GI system Flashcards
(126 cards)
1
Q
list 4 examples of chronic bowel disorders
A
coeliac disease
diverticular disease and diverticulitis
inflammatory bowel disease
short bowel syndrome
2
Q
what are the 3 most common symptoms in bowel disorders?
A
ADR
abdominal pain
diarrhoea
rectal bleeding
3
Q
what is coeliac disease?
A
autoimmune disease causes inflammation of small intestines triggered by gluten. can cause malabsorption of nutrients
4
Q
what are the 4 symptoms of coeliac disease?
A
ABCD abdominal pain bloating constipation diarrhoea
5
Q
what could be a complication of malabsorption of nutrients from coeliac disease?
A
osteoporosis / bone disease
6
Q
what are the different drug treatment options for coeliac disease?
A
- vitamin supplements eg vit C, D and folic acid
- osteoporosis/bone treatment
- prednisolone [as initial treatment]
7
Q
what is diverticular disease?
what is the prevalence for this disease?
A
diverticular [bulges] develop on small intestine
over 40 year olds
8
Q
what are the symptoms of diverticular disease? [4]
A
abdominal pain, constipation, diarrhoea, rectal bleeding
9
Q
what is the non-drug treatment for diverticular disease?
what is the drug treatment for diverticular disease?
A
non drug: lifestyle exercise, stop smoking, weight loss, healthy eating
drug: paracetamol, anti-spasmodics for abdominal cramps, bulk forming laxatives
10
Q
what is diverticulitis?
what symptoms are associated with this disease
A
- diverticula that forms becomes inflamed/ infected
- severe abdominal pains, fistula [hole], fever, malaise, rectal bleeding
11
Q
what is the drug treatment options of diverticulitis?
A
high fibre diet bran supplements bulk forming laxative paracetamol antibiotics antispasmodics
12
Q
what 2 conditions come under the umbrella term if inflammatory bowel disease?
A
crohns disease and ulcerative colitis
13
Q
what is the difference between crohns disease and ulcerative colitis?
A
crohns disease: affects whole intestinal system from mouth to anus
ulcerative colitis: affects colon only [large intestine]
14
Q
what age group is mostly affected by ulcerative colitis?
A
15 - 25 years
15
Q
what are the symptoms of inflammatory bowel diseases?
A
abdominal pain rectal bleeding diarrhoea fever weight loss anal fissure ulcers anaemia mouth ulcers
16
Q
what are some other less common symptoms of inflammatory bowel diseases? [3]
A
skin rash
inflammation/painful joints
liver inflammation
17
Q
what are the complications of crohns disease? [4]
A
fistula [hole]
perforation
stricture [narrowing of GI tract]
cancer
18
Q
what are the non drug treatment of crohns? [3]
A
stress management
diet
stop smoking
19
Q
what are some drugs that can be used to treat inflammatory bowel disease? [5]
A
- antibiotics
- aminosalicylates [eg mesalazine, sulphasalazine]
- steroids eg prednisolone
- immunosuppressants: eg methotrexate, azathioprine, mercaptopurine
- biological therapy monoclonal antibodies: infliximab
20
Q
the following question is related to mild to moderate ulcerative colitis:
what is the 1st line, 2nd line and then 3rd line treatment of proctitis? [rectal inflammation]
A
1st line: topical aminosalycilate
2nd line: after no improvement after 4 weeks then add oral aminosalycilate
3rd: if no improvement add oral or topical corticosteroid for 4-8 weeks
21
Q
the following question is related to mild to moderate ulcerative colitis:
what is the 1st line and 2nd line treatment for proctosigmoiditis and left sided ulcerative colitis?
A
1st line: topical aminosaliylate
2nd line: if no improvement after 4 weeks then add high dose oral aminosalicylate
22
Q
the following question is related to mild to moderate ulcerative colitis:
what is the 1st line treatment of extensive ulcerative colitis?
A
1st line: topical aminosalycilate and high dose oral aminosalycilate
23
Q
what is the treatment for acute severe life threatening ulcerative colitis?
A
iv corticosteroids [eg methylprednisolone/hydrocortisone] and infliximab
24
Q
what can be used to maintain remission in mild, moderate or severe ulcerative colitis?
what must be avoided?
A
aminosalicylates
avoid corticosteroids
25
which 2 drugs are used when remission is not being maintained with aminosalicylates or when there has been 2 or more exacerbations in a 12 month period that required treatment with corticosteroids?
azathioprine or mercaptopurine [unlicensed]
26
give an example of older aminosalycilates and a side effect associated with them?
sulfasalazine
stains contact lenses
27
give examples of newer aminosalycilates
mesalazine , balsalazide, olsalazine
28
what is the patient and carer advice for aminosalycilates?
report any bone marrow suppression / blood disorder signs and symptoms eg sore throat, bruising, bleeding
29
what must you monitor with aminosalycilates?
renal function before starting treatment, at 3 months and then annually
30
what are the side effects associated with amino salicylates [2]
what side effects are associated with sulfasalazine? [2]
- nephrotoxicity and salicylate hypersensitivity
| - yellow/orange body fluids and soft contact lenses stained
31
what is irritable bowel disease?
| who does it mostly affect?
long term chronic condition of bowel
women. 20-30 year olds
32
what are the symptoms of irritable bowel disease?
abdominal pain
either constipation or diarrhoea
bloating
33
what is the non drug treatment of irritable bowel syndrome?
- increase soluble fibre
- diet lifestyle exercise
- increase water intake
- reduce alcohol , caffeine, fizzy drinks
34
what kinds of drugs may be used for irritable bowel disease?
antispasmodics, antimuscarinics [eg mebeverine, hyoscine]
loperamide [diarrhoea]
peppermint oil [bloating]
anti depressants and SSRIs [amitriptyline and fluoxetine] unlicensed but for those who do not respond to laxatives]
35
what are the causes of constipation? [5]
```
pregnant
medications [eg codeine, opioids]
medical conditions eg IBS
little fluid intake
little fibre intake
```
36
what are the red flag symptoms of constipation? [5]
```
50 years and over
anaemia
blood in stools
weight loss
abdominal pain
```
37
what are the different types of laxatives for constipation use?
```
boss
bulk forming
osmotic
stimulant
softeners
```
38
what are some examples of bulk forming laxatives?
bran, isphagula husk, methylcellulose
39
what is the mechanism of action of bulk forming laxatives?
| what is the onset of action?
increases bulk in stool
| up to 72 hours
40
what are some symptoms that bulk forming laxatives can cause?
bloating, cramping, flatulence
41
what are some examples of stimulant laxatives?
| what is the mechanism of action of them?
- senna, sodium picosulfate, glycerol, bisacodyl, co-danthramer
increases intestinal motility
42
which stimulant laxative is reserved for terminally ill patients and why?
co-danthramer
| carcinogenic and colours urine red
43
what is the onset of action of stimulant laxatives?
| is this different with suppositories?
8-12 hours
| suppositories take 20-30 mins
44
when are stimulant laxatives recommended to be taken during the day?
at bed time
45
what are the side effects of stimulant laxatives?
abdomina pain
46
what is the MHRA warning of stimulant laxatives?
| what are the new restrictions associated with this warning?
misuse and abuse causing hypokalaemia
dietary and other laxatives 1st line before stimulant laxatives, children under 12 unable to buy otc, pack size limited to 2 short term courses
47
give an example of faecal softeners
| what is their mechanism of action?
liquid paraffin, docusate sodium, peanut [arachis]
| wets and softens the stools, increases penetration of liquid into stool
48
what are some examples of osmotic laxatives?
| what is the mechanism of action?
lactulose and macrogols
| either maintains or increases fluid in bowel
49
why is lactulose [osmotic] unsuitable for immediate relief of constipation?
takes up to 2 days to work
50
what is the management of short duration constipation, constipation in pregnancy and chronic constipation?
spc is BOS
| bulk forming first, then can either add or switch to osmotic laxatives then use stimulant if no improvement
51
what is the management of opioid induced constipation, constipation with faecal impaction, constipation in children?
focos children
OS- osmotic and stimulant first line
52
what can be used to treat opioid induced constipation in patients that have shown no response to laxatives?
naloxegol and methylnaltrexone
53
what class of laxatives is fybogel and laxido?
fybogel: isphagula husk bulk forming
| laxido - osmotic
54
what are the 2 types of diarrhoea?
acute: lasting less than 14 days and symptoms improve after 2-4 days
chronic: more than 14 days
55
what are the causes of diarrhoea? [4]
gastroenteritis [inflammation of stomach/intestines]
drug side effects
GI disorders
infection
56
what is the aims of treatment for diarrhoea?
prevent dehydration and loss of electrolytes/nutrients
57
what are the signs of dehydration?
```
tiredness
headache
light headache
muscle cramps
sunken eyes
dry mouth
weakness
reduced urine
confusion
```
58
what are the red flags of diarrhoea?
- recent hospital/antibiotic treatment
- weight loss
- persistant diarrhoea
- rectal bleeding
- systemic illness
- recent foreign travel
59
what is the non drug and drug treatment of diarrhoea?
drink lots of fluid and eat as normal
loperamide and oral rehydration sachets
60
what can you use as occasional prophylaxis for travellers diarrhoea?
ciprofloxacin
61
what is dyspepsia?
range of upper GI symptoms that can last for 4 or more weeks
62
what are the symptoms of dyspepsia?
```
upper abdominal pain
fullness
early satiety
bloating
nausea
```
63
what are the red flags of dyspepsia?
```
bleeding
difficulty swallowing [dysphagia]
weight loss
55 years or over
recurrent vomiting
```
64
what are the lifestyle advice for dyspepsia?
raise head of bed bc of heartburn
stop medication that causes dyspepsia
alcohol, smoking, lifestyle diet etc
65
what is the treatment options for dyspepsia?
life style
antacids
PPI up to 4 weeks
test for h.pylori
66
what is GORD and what are the symptoms?
gastro oesophageal reflux disease
heart burn
acid regurgitation
dysphagia
ulceration
67
what are the treatment options for gord?
PPI
alginates
h2 receptor antagonists
antacids
68
what is the management of gord in pregnancy?
diet and lifestyle changes first
then antacids and alginates
then ranitidine
then omeprazole
69
what is the management of GORD in infants and older children?
treat older children like adults
| infants: change frequency and volume of feed and use feed thickener
70
what is a side effect of aluminium [antacids]
| and magnesium?
aluminium - constipating
| magnesium - laxative
71
when during the day is it advised to take antacids?
after meals and at bedtime
72
why must you not take antacids together with modified release medication?
because it can damage the enteric coating of some modified release preparations
73
which types of patients is sodium bicarbonate antacid not suitable for?
has high sodium content so not suitable for people with high BP, ppl on lithium and on salt restriction diets
74
why can you not take antacids together with medication eg tetracyclines?
affect absorption, take antacids 1/2 hr before or after other medication
75
name the 4 different antacids?
```
scam
sodium bicarbonate
calcium carbonate
aluminium hydroxide
magnesium hydroxide
```
76
list some examples of proton pump inhibitors?
omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole
77
list some indications of proton pump inhibitors?
```
gastric and duodenal ulcers
GORD
dyspepsia
nsaid associated ulcers
h.pylori
zollinger ellison syndrome
```
78
what are the 3 P's of PPIs
porous bones - osteoporosis/bone fracture
possible gi infections - c.diff
prevents holes - ulcers
79
what are the cautions of PPIs?
osteoporosis/bone fracture risk
gi infections risk increased
masks symptoms of gastric cancer
lupus risk [low risk]
80
what is the MHRA advice with PPIs?
low risk of lupus [SCLE] when skin exposed to sun - lesions appear on skin
advice pt to not expose skin to sun
81
which is the only PPI safe in pregnancy?
omeprazole
82
what are the 2 important interactions with PPIs and explain them
methotrexate - omeprazole decreases clearance of methotrexate
clopidogrel - omeprazole decreases efficacy
83
what drugs are used in triple therapy of H.pylori?
ppi
clarithromycin
amoxicillin/metronidazole
84
what is the triple therapy treatment choice of H.pylori for a patient who is allergic to penicillin?
metronidazole, ppi, clarithromycin
PCM
85
what is the triple therapy treatment choice for h.pylori for a patient who is not allergic to penicillin?
amoxcillin or metronidazole
clarithromycin
ppi
pac or pam
86
for each PPI below, write down the doses for h.pylori eradication
```
omeprazoe
lansoprazole
esomperazole
pantoprazole
rabeprazole
```
omeprazole: 20-40mg twice daily
lansoprazole: 30mg twice daily
esomeprazole: 20mg twice daily
pantoprazole: 40mg twice daily
rabeprazole: 20mg twice daily
87
what are some diagnostic tests used to diagnose H.pylori?
urea 13c breath test
stool helicobacter antigen test
lab based serology
88
what are the 3 public health england advice for preventing false negatives with H.pylori?
- do not test 4 weeks after antibiotic treatment
- do not test 2 weeks after ppi treatment
- retesting for h.pylori should be performed 4 weeks after treatment
89
what are gastroprotective complexes and chelators?
| what are they used for?
complex of aluminium and sucrose eg sucralfate
used to protect mucosa from acid pepsin attack in gastric ulcers
90
what is a caution of chelators?
in intensive care pt can cause bezoar formation [solid indigestible mass]
91
when during the day must you give chelators?
1 hour BEFORE meals and at bedtime
92
list some examples of h2 receptor antagonists
| which one is the safest in pregnancy?
ranitidine, cimetidine, famotidine
ranitidine
93
which h2 receptor antagonist is an enzyme inhibitor and interacts with many drugs?
cimetidine
94
what is a caution of h2 receptor antagonist?
masks symptoms of gastric ulcers
95
what are the common side effects of h2 receptor antagonists?
diarrhoea, constipation, fatigue, headache, dizziness
96
what is misoprostol used for?
healing of gastric and duodenal ulcers
| termination of pregnancy
97
what is the conception and contraception advice for misoprostol?
avoid in child bearing potential women unless pregnancy has been excluded
wear effective contraception
98
what is the management of food allergies>
avoid the triggering food
| sodium cromoglicate
99
what drug can be used for symptomatic control of food allergy?
chlorphenamine maleate
100
what drug is used for food induced anaphylaxis?
adrenaline
101
what are some side effects of anti-muscarinic drugs?
cant see - blurred vision
cant pee - urinary retention
cant shit - constipation
cant spit - dry mouth
102
what BMI is classed as obesity?
over 30
103
in which patients is anti-obesity medication allowed in?
- pt with bmi over 28 and risk factors
| - pt with bmi over 30 who have had no results after 3 months of diet, exercise
104
which drug is the only licensed drug in the uk for weight loss?
what is the dose?
orlistat
| 120mg up to 3 times a day
105
when can you continue treatment in a patient with orlistat?
if after 3 months, weight loss exceeds 5%
106
what bmi is bariatric surgery considered in?
bmi over 40
bmi over 35-39.9 with risk factors eg diabetes
107
/what are the symptoms of anal fissure
bleeding
linear tear in anal mucosa
pain on defecating
108
what is the drug treatment for ACUTE anal fissure [lasts less than 6 weeks]
bulk forming laxatives [or osmotic]
topical anaesthetics eg lidocaine
simple analgesics
109
what is the drug treatment for chronic anal fissure [lasts more than 6 weeks]?
glyceryl trinitrate rectal ointment
| oral/topical diltiazem or nifedipine
110
what is haemorrhoids and what are the 2 types?
abnormal swelling around anus
internal: painless
external: painful or itchy
111
what kinds of ppl is haemorrhoids common in?
pregnant women
112
what is the non drug treatment of haemorrhoids?
dietary fibre
increase fluid intake
good anal hygiene
113
what is the treatment of haemorrhoids in pregnant women?
| what drugs must you avoid?
bulk forming laxatives. topical haemorrhoidal preparations
| avoid corticosteroids and anaesthetics
114
what is the drug treatment for haemorrhoids?
bulk forming laxative for constipation
simple analgesia
topical anaesthetic cream, corticosteroids, astringents
115
how many days are topical corticosteroids allowed to be used for for haemorrhoids?
7 days
116
what is exocrine pancreatic insufficiency?
reduced secretion of pancreatic enzymes into duodenum
117
what are the symptoms of exocrine pancreatic insufficiency?
diarrhoea
abdominal cramps
fat in stool
maldigestion and malnutrition
118
what is the drug treatment of exocrine pancreatic insufficiency?
pancreatic enzyme replacement therapy with pancreatin eg creon
119
what is a stoma?
| what are the 2 main types of stoma?
an artificial opening on the abdomen to divert the flow of urine and faeces into external pouch
colostomy and ileostomy
120
what types of formulation of medication are not allowed in patients with stoma?
enteric coated or modified release
soluble tablets
liquids , capsules and uncoated tablets
121
what ingredient in medicines is not allowed in people with stoma and why
sorbitol due to laxative effects
122
what analgesics is the only one allowed in patients with stoma?
paracetamol
123
what is the risk of alginates in people with stoma?
diarrhoea with magnesium and constipation with aluminium increased
124
what is the risk of using digoxin in patients with stoma?
hypokalaemia risk
125
why should you use diuretics with caution in patients with a stoma? which type of diuretic is best?
risk of potassium depletion
| use potassium sparing diuretics
126
which route of administration for iron is preferred in patients with a stoma?
im route.
oral route causes loose stools and sore skin
