GIT Flashcards
(85 cards)
Chronic management of anal fissures
- > 6 weeks: GTN rectal ointment
- Topical/oral diltiazem or nifedipine
- Specialist: bolutilinum toxin type A
Surgery if no drug response.
Acute management of anal fissures
Aim to ensure stools pass easily and help with pain:
* Bulk-forming or osmotic laxatives
* Short term topical treatment with local anaesthetic (lidocaine) or analgesic.
Common side effect of rectal GTN
Headache
What are haemorrhoids?
Swellings of the vascular mucosal anal cushions around the anus. Can be internal (painless) or external (itchy or painful).
Management of haemorrhoids
- Maintain easy stools to minimise strainingg: increased fibre, fluid and / or bulk-forming laxative.
- Oral analgesia - paracetamol ONLY (opioids cause constipation, NSAIDs can exacerbate rectal bleeding).
- Topical preparations containing anaesthetics (a few days lidocaine), corticosteroids ( max 7 days), lubricant, antiseptics).
Management of haemorrhoids in pregnancy
Very common in pregnancy.
* Bulk forming laxatives.
No topical preparations, only a simple soothing preparation if needed.
What is coeliac disease?
An autoimmune disease triggered by gluten whch causes an immune response of the intestinal mucosa of the small intestine, leading to malabsorption.
Management of coeliac disease
- Gluten free diet
- Manage symptoms such as diarrhoea, bloating, and abdominal pain with loperamide, simeticone etc.
- Avoid malnutrition with supplements (under supervision)
Long term complications of osteoporosis
Malnutrition
Osteoporosis
Cancer
What is the difference between diverticulosis, diverticular disease, acute diverticulitis, and complicated diverticulitis?
Essentially worsening levels of diverticula development on GIT
* Diverticulosis: development of small pouches on GIT but asymptomatic.
* Diverticular disease: small pouches on GIT leading to abominal pain, constipation, diarrhoea, and/or rectal bleeding.
* Acute diverticulitis: pouches become inflamed or infected causing severe abdominal pain, fever, significant rectal bleeding.
* Complicated acute diverticulitis: abscess, perforation, fistula, obstruction, sepsis, haemorrhage.
How are diverticular disease and diverticulosis managed?
Fibre
Bulk forming laxatives
Paracetamol
What is Crohn’s disease?
Inflammed GIT with thickened wall, extending through all layers, with deep ulceration.
Can affect entire GIT from mouth to rectum, usually in patchy areas.
Complications of Crohn’s
- Intestinal strictures or fistulae
- Anaemia and malnutrition
- Colorectal and small bowel cancers
- Growth failure and delayed puberty in children
- Extra-intestinal manifestation such as arthritis of joints, and abnormalities of eyes, liver and skin.
Treatment of Crohn’s flare:
1st flare in 12 months:
* Monotherapy with prednisolone, methylprednisolone, or IV hydrocortisone.
* If distal ileal, ileocaecal, or roght sided disease: 2nd line is budesonide.
* Aminosalicylates (e.g., sulfasalazine, mesalazine) may be used but don’t tend to be as effective.
2+ flares in 12 months:
As above plus:
- azathiopurine or mercaptopurine
- Methotrexate (if aza/mer contraindicated)
- Monoclonal antibodies if severe
Maintenance treatment of Crohn’s
- Monotherapy of azathioprine or mercapotopurine
- Methotrexate in induction or cannot tolerate above.
- Severe: surgery followed by azathoprine +/- metronidazole
Plus:
* smoking cessation ( smoking can worsen symptoms)
* Diarrhoea relief: loperamide, codeine, colestyramine.
What is fistulating Crohn’s disease?
When a fistula develops between the intestine and perianal skin, bladder, and vaginal.
Management of fistulating Crohn’s
- If asymptomatic N/A
- Symptomatic: metronidazole +/- ciprofloxacin for 1 month to ease symptoms (max 3 months due to peripheral neuropathy).
- Maintenance: for at least 1 year. 1st: Azathioprine or mercaptopurine. 2nd: Infliximab.
What is ulcerative colitis?
Inflammation of the colon down to the rectum. Associated with bloody diarrhoea, defecation urgency, or abdominal pain.
Complications of UC
- Colorectal cancer
- Secondary osteoporosis
- VTE
- Toxic megacolon
Most common ages for UC
15-25
What are the 5 types of UC?
- Proctitis - anus and rectum only.
- Proctosigmoiditis - upto sigmoid colon and bit of descending colon
- Distal/Left sided - upto descending colon
- Extensive colitis - upto transverse colon
- Pancolitis - entire colon upto ascending colon
Treatment of mild-moderate acute UC
Proctitis:
1. Topical (enema/suppository) aminosalicylate
2. + oral aminosalicylate if no improvement after 4 weeks ( or 1st line if pt choice)
3. + topical or po corticosteroid after 4-8 weeks.
Procotosigmoiditis and distal:
1. Topical aminosalicylate
2. + high dose oral aminosalicylate after 4 weeks
3. Switch to high dose oral aminosalicylate + 4-8 weeks of topical steroids.
Transverse + extensive:
1. Topical aminosalicylate + high dose oral aminosalicylate
2. No improvement in 4 weeks: Switch to high dose oral aminosalicylate + 4-8 weeks of topical steroids.
DO NOT give loperamide or codeine for diarrhoea relief - can cause toxic megacolon and should only be used by a specialist.
Treatment of severe acute UC
Life threatening medical emergency.
On admission to hospital:
* IV hydrocortisone or methylprednisolone
* Steroids CI: IV ciclosporin or surgery
No improvement in 72h:
* IV steroid + IV ciclosporin (infliximab if ciclosporin CI)
* Surgery
Maintenance treatment of UC
Proctitis & proctosigmoiditis: rectal +/- oral aminosalicylates
Left-sided or extensive: oral aminosalicylates
2+ annual flares: oral azathioprine or mercaptopurine.
