GI Flashcards by Lily Chan

Difference of location of UC and Crohns?

Ulcerative colitis is a colitus: COLON

Crohns is EVERYWHERE!

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Is UC and Crohn’s (IBD) curable?

No. It is chronic.

remission and flare ups

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What are the symptoms of IBD?

ADR!
abdo pain
Diarrhoea. weight loss
rectal bleeding. anal fissue

Fever
ulcers, anaemia

inflammed eye (uveitis), liver,
arthritis
skin rash

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Complications for IBD

stricture= narrowing of GI tract: vomit, nausea
perforation- due to absess
fistula
colon cancer

anaemia
osteoporosis

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what are the drug treatments for IBD

aminosalisylates: reduce inflam gut
mesalazine, balsalazide, alsalazine, sulphasalazine (stain contacts)

immunosupp:
AZA, MTX, mercaptopurine

MONOclonol antib: (req specialist)
infliximab, adalimumab, golimumab

CORT:
predni, methylpred, budeson, hydrocort

ATB

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examples of aminosalisylates

aminosalisylates: reduce inflam gut

mesalazine, balsalazide, alsalazine, sulphasalazine (stain contacts)

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EXAMPLES immunosupp

immunosupp:

AZA, MTX, mercaptopurine

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1st line UC

TOPICAL AMINOSALYCILATES

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examples MONOclonol antib:

MONOclonol antib: (req specialist)

infliximab, adalimumab, golimumab

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Older aminosalicylate example?

sulfasalazine

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SE sulfasalazine

sulfasalazine
STAINS contacts
bone marrow suppression

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newer aminosalicylate example?

mesalazine, balsalazine, olsalazine

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what needs to be monitored for aminosalycilates?

monitor renal for

sulfasalazine, mesalazine, balsalazine, olsalazine

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SE aminosalicialtes

neprhotoxic
salicylate hypersensitivity
yellow orange body fluids with sulfasalazine
bone marrow suppression (blood dyscrasia)

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symptoms of IBS?

ABCD
abdo pain
bloating
constipation
diarrhoea

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life style advice for IBS?

Soluble fibre: oats, isphagula husk, sterulia, husk. not bran
exercise
stress management
reduce spicy, acidic food (coffee)
not miss meals
stop smoking
8 glasses water dailiy

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drugs used in IBS?

SOLUBLE fiber: isapaghula husk
antispas: mebeverine, peppermint oil
antimus: hyoscine
loperamide
linaclotide: reduce pain, bloating etc...
AVOID lactulose: cause bloating

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what causes constipation in IBS?

IMMOTILITY OF GUT

lack of exercise,
lack fiber
lack fluids

drugs: 
Fe
antidep
opioids
some antacids

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what are the red flags for constipation

new onset over 50yo
more than 5 days
under 2yo
ANAEMIA
ABDO PAIN
weight loss
blood in stool

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onset of stimulants?

8 to 12 hours. best to give at bedtime

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SE of senna

abdo cramp

abuse can cause hypokalaemia

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what colour does the paliative laxative co-danthramer cause, and SE

urine red

carcinogen

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licensing of SENNA

senna P
only give after osmotic and bulk
12yo+ for P

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softener examples

liquid paraffin
docusate (also weak stimulant activity)
peanut (arachis) enemas

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onset of lactulose

up to 2 days (macrogol is a faster osmotic) (phosphate enemas and mg even faster osmotic)

which atb may be used to prevent traveller's diarrhoea?

ciprofloxacin (occasional prophylaxis for travellers diarrhoea)

list some atb for diarrhoea

kaolin with morphine ciprofloxacin oral rehydrat loperamide

red flags for dyspepsia?

``` blood dysphagia recurrent vomiting 55+ weight loss ```

1st line for dyspep

1st antacid 3rd PPI up to 4 weeks test for H.pylori

can cimetidine be given for dyspepsia

too many interactions

sodium bicarbonate with antacids should be avoided with who?

``` renal liver HTN lithium sodium restricted diet fluid retention ```

antacids caution with what drugs

tetracycline | MR coated

which antacid products are suitable for Mr Teaspoon who takes amlodipine?

he's got hypertension. needs a low sodium antacid: Co-magaldrox: Mucogel, Maalox Co-simalcite: Altacite plus

What are two conditions that may result from taking PPI

osteoporosis | possible C.DIFF infections

Which drug resulting in a rash would you be cautious of and refer to GP?

Lansoprazole: PPI MHRA warning: SCLE subacute cutaneous lupus erythematous =a photosentive rash withdraw PPI if possibe (if h.pylori, then continue since only 1 week?)

What are some main interactions with omeprazole?

ClOpidorel (decreased efficacy by Omeprazole)(lansoprazole ok) Methotrexate (decrease conc through increase clearance by omeprazole and lansoprazole) antivirals

what drugs are used for H.pylori?

PAM PAC PCM

What are the PPI doses for H.pylori?

``` lansoprazole 30mg BD Omeprazole 20-40mg BD / Esomeprazole 20mg BD pantoprazole 40mg BD rabeprazole 20mg BD ```

how many days is the H. pylori eradication regimens

what are the doses of amox, clari and metro in H.pylori regime?

amoxicillin 1 g twice-daily clarithromycin 500 mg twice-daily or metronidazole 400 mg twice-daily

what if allergic to both penicillin and mycin! | or previous exposure to mycin

PPI metronidazole 400mg BD levofloxacin 250mg BD (unlicenced but suggested in cks)

Pregnancy, which h.pylori regime?

omeprazole 20-40mg bd clarithromycin 500mg bd metronidazole 400mg bd (no amox nor other PPI for preg)

what criterias would you delay UREA 13 test due to FALSe negative for? ``` had atb 2 weeks ago had atb 3 weeks ago had atb 4 weeks ago had antacids today had PPI 2 weeks ago had PPI 3 weeks ago had PPI 4 weeks ago ```

delay UREA 13 due to false negative if: had atb within 4 weeks (so 2 and 3 weeks not okay) had PPI within 2 weeks (more than 2 weeks are okay)

if a urea 13 retest is needed to check if h.pylori eradication worked, when should it be done?

4 weeks after treatment

what time of the day is sucralfate taken?

bd or qid | 1 hour before meals and bedtime

What condition's symptoms do PPI, H2 antagonists (like ranitidine) mask?

gastric cancer

which class of antisecretion meds is most suitable for Zollinger–Ellison syndrome? (stomach tumours causing over acid secretion)

PPI | H2 receptor antagoists NOT suitable

What is misoprostol used for?

Termination of pregnancy (2nd step) (CVS risk) induce labour gastric ulcer (with PPP contraception) June drinks miso soup

Why not misoprostol in pregnancy

induces uterine contractions | teratogenic in 1st trimester

What are some symptoms to food allergy

rash, hives breathing difficulties, anaphylaxis NV

what minerals may a person suffering from food allergy lack?

fe - anaemia ca - osteoporosis mg? na?

name an antihistamine that is licenced for food allergy

chlorphenamine (piriton)

What are some antimuscarinic SE?

everything held up! can't see - pupil dilation can't pee- can't shit can't spit

Obesity related co-morbidities? and BMI

``` BMI 30kg/m2 cardiac disease, (HTN, cholesterol) type 2 diabetes fatty liver disease, gall stones GORD phychiatric ```

What drugs are used for IBS?

Antimuscarinics: dicycloverine hyoscine BUtylbromide (BUscopan) (not hyoscine hydrobromide, Kwells) Antispasmodics: alverine mebeverine

Other than eating habits, what medicines or conditions cause weight gain?

insulin, sulfonylurea OC, TCA, BB Atypical antipyschotics, lithium, sodium valproate hypothyroidism

what is the active ingredient of Rectogesic and what is it used for?

Glyceral trinitrate for anal fissue

What topical options are there for anal fissue?

lidocaine 5% ointment 15g (P) After 1 week: Rectogesic. Glyceryl Trinitrate 0.4% ointment. For 6-8 weeks (specialist after 6-8 weeks): Dilitiazem 2% ointment

what to give a pregnant woman with haemorrhoids?

NOT local anaesthetic or CRT

What are the symptoms of exocrine pancreatic insufficiency?

malnutrition in fat-soluble vitamins, lipoproteins, macronutrients steatorrhoea diarrhoea abdo cramp

What conditions can cause pancreatic insufficency?

cystic fibrosis coeliac disease zollinger-ellison syndrome, GI surgery pancreatitis, pancreatic tumours

Should creon be taken with food or 2 hours away from food?

creon with food | inactivated by gastric enzymes!

What are the 2 most common forms of stoma?

colostomy, ileostomy

Which of these analgesics are best for a stoma patient? paracetamol NSAIDS Opioids

paracetamol

What's the purpose of PPI in stoma patients?

PPI reduces acid secretion, reduces stoma output

stoma patient taking digoxin. What to watch out for?

hypokalaemia. loss of K together with fluid and Na loss. | give K supplement or k sparing diuretic concommitently

which route of Iron Fe is preferred in stoma patients? ``` tablets solution sc im iv ```

which haemorrhoid creams may be used in pregnancy?

``` Germoloids cream (lidocaine and zinc oxide) preparation H (natural, shark fin oil) ```

What type of skin reaction does lansoprazole cause? And sometimes statins too

Subacute cutaneous lupus erythramateous SCLE

What are the clinical features of SCLE

``` photosensitive rash (no pain. non-scarring) lansoprazole ```

What are the clinical features of Stevens–Johnson syndrome / toxic epidermal necrolysis? SJS/TEN

Flu-like symptoms for a few days, then Painful rash with blisters on red skin (40% caused by antibiotics) eg. allopurinol (dermnet SJS. bnf only says rash)

GI Flashcards

(71 cards)