Gastrointestinal system Flashcards
(166 cards)
1
Q
What is coeliac disease?
A
An autoimmune condition associated with chronic inflammation of small intestine triggered by dietary protein (gluten)
2
Q
List examples of food that contain gluten
A
Wheat, barley, rye, cakes etc
3
Q
Gluten activates an abnormal immune response in the intestine that leads to malabsorption of what kind of essential vitamins?
A
Folic acid, vit D, Ca and Fe
4
Q
Symptoms of celiac disease
A
ABCD
Abdominal pain
Bloating
Constipation
Diarrhoea
5
Q
What is the only effective tx for coeliac disease
A
A strict life long gluten free diet
6
Q
Drug tx of coeliac disease
A
Supplementation with ca, folic acid and vit D
Osteoporosis tx
7
Q
What is diverticulosis
A
Asymptomatic condition
Presence of diverticula
Age dependent usually 40+
8
Q
Difference between diverticulitis and diverticular disease
A
Diverticular disease is a condition where diverticulitis are present and cause symptoms such as abdominal tenderness, constipation and diarrhoea, rectal bleeds and Intermittent lower abdominal pain WITHOUT inflammation or infection
Whereas Diverticulitis causes inflammation and Infection
9
Q
Signs and symptoms of acute diverticular disease
A
Constant lower abdominal pain
Fever
Significant rectal bleeding
Sudden change in bowel habit
Abdominal tenderness
Abdominal mass
10
Q
State when to refer patients with diverticulitis
A
Pts with complications such as
Abscess
Bowel perforation
Intestinal obstruction
Sepsis
11
Q
Non drug tx for Diverculitis
A
Diet ,lifestyle changes
Eat healthy, balanced diet ,increase fibre
Weight loss, smoking cessation
Exercise
12
Q
State what to give patient with diverticulosis suffering from constipation
A
Bulk foaming laxative
13
Q
Tx for acute diverticulitis
A
Simple analgesia
Refer pts with Complications
No antibacterial prescribing
14
Q
What is IBD
A
A term to define to conditions Crohn’s disease and Ulcerative colitis
15
Q
Causes of IBD
A
Genes
Environment
Smoking
Alcohol
16
Q
Difference between Crohn’s disease and Ulcerative colitis
A
Crohn’s disease is an inflammation of the whole GI tract whereas UC is the inflammation of the colon
17
Q
Drug tx of IBD
A
Aminosalicylates
Medicine affecting the immune system
Biologic therapy
Corticosteroids
Abx
Other medication for Diarrhoea and constipation
18
Q
Mnemonic for medication used to tx IBD
A
IBD ACTS BAD
Aminosalicylates
C- corticosteroids
T- Thiopurine
B- Biological agents
A- Antibiotics
D- Diarrhoea, constipation and other drugs
19
Q
Antidiarrhoal drug is contraindicated in acute UC. True or False?
A
True
20
Q
Facts about Ulcerative colitis
A
Chronic inflammatory condition associated with significant morbidity and life long disease
Common in ages 15 and 25
21
Q
What’s the tx for mild to moderate Ulcerative colitis ( Procitis)
A
Ist line line tx- Give topical aminosalicylates
No improvement, give oral aminosalicylates
No improvement, give oral or topical corticosteroids for 4-8weeks
22
Q
Tx for Proctosigmoidisis and left sided UC
A
First line- Topical aminosalicylates
23
Q
Tx for Extensive Ulcerative colitis
A
First line- Topical amonosalicylates and high dose of oral aminosalicylates
24
Q
Tx of acute severe UC(life threatening)
A
I.V corticosteroids and Infiximab
25
What drug is used to maintain remission in mild, moderate or severe Ulcerative colitis
Use aminosalicylates
AVOID corticosteroids because of side effects
26
State when to use Oral Azathioprine or mercaptopurine?
It is used when two or more inflammatory exacerbations in a 12month period that required a systemic corticosteroids
27
Complications of Ulcerative colitis
Colorectal cancer
Secondary osteoporosis
Venous thromboembolism
Toxic megacolon ( widening of colon ,rare but life threatening
28
Facts about Sulfasalazine
Older aminosalicylates
With more side effects eg stains contact lenses
29
List eg of newer aminosalicylates with less side effects
Mesalalzine
Balsalazide
Olsalazine
30
State the most Important side effect of aminosalicylates
Bone marrow suppression
Blood dyscaria( perform blood count and stop drug immediately if blood dyscaria suspected)
31
What are the signs and symptoms of blood disorder
Unexplained bleeding
Bruising purpura
Sore throat
Fever or malaise
32
Monitoring requirements with Aminoglycoside
Renal function before starting, at 3months of tx and then annually
33
Does sulfasalazine stain bodily fluids?
Yes, orange/yellow
34
Is aminosalicylates nephrotoxic?
Yes
35
What is IBS( irritable bowel syndrome)
A long term condition of the bowel
Mainly affect s people BTW 20-30yrs
More common in women
36
What are the causes of IBS
Alcohol, stress, caffeine, certain spicy/fatty food
37
Symptoms of IBS
ABCD
Abdominal pain
Bloating
Constipation
Diarrhea
Symptoms worsen by eating and relieved by defecating
Flatulence
Passing mucus from bottom
Lethargy
Bowel incontinence
38
Non drug tx of IBS
Soluble fibre eg fybogel, oat, sterculia
Increase water intake( 8cups/day)
Diet and lifestyle changes
Increase physical activity
Eat regularly without missing meals
Limit fresh fruit consumption
Reduce alcohol, alcohol and fizzy drinks
39
Drug tx of IBS
Diarrhoea- loperamide
Bloating- peppermint oil
Constipation- increase fibre, avoiding lactose as can cause Bloating
Antispasmodic/ Antimuscarinic- abdominal pain( mebeverine, hyoscine butybromide and peppermint oil)
CBT- depression
Antidepressants
40
Drug used in moderate to severe IBS associated with constipation
Linaclotide
It's shown to reduce pain , Bloating and constipation
41
Causes of constipation
Inadequate fibre
Inadequate fluid intake
Certain medication eg codeine, morphine, some antacids aluminium and some Antidepressants and Iron tablets
Medical condition such as IBS, underactive thyroid
Pregnancy due to hormonal changed slowing bowel movements and baby growing
42
Red flag symptoms for constipation
New onset constipation 50+
Anaemia
Abdominal pain
Unexplained weight loss
Blood in the stool( black and mixed in stool)
Cancer or G.I bleed
43
Different types of laxative
BOSS
Bulk
Osmotic
Stimulant
Softeners
44
Give an example of Bulk laxative
Bran, isphaghula husk, sterculia, methyl cellulose
45
Give example of Osmotic laxative
Macrogols eg Laxido , lactulose
46
Give an example of stimulant laxative
Bisacodyl, senna
47
Give example of Softener laxative
Liquid paraffin
48
List examples of other laxative used in constipation
Linaclotide and pricalopride
49
Facts about bulk forming laxative
Onset of action = 72hrs
It's also a fecal softener eg methylcellouse
MOA: increase bulk in the stool like fibre
Maintain adequate fluid intake to prevent intestinal obstruction
Can cause symptoms of Bloating, flatulence and cramp occasionally
50
State other conditions Bulk forming laxatives are used in
Colostomy, ileostomy, haemorrhoids, anal fissure, IBS , diverticular disease and UC
51
List examples of stimulant laxative
Bisacodyl, sodium picosulfate , senna, glycerol and co- danthramer
52
A stimulant laxative that also acts as a fecal softener is called
DOCUSATE SODIUM
53
A stimulant laxative that is reserved for terminally ill patients due to carcinogenicity and colours urine RED is called
Co-danthramer and Co-danthrusate
54
State how Stimulant laxative work
They increase intestinal motility therefore causing abdominal cramps
Onset of action 8-12 hrs
Suppositories-20-60mins
Bed time dose recommended
55
Stimulant laxative is contraindicated in
Intestinal obstruction and undiagnosed abdominal pain
56
Side effects of stimulant laxative
Abdominal cramps
Abuse risk which can cause hypokaelamia
57
MHRA update on stimulant laxative
Following a national safety review and concerns over misuse and abuse, the MHRA has introduced new pack size restrictions, revised recommended ages for use, and new safety warnings for over-the-counter stimulant laxatives (administered orally and rectally). Patients should be advised that dietary and lifestyle measures should be used first-line for relieving short-term occasional constipation, and that stimulant laxatives should only be used if these measures and other laxatives (bulk-forming and osmotic) are ineffective.
Smaller packs will remain available for general sale for the treatment of short-term, occasional constipation in adults only, and will be limited to a pack size of two short treatment courses. Stimulant laxatives should not be used in children under 12 years of age without advice from a prescriber; in children aged 12 to 17 years, products can be supplied under the supervision of a pharmacist.
58
Facts about faecal softener
Decrease surface tension and increase penetrative of liquid into faecal mass. Softens and wet faeces
59
Facts about liquid paraffin as a faecal softener
Can cause malabsorption of fat soluble vitamins ADEK
Avoid- can cause anal seepage with prolonged use
60
Facts about docusate sodium as a fecal softener
Most commonly used softener
61
Facts about Peanut( arachis) as a fecal softener
Enemas soften and lubricate faeces
62
List the two types of osmotic laxative
Lactulose
Macrogols
63
MOA of osmotic laxative
Increase amount of water in large bowel either by drawing fluid from the body into bowel maintaining fluid in the bowel
64
Onset of action of lactulose to tx constipation
Can take up to 2days for max effect
Not suitable for immediate relief
Macrogols acts faster
65
Side effect of lactulose
Abdominal pain and Bloating
Electrolyte imbalance
66
Lactulose is also use to treat
Hepatic encephalopathy
67
Which drug cause constipation
Verapamil
Opiates
Antimuscarinics
Antihistamines
Antiepileptic
Antispasmodic
Antipsychotics
Antidepressants
Antacids (Aluminium)
68
Mnemonic of drugs that cause constipation
Very Old Aunties get Constipation
69
Pt and carer advice for those on bulk forming laxative
Preparation that swell in contact with liquid should be carefully swallowed with water and should not be taken immediately before going to bed. Full effect may take a few days to develop
70
List the two types of diarrhoea
Acute Diarrhoea < 14days
Chronic Diarrhoea > 14days
71
What are the causes of diarrhoea
Infection
Gastroenteritis
Side effects of drug
Symptoms of GI disorder
72
Mnemonic of drug that cause Diarrhoea
CALM diarrhoea
Colchicine
Abx
Laxatives
Magnesium (antacids)
Digoxin
73
Aim of tx diarrhoea
To prevent dehydration and fluid/electrolytes depletion esp in children and elderly
73
Signs of dehydration
Tiredness
Headaches
Light headedness
Muscular cramps
Sunken eyes
Dry mouth and tongue
Weakness, confusion, reduced urine output
73
What is dyspepsia
Umbrella term for upper G.I tract symptoms which typically present for 4 or more weeks
Upper abdominal pain or discomfort
Heartburn
Acid reflux
N and V
73
When to refer a pt with diarrhoea
Unexplored weight loss
Rectal bleeding
Persistent diarrhoea
Systemic illness
Has received recent hospital or abx tx
Recent foreign travel ( other than western Europe, North America, Australia and New Zealand)
74
How to tx diarrhoea
Hydration
ORS
Loperamide
Kaoline with morphine
Ciprofloxacin ( occasional prophylaxis for travellers diarrhoea, routine use not recommended)
75
Symptoms of dyspepsia for 4wks and more
Upper abdominal pain
Heartburn
Gastric reflux
Early satiety
Bloating
N and V
76
Red flags for dyspepsia
Bleeding
Dysphagia
Recurrent vomiting
Weight loss
55+( unexplained recent onset not responded to tx)
77
Lifestyle advice for dyspepsia
Lifestyle measures
Eat 3-4hrs before going to bed
Avoid smoking and etoh
Raising the head of the bed
Assess patient for stress, anxiety or depression as these may Exacerbate symptoms
78
State when urgent endoscopy is required in dyspepsia
Patients with dysphagia, significant acute GI bleed, age 55 and over with unexplained Weight Loss and symptoms of Upper abdominal pain reflux or dysphagia
79
Causes of dyspepsia
Too much acid( GORD, peptic uler Gastroesophageal malignancy, side effect from drugs , lifestyle)
80
List the two types of dyspepsia
Functional and Uninvestigated dyspepsia
81
Explain functional dyspepsia
Dyspepsia symptoms but no underlying cause. Normal endoscopic findings
82
What is uninvestigated dyspepsia
Symptoms in patients who have not had an endoscopy
83
Drugs that cause dyspepsia
Nsaids, theophylline, alpha blockers, aspirin, benzodiazepine, beta blockers, bisphosphonates, CCB, nitrate, TCA
Antacids can be used for short term control
84
How to tx dyspepsia
Antacids/ Alginate short term
85
Initial management of Dyspepsia ( uninvestigated )
Offer PPI for 4 weeks
Test for H.plyroi
Offer H2 receptor antagonist if inadequate response to
PPI
86
Initial management for functional dyspepsia
Lifestyle advice
Test for H.pylori and tx if positive
Leave a 2week wash put period after PPI use before testing for H.pylori
If no H.pylori tx with PPI or histamine receptor antagonist for 4weeks
87
State what to do in pts with uninvestigated dyspepsia unable to stop NSAIDs
Reduce NSAID dose and use long term gastro protection with acid suppression therapy
Switch to alternate to NSAID eg PCM or COX 2 inhibitors ( risk of CV event)
Pt on aspirin unable to stop- switch to an alternative Antiplatelet
88
What are symptoms of GORD
Heart burn
Acid regurgitation
Chest pain
Hoarseness
Cough
Wheezing
Asthma
89
Causes of GORD
Fatty food, pregnancy, hiatus hernia, family hx of GORD, stress , anxiety, obesity, smoking,
90
Drug used to tx GORD
Alginate
Antacids
H2 receptor antagonist
PPI
91
Drug tx in pregnancy
First line- diet and lifestyle
Antacids or alginate
Omeprazole ( for severe symptoms)
Or Ranitidine (discontinued due to cancer stuff)
92
How is GORD managed in children?
Change frequency and volume of feed
Use feed thickener
Older children- tx like adults( gaviscon sachet)
93
Counselling and Pt advice with dyspepsia
Avoid ppt factors such as spicy food, coffee, alcohol and smoking
Eat small.meals ,slowly and avoid eating at bed time .
Sleep with head raised, lose weight
94
Key points on antacids
See photo fav.
95
Memory trick for Antacid Ingredients
SCAM
Sodium bicarbonate
Calcium bicarbonate
Aluminium Hydroxide
Magnesium Hydroxide
Affect absorption of certain drugs eg tetracycline take 1-2hrs b or after
96
Antacids duration of action
Don't last long
Provide quick symptoms relief in 15-30mins
97
What is the definition of low sodium content
< 1mmol/tablet or 10ml dose
98
Which antacids has a low sodium content
MAM
Co- magaldrox = Mg and Al( MAALOX and MUCOGel
2. Co- simalcite eg Altacite plus simeticone
99
Example of antacids with high sodium
Magnesium carbonate
Magnesium Trisilicate
Sodium alginate with Potassium bicarbonate eg Gaviscon advance contains double Sodium compared to gaviscon original
100
High Sodium antacids should be avoided in
Liver, kidney failure, htn, sodium restricted diet and CVD
101
Eg of PPI
Pantoprazole
Omeprazole
Lansoprazole
Esomeprazole
Rabeprazole
102
Indication of PPI
Gastric Ulcer
Duodenal Ulcer
H.pylori
Dyspepsia
Gord
Nsaid associated Ulcerative
Zollinger - Ellison syndrome
103
Monitoring requirements for PPI
Measure serum Magnesium conc. Especially when used with other drugs that cause hypomagnesemia or with digoxin( toxicity if low)
104
MHRA warning for PPI
Lupus
105
Cautions with PPI
Risk of fracture
Risk of G.I infection
Mask symptoms of gastric cancer
Risk of osteoporosis
106
Mnemonic for PPI caution
MC GOLF
Osteoporosis ( give VIT D and Ca)
107
What are the signs of Hypomagnesaemia
Convulsions, muscle pain and weakness
108
MHRA advice with PPIs
Low risk of subacute cutaneous lupus erythematous (SCLE)
Lesions appear on skin when exposed to the sun, advice patients to avoid exposing the skin
Discontinue meds if possible
Most cases resolved when PPI is stopped
109
PPI safe in pregnancy
Omeprazole
110
Important Omeprazole interaction
Avoid CLOE
Omeprazole and esomeprazole decrease efficacy of clopidogrel.
Methotrexate: Omeprazole decreases the clearance of Methotrexate
High dose( use with caution)
Monitor Magnesium with Digoxin
111
PPI and Breastfeeding
Use with caution
112
Drug tx for H plyori
PPI
Clarithromycin
Amoxicillin/Metronidazole
Tetracycline and levofloxacin( unlicensed)
Bismuth subsalicylate
Rifabutan/
113
Memory trick for Triple therapy for H.pylori
PCM
PAM
PAC
PAT/PAL
114
First line tx for H.pylori in pen. Allergy
PPI + clarithromycin + Metronidazole
115
2nd line tx for H.pylori in pen allergy pt
PPI plus Metronidazole and Levofloxacin
116
Alternative first line tx in pt previously tx with clarithromycin
PPI plus bismuth plus Metronidazole plus tetracycline
117
What test do you use to confirm H.pylori
Urea(13) breath test
SAT
118
Public England advice for H.pylori test
See photo fav
119
Gastroprotective complexes
See photo fav
Sucrafate
Causes bezoar formation in pt in ITU
120
Facts about Sucralfate
Take it ONE hr before you eat
Take late( at bed time)
Take 1 hrs before meals or enteral feeds and at bed time
121
H2 receptor antagonist
See photo
122
What is misoprostol
Synthetic prostaglandin analogue
Promote healing of gastric and duodenal Ulcer
123
Conception and contraception with misoprostol
Do not use in women of child bearing age
Use effective contraception during treatment
124
What's a difference between food allergy and intolerance
Food allergy is immunological while food intolerance is not
125
Most common allergen
Cow's milk
Hen's egg
Soy
Wheat
Peanuts
Fish
Shell fish
126
Management of food allergy
Strict avoidance of causal food
Drug tx
Educate people about the allergens
127
Drug tx for food allergy
Sodium cromoglicate given as adjunct to dietary avoidance
128
What drug is licensed for the symptomatic control of food allergy
Chlorphenamine maleate
129
State what to offer for food induced anaphylaxis
Adrenaline. Check bnf for dose
130
State drugs used in gastro intestinal smooth muscle spasms
Antimuscarinic and other antispasmodic drugs used to relax intestinal smooth muscle and reduce intestinal motility
131
Examples of antimuscarinic drugs used
Hyoscine butylbromide
Dicycloverine HCL
132
List examples of antispasmodic drugs
Alverine, mebeverine
133
Side effect of antimuscarinic side effects
Can't see- blurry vision
Can't pee- urinary retention
Can't shit-constipation
Can't speak- Dry mouth
134
What is Obesity
BMI > or= 30kgm/m2
135
Obesity classification
See pic
136
State when to tx obesity with drugs
If BMI is greater than 30 in whom atleast 3months of diet, exercise fail to achieve a reduction in weight
Or if BMI is greater than 28 with associated risk factors eg T2D , HTN and hypercholeterolaemia
137
Drug for obesity
Orlistat
Vit D supplementation if concerned about deficiency of fat soluble vitamins
138
Patient with type 2 diabetes lose weight slower true or false?
True
139
State when an obesed patient should stop taking Orlistat
If when loss since start of tx does not exceed 5% within 3months
140
State when Bariatric surgery is suitable for obesed patient?
BMI greater than or equal to 40kg/m2( Class 111 Obesity) or between 35-39kg/m2 with a significant disease or high bp
141
State other drugs used as adjunct in weight management with diet and exercise
Saxenda( Liraglutide)
GLP receptor agonist
Used in pt With BMI >or = 30kg/m2 or 28kg/m2 with associated risk factors
142
What's the max daily dose of Saxenda?
3mg
143
State when to avoid Saxenda in obesed patient
If CrCL is < 30ml/min
144
Nice recommends Saxenda should be used with...
Caution
145
What is Anal fissure?
A tear or ulcer in the lining of the anal canal
146
Symptoms of anal fissure
Bleeding
Persistent pain on defecation
Linear split in the anal mucosa
147
Aim of tx
To relieve pain and promote healing of fissure
148
Drug tx for Acute Anal fissure
Present <6weeks
Bulk forming laxative
Osmotic laxative
Short term use of topical preparation containing local anaesthetic eg lidocaine
Simple analgesic - for prolonged burning following defecation
149
Drug tx for chronic anal fissure
>6weeks
GTN rectal ointment (s/e: headache)
Alternatively,
Oral or topical diltiezem or nifidipine
150
Non drug tx for anal fissure
Increase dietary fibre
Increase fluid intake
Good personal hygiene
151
What's Haemorrhoid
Abnormal Swellings of vascular mucosal around anus
152
What is Internal Haemorrhoids
Painless unless they become stragulated
153
Facts about External Haemorrhoids
Itchy or painful
154
Haemorrhoid is common in pregnancy . T/F
True
155
Drug Tx
Bulk forming laxative ( for constipation)
Simple analgesic ( pcm)
Avoid opoids because they cause constipation and avoid NSAID if rectal bleeding present.
Topical Prep. Containing local anaesthetics, corticosteroids, astringent, lubricants and antiseptic ( to reduce pain and itching)
Lidocaine, benzocaine, cinhocaine, pramocaine- should only be used for a few days as they may cause sensitization of the Anal skin.
156
Duration of tx for hemorrhoids
Short term use for 7days( steroids)
Long term use can cause UC.
Continous use of steroids can cause adrenal suppression
157
Tx of haemorrhoids in pregnancy
Bulk forming laxativeuse simple soothing products if a tx with topical Prep is required
158
Symptoms of reduced exocrine secretion
Maldigestion and malnutrition
Diarrhoea
Abnormal cramps
Steartorrhea- fatty stool
159
Causes of exocrine insufficiency
Chronic pancreatitis
Cystic fibrosis
Ceoliac disease
Zollinger Ellison syndrome
Pancreatic tumors
G.I enzyme
160
Drug tx for Exocrine Insufficiency
Pancreatin eg Creon, pancrex v and nutrizym22
Take with food( inactivated by gastric enzyme)and avoid heat
161
Two types of stoma
Colostomy
Ileostomy
162
Prescribing for pts with stoma
Avoid enteric coated tablet and MR pre due to insufficient release of active ingredients
Avoid preparation that contains Sorbitol as an excipients ( laxative effect)
163
Painkillers for pts with stoma
Paracetamol most suitable
Opioid may cause constipation in colostomy pts and aspirin, NSAID gastric irritation and bleeding
