GI Flashcards
(51 cards)
How does Loperamide work
Binds to the mu-opoid receptors ingut wall
Inhibits Ach & prostaglandin release
Decreases parasympathetic activity
What laxative do you give for opoid-induced constipation
Osmotic laxative (macrogol, laxido) + Senna
What laxatives should you avoid for opoid-induced constipation
Bulk forming laxatives (Ispaghulla husk, methylcellulose)
What medication should you avoid for diverticular disease
NSAIDs and antimotility drugs (loperamide, opoids)
Treatment for Diverticulosis
- Avoid anti-motility drugs - slowing down transit can lead to perforations
- Avoid NSAIDs
- Cramping? –> Anti-spasmodics {Mebeverine}
- Constipated? –> Bulk forming lax
- Plenty water
- 30g fibre/day
Diverticulitis treatment
Co-amoxiclav 500/125mg TDS for 5 days (or Cefalexin is allrgeic to penicillins)
What mediators cause Crohns Disease?
TH1 - IFNγ, TNF, IL-6
TH17- IL-17A/F, IL-21, IL-22
What mediators cause Ulerative collitis?
TH2 - IL-5, IL-6, IL-13, TNF
TH9 - IL-9
TH17 - IL17A/F, IL-21, IL-22
What mediators cause resolution in healthy cells?
IL-10, TGF-β
How does inflixumab work?
Human monoclonal antibodies that bind both soluble & trans membrane bioreactive forms of human TNFα -> prevents binding of TNFα to receptors -> –| biological activity of TNFα
What is the aim of UC therapy?
Reduce inflammation
Induce remission
maintain remission
Improve QOL
Minimise toxicity related to drugs
Maintain therapy used to maintain remission
What is the treatment for proctitis UC?
- Topical aminosalicylates
- Add oral aminosalicylate if remmision not achieved in 4 weeks
- For Pt that cannot tolerate aminosalicylates consider time limited oral/topical CC
What is the treatment for proctosigmoiditits & distal colitis UC?
- Topical aminosalicylates
- If remission not achieved in 4 weeks consider +high dose oral aminosalicylates
- if this still doesnt work then oral aminosalicylates + oral CC
What is the treatment for extensive UC?
- Topical aminosalicylates + high dose oral aminosalicylates
- no remission in 4 weeks then stop topical treatment & offer time limited course of oral CC
- For ppl who cannot tolerate aminosalicylates -> time limited oral CC
What are some aminosalicylate drugs
Mesalazine, Sulfasalazine
What should be monitored while on thiopurines?
FBC, U&E, LFT at least 2, 4 8 & 12 then 3 monthly
What should the PT report if they’re on thiopurines?
Ulceration
Fever
Infection
Bruising
Bleeding
What should you reduce the dose of azathioprine by when you are taking both allopurinol and azathioprine?
1/4
What is the treatment to induce remission is moderate to severe UC?
Biologics & JAK
Infliximab & adalinumab
What is the MOA of 5-aminosalcylates?
- Have an action on both PGD synthesi via cyclooxygenase and supression of pro-inflammatory cytokines
- Actions on supression of cytokines comes via –| of PPARgamma, NF.kB & other non-COX targets.
- Can also scavange reactive oxygen metabolites from superoxide anion generation by neutrophils which can in turn prevent DNA & tissue DMG.
What clinical features are unique to CD?
More debilitating that UC
Can be acute / insidious
Palpabke masses
Small bowel obstruction
Abcesses
Fistulas
What are the clinical features of both UC/CD?
- Diarrhoea
- Fever
- Abdominal pain
- N&V (More common in CD)
- Malaise
- Weight Loss (More common in CD)
- Malabsorption
Describe the pathophysiology of CD?
Can affect any part of the GUT
Usually terminal ileium & ascending colon.
Affected areas are thickened, deep ulcer can appear, can progress to deep fissuring uclers
What are the red flags & referral of IBS?
Unintentional weight loss
Unexplained rectal bleeding
Loose stool for >6weeks in Pt over 60 yrs
Anaemia
