylaxis against travelers’ diarrhea recommended?

A

No, routine prophylaxis is not recommended

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20
Q

What antibiotic can be used for travelers’ diarrhea if necessary?

A

Ciprofloxacin

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21
Q

What are the alarm symptoms associated with dyspepsia? (4)

A
  • Bleeding
  • dysphagia
  • recurrent vomiting
  • weight loss
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22
Q

A patient is over 55 and is presenting with new- onset dyspepsia. What should be done?

A

consider referring patient to GP

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23
Q

What are the treatment options for dyspepsia? (3)

A
  • Antacids
  • proton pump inhibitors (PPIs)
  • H2 receptor antagonists
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24
Q

What are the potential side effects of magnesium-containing antacids?

A

Laxative effect

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25
Q

What lifestyle changes are advised for patients with gastro-oesophageal reflux disease (GORD)?

A
  • Avoidance of aggravating foods such as fats
  • weight reduction
  • smoking cessation
  • raising the head of the bed
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26
Q

What medications are used in the treatment of GORD? (3)

A
  • Antacids
  • proton pump inhibitors (PPIs)
  • H2 receptor antagonists
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27
Q

What medication is reserved for women with severe or complicated reflux disease during pregnancy?

A

Omeprazole

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28
Q

What is the most likely cause of duodenal and gastric ulcers if not caused by NSAIDs?

A

H. pylori infection.

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29
Q

What is the first-line treatment for dyspepsia

A

Lifestyle modifications and over-the-counter antacids.

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30
Q

What is the recommended duration for initial treatment of Helicobacter pylori infection?

A

A one-week triple-therapy regimen

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31
Q

What does triple-therapy for Helicobacter pylori infection typically include? (3)

A
  • A proton pump inhibitor
  • clarithromycin
  • and either amoxicillin or metronidazole.
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32
Q

What treatment duration is associated with higher side effects and lower compliance for Helicobacter pylori infection?

A

Two-week triple-therapy.

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33
Q
A
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34
Q

What is recommended if an ulcer occurs in a patient taking NSAIDs?

A

Whenever possible, the NSAID should be withdrawn.

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35
Q

What medication can be considered for gastric and duodenal protection in patients at risk of ulceration with NSAIDs?

A

A proton pump inhibitor.

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36
Q

What are some alternatives to proton pump inhibitors for gastric and duodenal protection in patients at risk of ulceration with NSAIDs?

A

H2-receptor antagonists or misoprostol.

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37
Q

What may limit the dose of misoprostol in patients at risk of ulceration with NSAIDs?

A

Colic and diarrhea

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38
Q

Name some examples of chelates and complexes used as antisecretory drugs and mucosal protectants.

A

Sucralfate, peptobismol, triopotassium dicitratobismuthate.

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39
Q

What do these drugs do in the context of ulcer treatment?

A

They chelate and form ulcer-protecting complexes.

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40
Q

What are examples of H2-receptor antagonists?

A

famotidine, cimetidine, nizatidine.

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41
Q

How do H2-receptor antagonists work to reduce gastric acid output?

A

through histamine H2-receptor blockade

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42
Q

Name examples of proton pump inhibitors (3)

A
  • Lansoprazole
  • omeprazole
  • rabeprazole
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43
Q

How do proton pump inhibitors inhibit gastric acid secretion?

A

They block the hydrogen-pump of the gastric parietal cell.

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44
Q

What is the risk associated with sucralfate use?

A

Bezoar formation

which is the risk of indigestible material accumulating in the GI tract.

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45
Q

In which patients is caution advised when using sucralfate? (3)

A
  • Seriously ill patients
  • those under intensive care receiving enteral feeds
  • and those with predisposing conditions such as delayed gastric emptying
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46
Q

What is ursodeoxycholic acid used for?

A

It is used for the dissolution of gallstones and in primary biliary cirrhosis

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47
Q

What is the treatment for oesophageal varices?

A

Terlipressin

a vasoconstrictor that reduces portal hypertension.

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48
Q

How is obesity generally classified?

A

BMI of ≥ 30 kg/m2.

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49
Q

When should treatment with Orlistat be discontinued in obese patients?

A

Treatment should be discontinued after 12 weeks if weight loss has not exceeded 5% of starting weight.

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50
Q

What is the recommended treatment focus for haemorrhoids?

A

Ensuring that stools are soft and easily passed

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51
Q

What type of laxatives are recommended for haemorrhoid treatment?

A

Bulk-forming laxatves

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52
Q

What alternative laxative can be used for haemorrhoid treatment?

A

An osmotic laxative

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53
Q

What are some components found in topical preparations for haemorrhoids? (5)

A
  • local anaesthetics
  • corticosteroids
  • astringents
  • lubricants
  • antiseptics
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54
Q

Are there licensed preparations for treating haemorrhoids during pregnancy?

A

No, but a simple soothing preparation can be considered.

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55
Q

What are the main clinical indicators of exocrine pancreatic insufficiency?

A

Maldigestion and malnutrition

associated with low circulating levels of micronutrients, fat-soluble vitamins, and lipoproteins

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56
Q

What are some gastrointestinal symptoms associated with exocrine pancreatic insufficiency? (3)

A
  • Diarrhoea
  • abdominal cramps
  • steatorrhoea

Steatorrhea= excessive amounts of fat in poo. Looser, smellier, paler

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57
Q

What is the mainstay of treatment for exocrine pancreatic insufficiency?

A

Pancreatic enzyme replacement therapy

58
Q

What enzymes are contained in pancreatin to assist with digestion? (3)

A
  • Amylases
  • lipases
  • proteases
59
Q

What is Coeliac disease?

A

Coeliac disease is an autoimmune condition

associated with chronic inflammation of the small intestine

triggered by gluten consumption

60
Q

What dietary proteins can trigger an abnormal immune response in individuals with Coeliac disease?

A

Gluten

which is found in wheat, barley, and rye

can trigger an abnormal immune response in individuals with Coeliac disease.

61
Q

What are the symptoms of Coeliac disease? (4)

A
  • abdominal pain
  • diarrhoea
  • rectal bleeding
  • weight loss due to malabsorption of nutrients
62
Q

What is the non-drug treatment for Coeliac disease?

A

The non-drug treatment for Coeliac disease is a strict, lifelong gluten-free diet.

63
Q

What is the risk associated with drug treatment for Coeliac disease?

A

Drug treatment for Coeliac disease can increase the risk of malabsorption of key nutrients

like calcium and vitamin D

leading to the risk of osteoporosis.

64
Q

What is the non-drug treatment for Crohn’s disease

A

Smoking cessation

65
Q

What side effect is associated with Aminosalicylates?

A

orange/yellow staining of body fluids, such as urine.

66
Q

What precaution should be taken before starting treatment with monoclonal antibodies?

A

Patients must be screened for tuberculosis before starting treatment with monoclonal antibodies.

If latent tuberculosis is diagnosed, appropriate treatment must be initiated prior to starting treatment.

67
Q

What should be done if tuberculosis is diagnosed during treatment with monoclonal antibodies?

A

treatment should be discontinued until the infection is resolved

68
Q

How can flu-like infusion reactions associated with monoclonal antibodies be prevented or lessened?

A

with an antihistamine and paracetamol with or without a corticosteroid.

69
Q

What precautions should be taken regarding contraception during and after treatment with monoclonal antibodies?

A

Effective contraception is required during

and for at least 18 weeks after treatment with monoclonal antibodies.

70
Q

What should be monitored closely in breastfeeding individuals receiving monoclonal antibodies?

A

should be monitored closely for infection before, during, and after treatment due to the increased risk of opportunistic infections

71
Q

How should fresh fruit consumption be limited for individuals with IBS?

A

Fresh fruit consumption should be limited to no more than 3 portions per day for individuals with IBS.

72
Q

What type of dietary fibre is recommended for individuals with IBS?

A

Soluble fibre, such as Isphagula Husk or foods high in soluble fibre like oats, is recommended for individuals with IBS.

73
Q

Why should intake of insoluble fibre be reduced or discouraged for individuals with IBS?

A

because it can exacerbate symptoms.

74
Q

How much fluid intake, mostly water, is recommended for individuals with IBS?

A

: Individuals with IBS should increase their fluid intake to at least 8 cups per day, mostly water.

75
Q

What are some drug treatment options available over the counter for IBS?

A

antispasmodic drugs (such as Alverine citrate, Mebeverine hydrochloride, and Peppermint Oil)

laxatives (excluding Lactose)

and Loperamide as the first-line choice anti-motility drug for diarrhea.

76
Q

When is Peppermint Oil contraindicated in IBS treatment?

A

in pregnancy

77
Q

What is the recommended first-line choice anti-motility drug for diarrhea in IBS?

A

Loperamide

78
Q

What is the second-line treatment option for abdominal pain/discomfort in IBS for patients who haven’t responded to antispasmodics, anti-motility drugs, or laxatives?

A

A low dose of Tricyclic Antidepressant (TCA) such as Amitriptyline

79
Q

How is constipation defined?

A

the evacuation of hard stools less frequently than is normal for an individual

80
Q

What are examples of bulk-forming laxatives? (4)

A
  • bran
  • ispaghula husk
  • methylcellulose
  • sterculia
81
Q

What is the onset of action for bulk-forming laxatives?

A

is up to 72 hours

82
Q

What precaution should be taken when using bulk-forming laxatives?

A

Adequate fluid intake must be maintained when using bulk-forming laxatives

to avoid intestinal obstruction

and patients should be advised not to take these laxatives immediately before bed.

83
Q

What are examples of stimulant laxatives? (5)

A
  • Bisacodyl
  • sodium picosulfate
  • senna
  • co-danthramer
  • co-danthusate
84
Q

How do stimulant laxatives work?

A

by increasing intestinal motility

but they often cause abdominal cramps

so they should be avoided in cases of intestinal obstruction.

85
Q

Who should Co-danthramer and Co-docusate only be used in?

A

should only be used in the terminally ill due to their carcinogenicity and genotoxicity.

86
Q

How do faecal softeners work?

A

increase the penetration of intestinal fluid into the faecal mass

An example is Docusate sodium + Glycerol.

87
Q

Give an example of faecal softener

A

Docusate sodium + Glycerol.

88
Q

What are examples of osmotic laxatives? (4)

A
  • lactulose
  • macrogol 3350 with potassium chloride
  • sodium bicarbonate
  • sodium chloride
89
Q

What is the first-line treatment for short-term constipation?

A

a bulk-forming laxative while ensuring adequate fluid intake

90
Q

What should be done if stools remain hard after using a bulk-forming laxative?

A

f stools remain hard after using a bulk-forming laxative, an osmotic laxative can be added to or switched to.

91
Q

What should be added if stools are soft but difficult to pass or if a person complains of inadequate emptying in short-term constipation management?

A

a stimulant laxative

92
Q

What is the recommended treatment for opioid-induced constipation?

A

an osmotic laxative (or docusate sodium to soften stools)

along with a stimulant laxative is recommended.

93
Q

What should be considered if the response to other laxatives is inadequate in palliative care?

A

Methylnaltrexone bromide and Linaclotide can be used as adjunctive therapy

94
Q

What is the initial treatment approach for chronic constipation?

A

involves starting with a bulk-forming laxative while ensuring good hydration.

95
Q

What should be done if stools remain hard after using a bulk-forming laxative in chronic constipation management?

A

an osmotic laxative such as macrogol can be added or changed to

(If macrogols are ineffective or not tolerated, lactulose can be given)

96
Q

What should be considered if the response to laxatives is inadequate even after trying different classes for 6 months in chronic constipation?

A

the use of prucalopride (in women)

or lubiprostone should be considered.

97
Q

What should be done if regular bowel movements have been achieved in chronic constipation management? (3)

A

one laxative should be reduced and stopped at a time.

If possible, the stimulant laxative should be reduced first

but it may be necessary to adjust the osmotic laxative dose to compensate.

98
Q

What is the first-line treatment for constipation in pregnancy if dietary and lifestyle changes fail?

A

is fibre supplements in the form of bran or wheat

which are clinically safe and effective

99
Q

What laxative is first-line during pregnancy if fibre supplements fail?

A

A bulk-forming laxative is first-line during pregnancy if fibre supplements fail

100
Q

What precaution should be taken when using Senna during pregnancy?

A

Senna should be avoided near term or if there is a history of unstable pregnancy

101
Q

What is the first-line treatment for constipation during breastfeeding if dietary measures fail?

A

A bulk-forming laxative

102
Q

What can be used if stools remain hard during breastfeeding?

A

Lactulose or Macrogol can be used if stools remain hard during breastfeeding.

Alternatively, a short course of a stimulant laxative such as Bisacodyl or Senna can be used.

103
Q

What is the first-line treatment for constipation in children?

A

laxative in combination with dietary modification

104
Q

What should be avoided in the diet of children with constipation due to potential side effects?

A

Unprocessed bran should be avoided in the diet of children with constipation

due to potential side effects such as bloating, flatulence, and absorption of micronutrients.

105
Q

What is the first-line laxative for children if faecal impaction is not present or has been treated?

A

a macrogol laxative, such as macrogol 3350 with potassium chloride, sodium bicarbonate, and sodium chloride.

106
Q

What should be added if there is an inadequate response or poor tolerance to the first-line laxative in children?

A

n, a stimulant laxative can be added or changed to.

If stools remain hard, lactulose or another laxative with softening effects, such as docusate sodium, can be added.

107
Q

How long should laxatives be continued after establishing a regular pattern of bowel movements in children with chronic constipation?

A

Laxatives should be continued for several weeks

after establishing a regular pattern of bowel movements in children with chronic constipation.

108
Q

How should the dose of laxatives be adjusted after several weeks of regular bowel movements in children with chronic constipation?

A

gradually tapered over a few months

109
Q

What is the recommended treatment approach for faecal impaction in children over 1 year old?

A

an oral preparation

containing a macrogol, such as macrogol 3350 with potassium chloride, sodium bicarbonate, and sodium chloride

is recommended to clear faecal mass and establish and maintain soft, well-formed stools.

110
Q

What is a general side effect for all laxatives?

A

Abdominal pain

111
Q

What is the onset of action of senna?

A

8- 12 hours

112
Q

What is the onset of action of Bisacodyl?

A

10 - 12 hours

113
Q

What are antispasmodic drugs, such as Hyoscine (Buscopan), used for?

A

abdominal cramp

114
Q

Why should antispasmodics and anti-emetics be avoided in young children with gastroenteritis?

A

because they are rarely effective and have troublesome side effects.

115
Q

What is the recommended treatment approach for abdominal cramp in children with chronic constipation?

A

Antispasmodic drugs, such as Hyoscine (Buscopan)

116
Q

How are bulk-forming drugs useful in diverticular disease?

A

Bulk-forming drugs such as ispaghula husk and methylcellulose

are useful in controlling diarrhoea associated with diverticular disease.

117
Q

What is the typical cause of most cases of diarrhoea?

A

Most cases of diarrhoea are due to viruses and do not need antibiotic treatment

118
Q

When is colestyramine used for diarrhoea?

A

following ileal disease or resection

119
Q

What precaution should be taken when taking other medication with colestyramine?

A

Patients on colestyramine should take other medication an hour before

or 4 to 6 hours after taking it

120
Q

What is the age restriction for using Loperamide over the counter (OTC)?

A

Loperamide is only licensed for use in children over 12 when sold over the counter (OTC)

but it can be used in children over 4 under medical supervision.

121
Q

What symptoms are commonly associated with dyspepsia (indigestion)?

A
  • heartburn
  • feeling full (satiety)
  • bloating
  • nausea (often occurring after eating or drinking)
122
Q

What dosage adjustment may be necessary for patients over 65 years old who are taking NSAIDs along with a PPI?

A

may require a double dose of the PPI

for example, Omeprazole 20mg twice daily

instead of 20mg once daily

(due to being at high risk of developing ulcers from NSAIDs)

123
Q

In which population can Misoprostol be used for long-term NSAID therapy?

A

Misoprostol can be used for the elderly who are on long-term NSAID therapy, such as aspirin.

124
Q

Why is Misoprostol contraindicated in pregnancy?

A

because it can induce labor or abortion.

125
Q

What treatment options are available for gastro-oesophageal reflux disease (GORD) during pregnancy?

A

lifestyle advice

antacids/alginate

(Omeprazole is reserved for women with severe or complicated reflux disease)

126
Q

What lifestyle advice can be given for the treatment of GORD in children? (2)

A

changing the frequency and volume of feed

and using a feed thickener or thickened formula.

127
Q

What pharmacological treatment can be used for children with GORD who do not respond to lifestyle changes?

A

an antacid (alginate)

and if resistant, a H2 antagonist or Omeprazole may be used.

128
Q

What is a stoma?

A

an artificial opening on the abdomen

used to divert the flow of faeces or urine

into an external pouch located outside of the body.

129
Q

What are the most common forms of stoma? (2)

A
  • colostomy
  • ileostomy
130
Q

Why are enteric-coated and modified-release medicines not suitable for patients with a stoma?

A

because there may not be sufficient release of the active ingredient.

131
Q

What types of medicines are more suitable for patients with a stoma?

A
  • Soluble tablets
  • liquids
  • capsules
  • uncoated tablets

due to their quicker dissolution

132
Q

Why should preparations containing sorbitol be avoided for stoma patients?

A

because sorbitol has laxative side effects

which may exacerbate gastrointestinal issues for these patients

133
Q

In patients who have a history of upper GI bleeding or have 3 or more risk factor

what type of NSAID would we give with a PPI?

What are alternatives to this treatment?

Risk factors for NSAID associated ulcers include age >65, history of ulcers, additional co-morbidities (diabetes, CV disease etc.) and medicines that G.I. side effects.

A

a selective COX-2 inhibitor

Alternatives are:
* H2 Antagonist e.g. Ranitidine

  • Prostaglandin analogue e.g. Misoprostol.
134
Q

What type of laxatives have the fastest onset of action?

A

Faecal softeners have the fastest onset of action

typically within 15 minutes

135
Q

What can be added if faecal impaction does not occur after 2 weeks of first line treatment in children?

A

a stimulant laxative can be added

or if stools are hard, it can be used in combination with an osmotic laxative such as lactulose.

136
Q

What is the purpose of glycerol suppositories?

A

act as a lubricant and rectal stimulant

137
Q
A
138
Q

How should pancreatin preparations be taken to maximize effectiveness? (2)

A

They should be administered with meals and snacks

and excessive heat should be avoided.

139
Q

What patient populations are considered at high risk of developing gastrointestinal complications with NSAIDs? (3)

A
  • Patients aged over 65 years
  • those with a history of gastrointestinal complications
  • those with serious co-morbidities such as cardiovascular disease, diabetes, renal or hepatic impairment.
140
Q

What is the first-line recommendation for treating constipation if dietary and lifestyle changes are ineffective?

A

A bulk-forming laxative

Nafisa Pre Reg (11 decks)

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