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Medium Weighted Topics > GI > Flashcards

GI Flashcards

1
Q

Coeliac disease

A

Autoimmune condition associated with chronic inflammation of small intestines
Immune response triggered by gluten
Leads to malabsorption of nutrients (calcium and vitamin D =osteoporosis)
Diagnose with igA tissue glutaminase test

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2
Q

Coeliac disease symptoms

A

Abdominal pain
Bloating
Complications from nutrient malabsorption (e.g calcium and vitamin D) =osteoporosis / bone disease
Diarrhoea

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3
Q

Non-drug treatment for coeliac disease

A

Strict life long gluten free diet
Assess risk osteoporosis
Vitamin and mineral supplement

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4
Q

Drugs used in coeliac disease

A

Supplementation with calcium and vitamin D
Osteoporosis and bone disease treatment e.g biphosponates
Prednisolone (initial management while awaiting specialist advice)

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5
Q

Diverticular disease

A

Condition where diverticula causes intermittent lower abdominal pains without inflammation or infection
Prevalence; increases with age, mainly patients over 50 years +

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6
Q

Diverticulitis

A

Infected and inflammed diverticula
Symptoms; fever, general malaise, fistula, large rectal bleeds, constipation, abdominal pain

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7
Q

Drug treatment for diverticulitis

A

High fibre diet
Bran supplements
Bulk forming drugs (treat constipation or diarrhoea)
Antispasmodics (relieve colic)
Antibiotics (infection)
Elective surgery
AVOID; anti-motility drugs as they can exacerbate symptoms; make you constipated e.g codeine

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8
Q

Irritable bowel disease

A

Autoimmune no triggers
Umbrella term to define Crohn’s disease (mouth to anus) and ulcerative colitis (inflammation of gut)

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9
Q

Crohn’s disease exacerbation treatment

A

Mouth to anus
For acute exacerbation; corticosteroid for single exacerbation in last 12 months or aminosalyclates
When 2/+ exacerbation in 12 months; add th iPrint or methotrexate to corticosteroid
Severe or unresponsive to conventional therapy use biological therapy

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10
Q

Crohn’s disease maintenance of remission treatment

A

Thioprine or methotrexate
Not to use corticosteroids for remission due to s.e

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11
Q

Ulcerative colitis acute exacerbations treatment

A

Acute mild-mod; topical amino salicylates alone or adding oral. (Alternative corticosteroid)
Left sided and extensive UC; high dose oral aminosalicylate; consider adding of topical as well or oral corticosteroid
Acute Mod-severe; biological therapy
Acute severe; IV corticosteroids (+/- ciclosorpin +/or tacrolimus)

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12
Q

Maintenance of remission for ulcerative colitis

A

1st line aminosalicylates - topical +/or oral (depending on severity)
If 2 or more exacerbations in 12 months or uncontrolled with aminosalicylates ADD thioprine or methotrexate (2nd line)
If severe or unresponsive to conventional therapy consider biological therapy (infliximab , adalimumab etc under specialist supervision)

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13
Q

Symptoms of IBD

A

Vary between patients and severity
Abdominal pain
Rectal bleeding
Diarrhoea; can be bloody or mucus
Fever
Weight loss
Anal fissures
Ulcers, anaemia and mouth ulcers
Skin rashes, liver inflammation, middle layer eye inflammation, joints

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14
Q

IBD complications

A

Stricture; narrowing of GIT; difficulty passing food = vomiting and sickness
Perforation holes in the GIT, infection or abscess in abdomen
Fistula
Cancer (higher risk colon cancer)

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15
Q

Non drug treatment for IBD

A

Diet change
Stop smoking
Stress management

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16
Q

Ulcerative colitis CI

A

Loperamide or codeine is CI
Avoid anti motility drug or antispasmodics
Paralytic ileus increase risk of toxic mega colon
(Can use to treat crohns diarrhoea though)

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17
Q

Aminosalicylates mechanism of action and examples.

A

Sulfasalazine and mesalazine
Exerting immunomodulatory effects, antibacterial effects, effects on the arachidonic acid cascade and alteration of activity of certain enzyme

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18
Q

Patient and carer advice for aminosalicylates

A

Report; bleeding, bruising, purpura, sore throat, fever or malaise = signs blood dyscrasia
Swallow tablets whole and ensure adequate fluid intake
Stain contacts or bodily fluids yellow/orange
Monitor salicylate hypersensitivity - itching or hives

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19
Q

Monitoring requirements for aminosalicylates

A

Monitor renal function before starting treatment, 3 months and annually thereafter

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20
Q

Aminosalicylate interactions

A

Drugs that increase hepatotoxicity (alcohol, statin, flucloxacilin, carbamezapine) - not severe advise patients to motion signs of hepatotoxicity
LACTULOSE; and MR/GR of the drug; prevent breakdown of mesalazine in lower pH levels as lactulose lowers pH

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21
Q

Adverse effects of aminosalicylates

A

Arthralgia (joint stiffness)
Cough
Diarrhoea
Fever
GI discomfort
Headache
Leukopenia
Nause and vomitingg

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22
Q

Contraindications and caution with aminosalicylates

A

Acute porphyria’s
G6PD deficiency
Hx allergy
Hx of asthma
Risk haematological toxicity
Risk hepatic toxicity
Slow acetylator status

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23
Q

What is irritable bowel syndrome?

A

Long term chronic condition of the bowel
Mainly affecting ages 20-30 years
More common in women
Disturbance in brain triggers it
Managed by Food and mood

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24
Q

Symptoms of IBS

A

Abdominal pain
Bloating
Either diarrhoea or constipation

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25
Q

Non-drug treatment of IBS?

A

Diet and lifestyle changes; aggregated by stress, depression, anxiety or lack dietary fibre etc
Increase physical activity
3 fruit a day not 5
If fibre is required use soluble (oats, ispaghula) as insoluble (bran) can cause exacerbation
Increase water intake
Reduce caffeine, alcohol and fizzy drinks

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26
Q

Drug treatment for IBS?

A

Depends on severity
Antispasmodics; mebeverine, hyoscine and peppermint oil
Constipation; increase fibre, laxative (AVOID LACTULOSE = bloating)
Linaciotide; used if other laxatives infective and lasts for 12 months; to reduce bloating, pain constipation
Diarrhoea; loperamide
Bloating; peppermint oil
Antidepressants are last line for abdominal discomfort; TCAs and SSRIs
CBT
Antimuscarinics

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27
Q

Constipation

A

Passage of hard stool less frequently than the patients normal pattern

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28
Q

Symptoms of constipation

A

Hard difficult and painful stools to pass
Change from usual bowel habit
Can be accompanied by abdominal pain, bloating and sickness (if severe)

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29
Q

Causes of constipation

A

Inadequate fibre intake
Inadequate fluid intake
Medications; codeine, morphine, aluminium (antacids), iron, some antidepressants
Medical conditions; IBS, bowel disorders, under active thyroid
Pregnancy; bowels are slowed, baby growing bigger

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30
Q

Red flags in constipation

A

New onset of constipation in patients over 50 years
Anaemia
Abdominal pain
Unexplained weight loss
Blood in stool

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31
Q

4 types of laxatives?

A

Bulk forming
Stimulants
Osmotic
Faecal softners

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32
Q

What are the line of treatments for laxatives?

A

Bulk forming
Osmotic laxatives
Stimulants
Then high dose of macrogol osmotic

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33
Q

Bulk forming laxatives

A

E.g bran, ispaghula, methylcellulose (also a softener), sterculia
- increase bulk of stool
- 72 hour onset
Can cause bloating, flatulence and cramping

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34
Q

Stimulant laxatives

A

E.g bisacodyl, sodium picosulphate , senna, glycerol (suppositories work within 30 mins), co-danthramer (terminally ill patients)
Increase intestinal motility
Onset 8-12 hours so best to use at night and go in the morning
Can cause abdominal pain and cramping

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35
Q

Osmotic laxatives

A

Lactulose, macrogols (laxido), phosphate enemas and magnesium salts
Lactulose works within 2 days and can cause pain and bloating
Increases water drawing in fluid from the body into the bowel or main thing fluid in bowl
Hypokalaemia

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36
Q

Faecal softeners

A

Liquid paraffin; avoid as it can cause anal seeping in prolong use
Docusate sodium; weak stimulant activity
Peanut; softener/lubricant
Decreases surface tension and increases penetration of liquid into faecal mass, softens and wets poo

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37
Q

Opioid induced constipation

A

Avoid bulk forming as it can cause obstruction, painful colic
Use only osmotic or stimulant
Co-danthramer or co-danthrusate in palliative care only
Naloxegel or methylnarexate; used for peripheral Ovid-receptor antagonist when response to laxative is inadequate

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38
Q

Pregnancy and constipation

A

Dietary and lifestyle advice first; fibre supplement such as bran or wheat
1st line is bulk forming if above fails
2nd line osmotic e.g lactulose
Stimulants avoided can cause abdominal pain and diarrhoea, not to use senna near term time or history of unstable pregnancy as it can stimulate uterine contractions

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39
Q

Constipation in children

A

Use laxatives and dietary advice as first line treatment (lifestyle advice alone is not recommended)
Macrogols are first line e.g laxido paeds
Second line is stimulants
Lactulose if above fails and stool remains hard

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40
Q

Patient and carer advice with bulk forming laxatives

A

Preparations that swell in contact with liquids should always be carefully swallowed with water and shouldn’t be taken immediately before going to bed
Full effect may take a few days to develop

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41
Q

Diarrhoea

A

Abnormal passing of loose or liquid stools with increased frequency, increased volume or both
Acute diarrhoea lasts for <14 days and symptoms improve between 2-4 days
OR
Chronic diarrhoea >14 days

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42
Q

Causes of diarrhoea

A

Infection (salmonella, noro virus, e.coli C.diff)
Gastroenteritis
Side effects of drug
Gastrointestinal disorder symptom

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43
Q

Aims of diarrhoea treatment

A

Prevent dehydration and fluid electrolyte depletion

44
Q

Dehydration symptoms

A

Tiredness
Headaches or light headless
Sunken eyes
Dry mouth and roundup
Weakness
Confusion
Decreased urine output

45
Q

Red flags of diarrhoea

A

Unexplained weight loss
Rectal bleeding
Systemic illness
Travel abroad
Recent hospital treatment

46
Q

Treatment of diarrhoea

A

Drink plenty to avoid dehydration
Eat as normal
Self-limiting
Oral rehydration satches; 1st line, IV only in severe
Loperamide; for rapid control used travellers diarrhoea
Ciprofloxacin; occasional prophylaxis for travellers diarrhoea
Other drugs used methycellulose, colesyramine, ispaghula husk if associated with diverticular diease

47
Q

Loperamide

A

12 +
MHRA; cardiac reaction with high doses e.g abuse or overdose
S/e dizziness, flatulance and nausea
CI; UC, antibiotic associated colitis, avoid bloody or inflamed diarrhoea

48
Q

Dyspepsia

A

Disorder of gastric acid and ulceration
Pain or discomfort in the upper abdomen
Can occur from gastric, duodenal ulcers, medication related or gastric cancer

49
Q

Symptoms of dyspepsia

A

Epigastric pain
Fullness or bloating
Nausea
Flatulence
Early satiety

50
Q

Red flags with dyspepsia

A

Bleeding
Dysphagia
Recurrent vomiting
Weight loss
>55 years
Not responded to treatment

51
Q

Advice for dyspepsia

A

Lifestyle changes avoid excess alcohol and foods
Weight loss advice
Smoking cessation advice
Raise head of bed
Stop any medication that may cause dyspepsia e.g NSAIDs, steroids, etc

52
Q

Referral for dyspepsia

A

Chronic GI bleeding
Progressive dysphasia
Persistent vomiting
Iron deficiency anemia
Epigastric mass
Pts over 55 with unexplained and persistent onset of dyspepsia - refer urgent endoscopy

53
Q

Treatment of dyspepsia

A

Antacids
If symptoms persist in uninvestigated dyspepsia then PPI given for 4 weeks
If uninvestiagted and not responded well to PPI test for H.pylori
If there is population where H.pylori is common treat straight away whilst testing
If symptoms persist, PPI or H2 receptor antagonist for 4 weeks

54
Q

Antacids

A

Contain magnesium or aluminium compounds
Take after each meal and at bedtime prn
Used to relive symptoms of ulcer dyspepsia, non-erosive GORD, symptoms present
Liquid more effective than tablets

55
Q

Aluminium and magnesium containing antacids

A

Magnesium; tend to be laxatives
Al; tends to be constipating

56
Q

Bismuth containing antacids

A

Pesto-bismol
16 plus
Not recommended as bismuth can be constipating neurotoxic and cause encalopathy

57
Q

Calcium contains antacids

A

Causes rebound acid secretion
High doses can cause hypercalcaemia
Can precipitate the milk alkali syndrome interaction

58
Q

Simeticone containing antacids

A

Acts as anti forming agents to relieve flatulence
Useful for relive of hiccups in palliative care
Antifoaming drug
E.g detinex and infacol
Simeticone (Activated dimeticone)

59
Q

Alginate containing antacids

A

Increases viscosity of stomach content and can protect oesophageal mucosa from acid reflux
Sodium varies in different antacid perpetrations; avoid hypertension, fluid retention, heart, liver, kidney or those with restricted sodium diets (e.g lithium patients)
Gaviscon has mg and Na
Gaviscon advance K and Na
Not interchangable

60
Q

Peptic ulceration

A

Involves stomach, duodenum and lower oeseophagus
Nearly all duodenal ulcers and most gastric ulcers not associated with NSAIDs are caused by H.pylori

61
Q

H.pylori infection

A

Diagnose with urea breath test kit (carbon 12 urea test)
Initial treatment 1 week triple therapy
PPI + clarithromycin + (amoxicillin OR metronidazole)
If pt has been treated with metronidazole for other infections use amoxicillin, if pt allergic to amoxicillin use metronidazole

62
Q

NSAID associated ulcer

A

NSAID can cause GI bleeding and ulcers
Withdraw if ulcer occurs
High risk; 65+, hx of peptic ulcer disease or serious GI complication, taking other medication that increase ulcer risk, serious co-morbidities e.g CVD, DM, renal/hepatic impairment

63
Q

NAID associated ulcer risk protection

A

Give PPI
Ranitidine or misoprostol
Misoprostol is more appropriate for old or frail who NSAIDs can’t be stopped can cause colic and diarrhoea

64
Q

Gastro-protective complexes and chelators

A

Chelators; e.g sucralfate protect the mucosa from acid-pepsin attack in gastric and duodenal ulcers
Complex of aluminium hydroxide and sulphate sucrose
Has minimal antacid properties
Given one hour before meals
Caution bezose formation

65
Q

H2 receptor antagonoits

A

Famotidine, ranitidine and cimetidine
Heal gastric and duodenal ulcers
Relives GORD symptoms
S/e; rash, dizziness, psychiatric reactions
Can masks signs of gastric ulcers
Not used for Zollinger-Ellison syndrome as PPI is more effective

66
Q

Prostaglandin gastroprotection

A

Misoprostol; synthetic prostaglandin analogue
Teratogenic
Heal gastric and duodenal ulcers
Avoid women in childbearing age as it induces undermine contractions, associated with abortion and birth defects
S/e diziness and can impair driving or skills tasks

67
Q

PPI

A

Effective in short term treatment for gastric and duodenal ulcers
Lowest effective dose at shortest time
Use with abx eradication of H.pylori, treat dyspepsia, GORD, NSAID associated ulcers

68
Q

PPI caution

A

Can masks signs of gastric cancers
Increase risk of osteoporosis
Increase GI infection risk

69
Q

PPI side effects

A

Long term
HPYOmagnesia - predisposes digoxin toxicity
Fractures
Rebound secretion

70
Q

PPI interactions

A

Omeprazole
Reduced clopidogrel antiplatlet effect
Decrease clearance of methotrexate

71
Q

GORD symptoms

A

Heart burn
Acid regurgitation
May also cause in extreme cases; dysphagia, oesophagitis, ulceration, stricture formation

72
Q

GORD management

A

Drug treatment
Lifetyle advice - avoid excess alcohol, aggravating food, weight loss, raising head of bed
Surgery
Treatment based on severity of symptoms

73
Q

Mild symptom of GORD treatment

A

Antacids and alienates
H2 receptor antagonists
PPI
PPI for 4-6 weeks then reassess

74
Q

Pregnancy and GORD

A

Dietary and lifestyle advice first
Antacid or alginate
Ranitide
Omeprazole

75
Q

Children and GORD

A

Most resolve without treatment
For infants change volume and frequency of feed; more thickeners (thinner it is =more likely to come back up)
Can use alginate in older children similar to adults

76
Q

Food allergy

A

Adverse immune response to food
Immunological while food intolerance is not
Most common; cow milk, hen eggs, soy, wheat, fish, peanuts,

77
Q

Management of food allergies

A

Strict avoidance of food
Sodium cromoglicate given as adjuvant
Educate patients on allergies

78
Q

Drug treatment for food allergies

A

Chlorphenamine maleate for symptomatic control of food allergy
Adrenaline in anaphylaxis

79
Q

Gastroenteritis intestinal and smooth muscle spasm

A

Antimuscarinic; to relax intestinal smooth muscle; hysocine butylbromide (buscopan for 6+ in diangnosed IBS or buscopan relief in 12+)
Antispasmodics reduce intestinal motility e.g mebeverine and alverine

80
Q

Obesity

A

Increases risk many health problems
BMI over or greater 30 is obese
25 to 30 is overweight
Assess any underlying issues and encourage lifestyle changes

81
Q

Drug treatment in obesity

A

Never drug treatment alone use weight management plan
Anti-obesity drugs considered in over or greater than 30 BMI and have had least 3 months of diet and exercise or behavioural changes and failed to achieve a realistic weight reduction
OR BMI over or greater 28 of they have associated risk factors

82
Q

Orlistat

A

Obesity treatment
Reduces absorption of dietary fat
Licensed over or greater 30 BMI or 28 if have other associated risk factors
Discontinue after 12 weeks if no weight loss of 5% from start of treatment
Vitamin D supplementation if concerns of loss

83
Q

Surgery for obesity

A

Bariatric surgery
BMI over or greater than 40 or between 25-39.9 if they have significant risk factors

84
Q

Anal fissure

A

Tear or ulcer in the lining of anal canal
Symptoms; bleeding, persistent pain on defecation and linear split in anal mucosa

85
Q

Treatment of anal fissure

A

Acute anal fissue <6 weeks; bulk forming laxatives or osmotic laxatives (constipation can aggravate condition), short term use topical local anaesthetic (lidocaine) or simple analgesia
Chronic fissure >6 weeks; glyceryl trininitrate rectal great (rectogesic)

86
Q

Haemorrhoids

A

Swelling of vascular mucosal around the anus
Internal haemorrhoids; painless unless they become strangulated
External haemorrhoids; itchy or painful
Common in pregnancy
Aimee reduce symptoms, promote healing and prevent recurrence

87
Q

Non-drug treatment for haemorrhoids

A

Increase dietary fibre
Increase fluid intake
Good perinatal hygiene

88
Q

Drug treatment for haemorrhoids

A

Bulk forming laxatives
Simple analgesia
Local topical; anaesthetics, corticosteroids lubricants, antiseptics to reduce pain and itchiness
Topical corticosteroids are suitable for occasional short term use; no more than 7 days; long term can cause ulcerations or permanent damage due to thinning of skin and continuous use = adrenal suppression

89
Q

Pregnancy and haemorrhoids

A

Bulk forming laxatives are safe to use
Only use simple soothing products if a treatment with topical haemorrhoids preparations is required; avoid any local anaesthetic or corticosteroid.

90
Q

Specialist treatment for haemorrhoids

A

Rubber band ligation
Injection sclerotherapy (using phenol in oil)
Infrared coagulation
Haemorrhoidectomy

91
Q

Reduced exocrine secretions

A

Reduced secretion pancreases
Exocrine pancreatic insufficiency reduced secretion of pancreatic enzymes into the duodenum
Symptoms; maldigestion and malnutrition , diarrhoea, abdominal cramps steatorrhoea
Causes; exocrine pancreatic insufficiency can be caused by; chronic pancreatitis, cystic fibrosis, coeliac disease, Zollverein-Ellison syndrome, pancreatic tumour GI surgery
Aims of treatment; to relieve GI symptoms and to achieve normal nutritional status

92
Q

Reduced exocrine secretions; drug treatment

A

Main treatment is pancreatic replacement therapy with pancreatic (crean, pancrx V, and nutrizum 22)
Inactivated by gastric enzyme (take with food so it doesn’t get broken down by gastric enzyme) and avoid heat
Pancreatic contains 3 groups of enzymes (lipase, amylase and protease)which assists in the digestion of fats, carbohydrates and protein.

93
Q

Non-drug management with reduced exocrine secretions

A

Dietry advice
Distribute food intake between 3 main meals a day and 2 or 3 snacks
Avoid hard to digest foods such as legumes (peas beans lentils and high fibre foods)
Reduced fat diets not recommended
Avoid alcohol completely
Ensure adequate hydration for patients on high strength pancreatin

94
Q

Stoma

A

Stoma is an artificial opening opening on the abdomen to divert flow of faeces or urine into an external pouch located outside the body
2 most common forms;
Colostomy
Ileostomy

95
Q

What to AVOID in stoma

A

Avoid E/C and MR medicine = medicine unsuitable especially for ileostomy due to insufficient release of active ingredients
Avoid sorbitol due to its laxative effects
Soluble tablets, liquids, caps and uncharted tablets suitable due to quicker absorbtion

96
Q

Stoma drugs

A

Analgesics; paracetamol most suitable, opioids may cause constipation and NSAIDS gastric irritation and bleeding in colostomy patients
Antacids; risk diarrhoea from Mg and constipation from Al salts increased in pts with stoma
Antisecretory drugs; gastric acid secretion increases output (PPI used to reduce risk)
Antidiarhoeal drugs; loperamide, codeine and co-phenotype are effective
Digoxin susceptible to hypokalaemia esp when on digoxin due to fluid and sodium depletion. Should be given potassium supplements or pottasoum sparing diuretics
Diuretics; caution with ileostomy; risk dehydration and K depletion
Oral iron may cause loose stools IM preffered
Avoid enemas as their stronger can cause rapid and severe loss of water and electrolyte.
Advice colostomy pts to increase fluid intake and fibre intake to prevent constipation can use bulk forming and senna
Pottasoum supplements; liq preparation preferable to MR ones, daily doses to split to avoid osmotic diarrhoea

97
Q

What test is used to differentiate IBS and IBD?

A

Faecal calprotectin test
IBS; doesn’t produce signs of disease of colonoscopy or other tests
IBD is inflammatory so can be detected

98
Q

How would you test for colon cancer?

A

Flexible sigmoidoscopy

99
Q

How would you test for lactose intolerance or bacterial growth?

A

Hydrogen breath test

100
Q

NSAIDs and alcohol

A

Alcohol increases the risk of GI haemorrhage associated with NSAIDs
Some cases of AKI in excessive use

101
Q

Risk of NSAIDs

A

Highest risk; piroxicam, ketoprofen and ketorolac trometamol
Intermediate risk; indometacin, diclofenac and naproxen
Lowest risk; ibuprofen (higher does = intermediate)
Start lowest recommended dose and use one NSAID at a time

102
Q

Cardiovascular events and NSAIDs

A

NSAIDs can increase small irks of thrombotic events
Greatest risk is higher doses for long term use
Diclofenac 150 mg and ibuprofen 2.4 g daily is associated with increase thromobotic event risk

103
Q

Peptic ulcer

A

Dark brown red tarry bleed
Duodenal ulcer symptoms are relived after eating whereas pain from gastric ulcer is exacerbated after eating

104
Q

Cirrhosis

A

Damage to the liver
Nodules become surrounded by fibrosis which overall affects the livers ability to function
Can progress further into liver failure

105
Q

Compensated vs decompensated cirrhosis

A

Decompensated cirrhosis; liver damaged to the point it cant function
Compensated; damage but the liver can still function few or no clinical symptoms

106
Q

Major complications with decompensated cirrhosis

A

Ascites
Hepatic encephalopathy
Haemorrhage
Infection
Jaundice

107
Q

What drugs to avoid in hepatic encephalopathy?

A

Drugs can further impair cerebral function
Sedative drugs, opioid analgesics diuretics that cause hypokalaemia and drugs that cause constipation

Medium Weighted Topics (5 decks)

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