GI disorders

Question 1

Gastroesophageal reflux disease (GORD)

What is it

Answer 1

Backflow of acid and stomach contents to oesophagus

Question 2

Acute Gastritis

What is it, causes

Answer 2

Mucosal inflammatory process
Caused by irritants e.g. drugs (NSAIDs), excessive coffee, tobacco, alcohol or infection

Question 3

Chronic Gastritis

What is it, types

Answer 3

Chronic inflammation of the gastric mucosa
Type A - Autoimmune
Type B - H. Pylori infection

Question 4

Peptic Ulcer

What is it, types

Answer 4

Ulcerated lesion in the stomach mucosa (gastric ulcer) or duodenum (duodenal ulcer)

Question 5

H. Pylori infection

Answer 5

Most common bacterial infection
Organisms synthesise urease producing ammonia that damages the gastric mucosa

Question 6

Peptic Ulcer: Diagnosis

Answer 6

Oesophogastroduodenoscopy - gold standard
H. Pylori infection screen

Question 7

H. Pylori detection

Answer 7

C-Urea Breath Test - detects H. Pylori infection through breakdown of urea swallowed by the patient to CO2 and H2O

Question 8

Peptic Ulcer Treatment: Inhibit / neutralise gastric acid secretion

drug class

Answer 8

Antacids - Alginates, Sodium Bicarbonate, Magnesium trisilicate, Aluminium hydroxide
H2RA - Cimetidine, Ranitidine
PPI - Omeprazole, Lansoprazole

Question 9

Peptic Ulcer Treatment: Promote protection

drug class

Answer 9

Prostaglandin analogs - Misoprostol, PGE1
Mucosal barrier fortifiers - Sucralfate, Bismuth

Question 10

PPI Interactions

Answer 10

Omeprazole inhibit metabolism of phenytoin, warfarin and diazepam
PPI decreases bioavailability of itraconazole, iron salts

Question 11

H. Pylori - Peptic Ulcer Treatment: Combination Therapy

Answer 11

Two antibiotics + PPI for 7 days

Question 12

Peptic Ulcer treatment: when NSAIDs must continue

Answer 12

Continue PPI or switch to Misoprostol
PPI + NSAIDs

Question 13

Constipation

Answer 13

Infrequent and / or unsatisfactory defecation
Passing hard stools or straining
Incomplete or painful defecation

Question 14

Constipation: Causes

Medicines related

Answer 14

Narcotics - opioids
Antacids - containing aluminium
Antidepressants
Iron supplements
Diuretics

Question 15

Constipation: Treatment (BOSS)

Types of laxatives, examples

Answer 15

Bulk-forming - Isphagula husk, Sterculia
Osmotic - Lactulose, Macrogol
Stimulant - Senna, Bisacodyl
Stool softeners - Docusate sodium, Glycerol

Question 16

Constipation Treatment: Short duration

Answer 16

Dietary measures - should be first
Bulk-forming + fluid intake
Osmotic - if stools remain hard, add or switch
Stimulant - if difficult to pass, add

Question 17

Constipation Treatment: Opioid-induced

Answer 17

Stimulant + Osmotic
Bulk-forming - avoid

Question 18

Constipation Treatment: Faecal Impaction

Answer 18

Depends on stool consistency
Macrogol - high dose for hard stools
Stimulant PO - start if soft stools, add if hard stools after macrogol
Bisacodyl - rectal for soft stools
Glycerol - rectal for hard stools

Question 19

Constipation Treatment: Chronic

Answer 19

Bulk-forming
Osmotic - add or switch
Stimulant - can add

Question 20

Constipation Treatment: Pregnancy and breast-feeding

Answer 20

Lifestyle changes
Bulk-forming
Osmotic
Senna - avoid near term or history of unstable pregnancy

Question 21

Constipation Treatment: Children

Answer 21

Dietary modification + laxative
Macrogol
Stimulant - add or switch

Question 22

Diarrhoea

Answer 22

Abnormal passing of loose stools, with increased frequency and / or volume

Question 23

Diarrhoea: Treatment

Answer 23

ORS / ORT
IV Fluid
Antimotility - Loperamide
Antibiotics - Ciprofloxacin (not always)

Question 24

Irritable Bowel Disease (IBD)

Answer 24

Inflammatory disorder of the GIT
Chronic and relapsing inflammation
CD
UC

Question 25

IBD: Diagnosis

Answer 25

Lab tests - Haemogram (FBC), Fecal Calprotectin (FC), IBD antibodies Endoscopy - sigmoidoscopy and colonoscopy Radiography Biopsy

Question 26

IBD: Crohn's Disease (CD)

Answer 26

IBD that affects any part of the GIT Causes secondary osteoporosis Associated with - arthritis and abnormalities of the joints, eyes, liver and skin

Question 27

CD Treatment: Monotherapy

Answer 27

Prednisolone or Methylprednisolone or IV Hydrocortisone Budesonide - if corticosteroid is contra-indicated Sulfasalazine or Mesalazine - alternative

Question 28

CD Treatment: Add-on

Answer 28

Azathiopurine or Mercaptopurine - added to corticosteroid or Budesonide Methotrexate - alternative if Azathiopurine / Mercaptopurine not tolerated Anti-TNF, IL or JAK inhibitors - specialist

Question 29

CD Treatment: Remission maintenance

Answer 29

Azathiopurine or Mercaptopurine Methotrexate - only for patients who requires this

Question 30

CD Treatment: Remission maintenance after surgery

Answer 30

Azathiopurine + Metronidazole

Question 31

CD Treatment: Others

Answer 31

Loperamide - management of diarrhoea Colestyramine - management of CD associated diarrhoea

Question 32

IBD: Ulcerative Colitis (UC)

Answer 32

IBD that always begin in the rectum Increased risk - bowel cancer, osteoporosis, VTE

Question 33

UC: Acute mild-to-moderate

Answer 33

Topical aminosalicylate Oral aminosalicylate - considered Topical or oral corticosteroid - if aminosalicylate is not suitable

Question 34

UC: Acute moderate-to-severe

Answer 34

JAK inhibitors, Anti-TNF, IL - specialist

Question 35

UC: Acute severe

Answer 35

IV Hydrocortisone or IV Methylprednisolone IV Cyclosporin - if corticosteroids are not tolerated Surgery - considered Infliximab - acute exacerbations

Question 36

UC: Remission maintenance

Answer 36

Aminosalicylate Azathiopurine or Mercaptopurine - considered JAK inhibitors, Anti-TNF, IL - can continue