Gastrointestinal system Flashcards
(112 cards)
1
Q
What is the nice definition of constipation
A
less than 3 visits per week
2
Q
what are the three main type of laxatives
A
bulk forming
osmotic
stimulant
3
Q
what lifestyle advice can we give to patients with constipation
A
increase fluids
increase fibre
increase activity
4
Q
what is the moa of bulk forming laxatives
A
swells in the gut increasing mass of stool and forcing manual peristalsis
5
Q
what is the moa of osmotic laxative
A
increases the water in the gut meaning that the solid stool can flow easier out the body
6
Q
what is the moa of stimulant laxative
A
harms the lining causing peristalsis
7
Q
what is an example of bulk forming laxative
A
ispaghula husk
8
Q
what is an example of osmotic laxative
A
macrogol
lactulose
9
Q
what is an example of stimulant laxative
A
bisacodyl
senna
10
Q
what are the side effects of bulk forming laxative
A
flatulence
cramps
gut obstruction
11
Q
what advise can we give regarding taking bulk forming laxatives
A
dont take at night
increase fluids
12
Q
what are the side effects of osmotic laxatives
A
discomfort
flatulence
cramping
nausea
13
Q
what is a side effect specific to lactulose (osmotic laxative)
A
osmotic diarrhoea of low faecal pH
14
Q
what are the side effect of stimulant laxatives
A
abdominal cramps
15
Q
what can an overuse of stimulant laxatives lead to
A
hypokalaemia and lazy bowel
16
Q
Treatment pathway for constipation in a healthy adult
A
attempt first laxative
attempt of second laxative
consider prucalopride or lubiprostone
17
Q
when do we consider prucalopride or lubiprostone
A
after the attempt of two laxatives for six months at max strenght
18
Q
if a bout of constipation is caused due to opioids how can we treat it
A
osmotic laxative
naloxegol 2nd line
19
Q
if a pediatric patient presents with constipation what would we give
A
osmotic and behavioural interventions then stimulant
20
Q
if a patient was pregnant or breastfeeding with constipation what would we give
A
bulk forming
osmotic
bisacodyl
docusate
glycerol
21
Q
what is senna contraindicated in.
A
pregnancy and breastfeeding
22
Q
what does peptic ulceration cover
A
duodenal and gastric ulceration
23
Q
what are the two major factors that cause peptic ulceration
A
nsaid
hyplori
24
Q
what are some other factors that influence peptic ulceration
A
stress
smoking
obese
alcohol
25
what medications can worsen peptic ulcer
nsaid
aspirin
bisphosphonates
kcl
ssri
26
all treatment for peptic ulceration involves what
proton pump or h2 antagonists
27
how long do we carry on the ppi after hplyori eradication if also history of nsaid
2 months
28
what lifestyle advise can we give to patients with peptic ulceration
increase small meals
increase helahty meals
decrease alcohol
decrease smoking
increase exercise
29
when is peptic ulceration considered an urgent colonoscopy required
over 55 and had a loss of weight unexpectedly
30
If someone has diarrhea what is first line
give fluid replacement and potentially loperamide if not contraindicated
31
what is the moa of loperamide
binds to the gut opiate receptors and causes an increase in absorption of water and electrolytes back into the gut
this then reduces diarrhea
32
when can we not give loperamide
any type of food poisoning
or
AAC
33
what is the earliest age we can give loperamide
12
34
can we give loperamide in pregnancy
no
35
what is a major side effect of loperamide
qt prolongation
cardiac arrest
36
if a patient is presenting with diarrhea when should we refer
if under 3 months
if under a year if symptom last for a day
if under a year if symptoms last for 2 days
longer than 3 days
37
what is a stoma
artificial opening on the abdomen to divert flow of faeces or urine into an external pouch located outside the body
38
is stoma permanent?
can be temporary or permanent
39
what are the most common forms of stoma
colostomy and ileostomy are the most common
40
what are some other forms of stoma
gastrostomy
jejunostomy
duodenostomy
caecostomy
41
where is the site of a colostomy
large intestine
42
where is the site of ileostomy
small intestine
43
if a patient has had a ileostoma what type of medications may not be suitable
modified release or enteric coated medications
44
what is a side effect of calcium containing antacids in stoma patients
constipation
45
what can magnesium containing antacids cause in stoma patients
diarrhoea
46
what is a side effect of aluminium antacids in stoma patients
constipation
47
what products contained in antacids can cause constipation in stoma patients
aluminium
calcium
48
what is a side effect of iron preparations in stoma patients
diarrhoea in ileostomy
constipation in colostomy patients
49
what does dyspepsia refer to
range of upper gi symptoms which present for 4 or more weeks
50
what are the main symptoms of dyspepsia
abdom pain
heartburn
blaoting
discomfort
51
what advice can we give to patients with dypepsia
healthy eating
weight loss
avoid trigger foods
eat small meals
eat evening meal 3 -4 hours before bed
raising head of bed
alcohol and smoking cessation
52
what are some drugs that can induce dyspepsia
alhpha blockers
bisphosphonates
antimuscarinics
ccb
nsaids
nitrates
theophyline
tricyclic antidepressants
53
what can dyspepsia be managed by
antacids
54
how long do antacids take to work
15-30 minutes
55
how do we take antacids
after each meal and before bed as required
56
what are the main drug interactions between antacids and other medications
tetracyclines
quinolones
bisphosphonates
57
how long needs to be left between dose of antacids and the drugs it interacts with
2 hours before or after
58
in what groups should antacids be used with caution in and why
due to a high salt content patients with
hepatic failure
renal failure
hypertension
heart failure
59
what is gastro oesophageal reflux disease
chornic condition where there is reflux of gastric contents back into the oesophagus
60
what are the symptoms of GORD
hearburn and acid regurgitations
chest pain
hoarseness
cough
wheeze
asthma
dental errosions
61
when can gord be classified as non erosive
person has had symptoms but the endoscopy is normal
62
what can contribute to GORD
family history
trigger and fatty foods
pregnancy
hiatus hernia
obesity
drug
63
what are the complications of GORD
oesophageal inflammation
ulceration
haemorrhage
stricture formation
anaemiaho
64
how do we treat gord
antacids
alginates
h2 antagonists
ppi
65
what is cholestasis
refers to an impairment of bile formation or flow
66
what does cholestasis present as
fatigue
pruritic skin
dark urine
pale stool
jaundice
67
what is the first line drug in the treatment of cholestasis
colestyramine
68
how does colestyramine
anion exchange resin that is not absorbed from gi tract
it relieves by forming an insoluble complex in the intestine with the bile which is then excreted
69
what is a drug that is unliscenced to treat cholestasis
rifampicin
70
what is intrahepatic cholestasis
occurs in late pregnancy and is associated with adverse foetal outcomes
71
how can we treat intrahepatic cholestasis
ursodeoxycholic acid
72
what is exocrine pancreatic insufficiency
pancreas doesnt secrete enough enzymes into the duodenum which can lead to maldigestion and malnutrition
73
what is exocrine pancreatic insufficiency common in
cystic fibrosis
chronic pancreatic
zolinger ellison syndrome
coeliac disease
tumors
surgery on pancreas
74
what is the aim of treatment for exocrine pancreatic insufficiency
relieve gi symptoms and to achieve normal nutrition
75
what treatment can we give with someone who has exocrine pancreatic insufficiency
diet advice
- avoid high fibre foods
- avoid alcohol
- avoid reduced fat diets
Pancreatin replacement therapy required
76
what are different examples of pancreatin replacement therapy
nutrizym 22
pancrease hl
creon
77
in what age is nutrizm and pancrease contra-indicated
15
78
what are the side effects of pancreatin
gi upset
irritation to perioral and buccal mucosa
can cause perianal irritation and hypersensitivity
79
what should pancreatin not be used with
HOT DRINKS and FOODS mixed
80
what is IBD
irritable bowel disease which is where there is something structurally wrong with visual abnormalities
81
what is IBS
where there is something functionally wrong with the bowels
82
what are the two types of IBD
Ulcerative colitis
Chrohn's disease
83
what is crohns disease
84
what is ulcerative colitis
affects the colon that comes in phases
85
what are the phases of ulcerative colitis
proctitis - rectal inflammation
proctosigmoiditis - rectal and sigmoidal inflammation
left sided colitis - colitis
extensive colitis - including tranverse colon
86
what is proctitis
rectal inflammation and one of the phases of ulcerative colitis
87
what is proctosigmoiditis
rectal and sigmoidal colon inflammation and one of the phases of ulcerative colitis
88
what is extensive colitis
inflammation of the colon and tranverse colon and one of the phases of ulcerative colitis
89
what are the symptoms of uc
bloody diarrhoea
abdom pain
acute flare up
mouth ulcers
arthritis
weight loss
fatigue
90
what are the major complications of uc
cancer
secondary osteoporosis due to diet changes
vte
toxic megacolon
91
what is toxic megacolon
colonic distention type associated with shock, fever and abdominal pain.
92
how do aminosalicylates work
limit the inflammation in the lining of the gi tract
93
what are 4 examples of aminosalicylates
sufasalazine
mesalazine
balsalazine
olsalazine
94
which aminosalicylate is more associated with blood dycrasias and neprotoxicity
sulfalazine
95
how can methotrexate be used to help with uc and chrons
it inhibits the inflammatory response to induce remission.
96
what type of drug is methotrexate aside from an immunosuppressant
antifolate agent
97
what drug do we recommend patients on methotrexate to take alongside
folic acid
98
how do we take methotrexate
once a week with folic acid
99
what are the main side effects of methotrexate
gi toxicity
liver toxicity
100
what are common side effects for drugs affecting any form of immune response
blood disorders
bone marrow suppression
sore throat
pnuemonitis
mouth ulcers
rash
bruising
fever
101
how do we monitor any drug affecting the immune response
full blood count
renal and liver test
102
initially how often do we monitor a patient on an immunosuppressant
1-2 weeks
103
once a patient has been stabilized on an immunosuppresant how often are they monitored
2-3 months
104
what are the side effects of glucorticosteroids
adrenal suppression
nausea
vomit
weight loss
fatigue
headache
muscle weakness
105
what diseases can an immunosuppresed patient contract
chicken pox
measles
oral candidiasis
106
what are some psychiatric reactions of glucocorticosteroids
suicidal thoughts
depression
insomnia
107
what is the mechanism of action of azathioprine and mercatopurine
inhibits purine and stops dna/rna synthesis and protein synthesis
108
what are azathioprine and mercatopurine used in
ulcerative collitis and chrons
109
what are the side effects associated with azathiprine and mercaptopurine
hypersensitivity reactions
bone marrow suppression
neutropenia
thrombocytopenia
110
when does a hypersensitivity reaction most likely occur for azathiprine and mercaptopurine
first few weeks
111
on what drug does a patient on azathioprine and mercaptopurine
alopurinol
112
