IBD

Question 1

Acute diarrhoea is not infectious. True or false?

Answer 1

False - usually infectious

Question 2

Acute diarrhoea is usually self-limiting in 3 days. True or false?

Answer 2

True

Question 3

How does loperamide work?

Answer 3

Increases salt and water reabsorption by decreasing motility of gut longitudinal and circular muscles

Question 4

Loperamide is an OTC medicine that can be given to children. True or false?

Answer 4

False - OTC not for children

Question 5

Loperamide is a synthetic opioid but has no opiate activity at therapeutic doses. True or false?

Answer 5

True

Question 6

If symptoms of overdose of loperamide occur, what drug is given?

Answer 6

Naloxone

Question 7

Other than loperamide and oral rehydration therapy, what is available for treatment of diarrhoea?

Answer 7

Antispasmodics

Question 8

Loperamide and antispasmodics can be used for treatment of acute diarrhoea in young children. True or false?

Answer 8

False - neither can be used in young children

Question 9

Acute diarrhoea that is infectious is caused by a virus. True or false?

Answer 9

True - e.g. norovirus, rotavirus

Question 10

Traveller’s diarrhoea is usually caused by a virus. True or false?

Answer 10

False - usually by a bacteria e.g. E.coli, 10% of cases are viral

Question 11

What drug is used adjunct to oral rehydration therapy in children aged 3 months and over?

Answer 11

Racecadotril

Question 12

What does racecadotril do?

Answer 12

It is an enkephalinase inhibitor
It reduces hypersecretion of water and electrolytes into the intestinal lumen
Given orally

Question 13

The rotavirus is a live vaccine given IV. True or false?

Answer 13

False - given orally

Question 14

The rotavirus vaccine should be started in children over 15 weeks old, given in two divided doses. True or false?

Answer 14

False - should not be started in children over 15 weeks

Question 15

What is the recommended schedule for rotavirus vaccine?

Answer 15

The first dose at 2 months of age (must be given between 6 weeks-15 weeks)
The second dose 3 months of age

Question 16

What are the warning signs of diarrhoea for referral?

Answer 16

Symptoms for more than one week
Babies/young children
Signs of dehydration
Diarrhoea accompanied by fever
Stools are bloody or black
Severe abdominal or rectal pain

Question 17

What causes pseudomembranous colitis?

Answer 17

Overgrowth of C.diff and release of toxin

Question 18

How is pseudomembranous colitis managed?

Answer 18

Stop antibiotics
Fluid and electrolyte replacement
Isolation strategies, environmental control and hand hygeine

Question 19

How is C.diff treated?

Answer 19

Metronidazole or oral vancomycin

Question 20

Alcohol gel kills C.diff spores. True or false?

Answer 20

False

Question 21

Which drug classes should be avoided in the management of C.diff?

Answer 21

Quinolones
Cephalosporins
Clindamycin

Question 22

What area does ulcerative colitis involve?

Answer 22

The mucosa of the rectum and colon

Question 23

Which areas does Crohn’s disease effect?

Answer 23

Whole GIT from mouth to anus

Question 24

What surgical procedure provides total cure of ulcerative colitis?

Answer 24

Total colectomy

Question 25

Surgery for Crohn's disease is curative. True or false?

Answer 25

False

Question 26

What is the general management of acute mild to moderate IBD?

Answer 26

Local application of corticosteroid or aminosalicylate

Question 27

How is diffuse inflammatory disease not responding to local therapy managed?

Answer 27

Oral treatment with aminosalicylate or corticosteroid

Question 28

How is sever inflammatory bowel disease managed?

Answer 28

Admission to hospital, IV corticosteroids and other immunsuppressive agents

Question 29

What are the monitoring parameters for IBD?

Answer 29

``` Faecal calprotein Stool frequency Presence of blood and/or mucous in the stool Temperature CRP U&Es ```

Question 30

Name 3 aminosalicylates that are only licensed for use in UC

Answer 30

Mesalazine Balsalazide Olsalazine

Question 31

What causes side effects in sulphasalazine?

Answer 31

Sulphapyridine - carrier molecule - this is not present with new analogues of aminosalicylates

Question 32

What actions are taken if there is acute relapse of UC or Crohn's?

Answer 32

Bed rest Low residue diet Monitoring Corticosteroids - hydrocortisone IV or methylprednisolone

Question 33

When are immunosuppressive agents used?

Answer 33

In patients where the disease is not responding to oral corticosteroids

Question 34

Immunosuppressants work immediately. True or false?

Answer 34

False - may take 1 or 2 months to be effective

Question 35

Name the immunosuppressants that are used for patients who do not respond to oral corticosteroids

Answer 35

Azathioprine 6-mercaptopurine Once weekly methotrexate Ciclosporin - UC only

Question 36

Which monoclonal antibodies are used in IBD and why?

Answer 36

``` Infliximab Adalimumab Golimumab Vedolizumab Used as they have a high afftinity to alpha-TNF and so inhibit its activity ```

Question 37

What is the dietary advice for someone who is constipated?

Answer 37

Increase fluid intake 2L/day and increase fibre

Question 38

Name the 6 causes of constipation

Answer 38

``` Lifestyle Diet and fluid Mechanical - tumours, strictures etc. Systemic affecting motility - pregnancy, hypercalcaemia Neurological - paralysis Drugs - opiates, diuretics, CCBs ```

Question 39

Type 1 and 2 of the bristol stool chart indicate diarrhoea. True or false?

Answer 39

False - indicate constipation

Question 40

What are the treatment options for constipation?

Answer 40

Bulking agents e.g. dietary fibre, isphaghula, methyl cellulose Stimulants e.g. senna, bisacodyl

Question 41

How do bulking agents work in relieving constipation?

Answer 41

They increase faecal mass and so stimulate peristalsis

Question 42

Laxatives should be offered to any patients starting on opiates. What are some other reasons for use of laxatives?

Answer 42

``` Post MI - to prevent strain Expulsion of parasites after anthelmintic treatment Prior to surgery Prior to certain X-ray procedures In liver failure ```

Question 43

How do stimulants relieve constipation?

Answer 43

Increase intestinal motility - but should be avoided in intestinal obstruction

Question 44

How do osmotic agents relieve constipation?

Answer 44

Increase the amount of water in the large bowel, either by drawing fluid from the body into the bowel or by retaining the fluid they were administered with

Question 45

Glycerol is a softening agent that is used orally to relieve constipation. True or false?

Answer 45

False - for rectal use only

Question 46

Name a stimulant that is used for treatment of constipation

Answer 46

Senna

Question 47

Name an osmotic agent that is used to treat constipation

Answer 47

Lactulose

Question 48

Name a softening agent used to treat constipation

Answer 48

Glycerol Docusate Liquid paraffin