Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Kirsty - Y3S2 > IPP: Gastrointestinal > Flashcards

IPP: Gastrointestinal Flashcards

1
Q

What is constipation?

A

Constipation is described as a reduced frequency of defecation compared to what is normal for that person usually with the passage of small, hard stools.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What gender is most affected?

What is the relationship between prevelance and age?

A

It is more common in women than men and its prevalence increases with age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk Factors for developing constipation

A

Social

  • Low fibre diet or low calorie intake.
  • Difficult access to toilet, or changes in normal routine or lifestyle.
  • Lack of exercise or reduced mobility.
  • Limited privacy when using the toilet.

Psychological

  • Anxiety and/or depression.
  • Somatization disorders.
  • Eating disorders.
  • History of sexual abuse.

Physi​cal

  • Female sex.
  • Older age.
  • Pyrexia, dehydration, immobility.
  • Sitting position on a toilet seat compared with the squatting position for defecation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diagnosis/ symptoms

A
  • Reduced defication - typically less than 3 bowl movements a week
  • Excessive straining
  • Lower abdominal pain, discomfort, distnetion, bloating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Assessment of constipation

A
  • Ask Red flag symptoms
  • Duration of constipation and frequency and consistancy of stools (bristol stool chart)
  • Associated symptoms
  • Family history
  • Self-meausres and drugs tried
  • Risk factors

https://cks.nice.org.uk/topics/constipation/diagnosis/assessment/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What lifestyle changes can be made to manage constipation?

A

Changes to diet and lifestyles can help manage constipation:

  • Healthy balanced diet with regular meals
  • Diet with whole grain, veg and fruit high in sorbital e.g. grapes, apples, pears
  • Add fibre gradually - aim for 30g/day - to avoid flaculatance and bloating.
    • Advise may take several weeks to notice effects
  • Increase fluid intake (more water and less alcohol)
  • Add wheat bran to diet (e.g. bran flake cereal)
  • Increase activity (e.g. walk or run)
  • Improve toilet routine
    • keep to a regular time, place and allow for adequate time to use
    • Do not delay pooing
    • Elevate feet on low stool while pooing. If possible raise knees above hips.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of constipation?

A
  1. Manage any underlying secondary cause of constipation, and advise the person to reduce or stop any drug treatment that may be causing or contributing to symptoms, if possible and appropriate.
  2. Advise on lifestyle measures, such as increasing dietary fibre, fluid intake, and activity levels.
  3. If these measures are ineffective, or symptoms do not respond adequately, offer treatment with oral laxatives using a stepped approach:
  • Offer a bulk-forming laxative first-line, such as ispaghula. Note: it is important for the person to drink an adequate fluid intake.
  • If stools remain hard or difficult to pass, add or switch to an osmotic laxative, such as a macrogol.
  • If a macrogol is ineffective or not tolerated, offer treatment with lactulose second-line.
  • If stools are soft but difficult to pass, or there is a sensation of inadequate emptying, add a stimulant laxative.

https://cks.nice.org.uk/topics/constipation/management/adults/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to manage constipation when opiod-induced

A

If the person has opioid-induced constipation:

  • Do not prescribe bulk-forming laxatives.
  • Offer an osmotic laxative and a stimulant laxative (or docusate is an alternative which also has stool-softening properties).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to stop laxatives

A
  • Advise the person to gradually reduce and stop laxatives once the person is producing soft, formed stool without straining at least three times per week.
  • Arrange to review the person regularly, depending on clinical judgement.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is diarrhoea?

A

The frequent passing of watery stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the main objective of management of diarrhoea?

A

To prevent suffering from dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are redflag symptoms for diarrhoea?

A

Emergency:

  • vomit blood or have vomit that looks like ground coffee
  • have bright green or yellow vomit
  • might have swallowed something poisonous
  • have a stiff neck and pain when looking at bright lights
  • have a sudden, severe headache or stomach ache

Call 111 if your child:

  • you’re worried about a baby under 12 months
  • your child stops breast or bottle feeding while they’re ill
  • a child under 5 years has signs of dehydration – such as fewer wet nappies
  • you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets
  • you or your child keep being sick and cannot keep fluid down
  • you or your child have bloody diarrhoea or bleeding from the bottom
  • you or your child have diarrhoea for more than 7 days or vomiting for more than 2 day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is:

  • acute
  • persistant
  • Chronic

diarrhoea?

A
  • Acute diarrhoea is defined as lasting less than 14 days.
  • Persistent diarrhoea is defined as lasting more than 14 days.
  • Chronic diarrhoea is defined as lasting for more than 4 weeks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is diarrhoea typically caused by?

A
  • Acute diarrhoea is usually caused by a bacterial or viral infection. Other causes include drugs, anxiety, food allergy, and acute appendicitis.
  • Causes of chronic diarrhoea include irritable bowel syndrome, diet, inflammatory bowel disease, coeliac disease, and bowel cancer.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is important information to obtain when performing an assessment for diarrohea?

A

Assessment for acute and chronic diarrhoea should include:

  • Determining onset, duration, frequency, and severity of symptoms.
  • Identifying red flag symptoms.
  • Ascertaining the underlying cause.
  • Looking for complications, such as dehydration.

Acute diarrhoea should be investigated with a stool specimen for routine microbiology investigation under certain circumstances, including if:

  • The person is systemically unwell; needs hospital admission and/or antibiotics.
  • There is blood or pus in the stool.
  • The person is immunocompromised.
  • The person has recently received antibiotics, a proton pump inhibitor (PPI) or been in hospital (specific testing for Clostridium difficile should also be requested).
  • Diarrhoea occurs after foreign travel (tests for ova, cysts, and parasites should also be requested).
  • Amoebae, Giardia, or cryptosporidium are suspected, particularly if diarrhoea is persistent (14 days or more) or the person has travelled to an at-risk area.
  • There is a need to exclude infectious diarrhoea.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diarrhoea - AB associated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lifestyle treatment for diarrhoea?

Pharmacists can offer?

A

Lifestyle Treatment:

  • Drink plenty of fluids
    • Pee should be clear or light yellow
  • Continue with normal diet when feel able to
  • If temperature rises above 38 take painkiller e.g. paracetamol

A pharmacist may offer:

  • oral rehydration sachets you mix with water to make a drink
  • medicine to stop diarrhoea for a few hours (like loperamide) – not suitable for children under 12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is irritable bowl syndrome

A

BS is a chronic non-inflammatory bowel condition where there is recurrent abdominal pain associated with a change in bowel habit with no underlying structural abnormalty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptoms of IBS

A
  • Bloating
  • Abdominal pain (relived on defication)
  • Altered bowl habbit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management

A

Initial management of a person with IBS should include:

  • Providing advice and reassurance about the diagnosis, and offering sources of information and support.
  • Managing any associated stress, anxiety, and/or depression appropriately.
  • Advising the person to eat regular meals with a healthy, balanced diet, and to adjust their fibre intake according to symptoms.
  • Considering a trial of over-the-counter probiotic supplements for at least four weeks, if there are predominant symptoms of diarrhoea and/or bloating.
  • Trying soluble fibre supplements or foods high in soluble fibre if there are predominant symptoms of constipation.
  • Drinking an adequate fluid intake.
  • Encouraging regular physical activity.

If symptoms persist despite initial dietary and lifestyle advice, further management options include a trial of:

  • A bulk-forming laxative for constipation symptoms, with additional laxatives if needed.
  • Linaclotide for refractory constipation symptoms.
  • Loperamide for diarrhoea symptoms.
  • An antispasmodic drug for abdominal pain or spasm.
  • A low-dose tricyclic antidepressant (TCA) for refractory abdominal pain.
  • A selective serotonin reuptake inhibitor (SSRI) for refractory abdominal pain, if a TCA is ineffective, contraindicated, or not tolerated.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Red flag symptoms of IBS

A
  • Unexplained weightloss
  • Blood in stools
  • Night-time wakening with gut symptoms
  • sudden changes in symptoms
  • unexplained low iron levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Dietary advise for IBS

A
  • Reduce alcohol intake - 14 units per week
  • Reduce Caffeine (less than 4 cups coffee or 10 coke)
  • Reduce Spicy food
  • Reduce fatty food
  • Reduce lactose intake

http://file:///C:/Users/kirst/Downloads/low-fodmap-diet-factsheet-august-2019%20(2).pdf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is dyspepsia?

What causes it?

A

Dyspepsia is a term that is often used to encompass a range of upper abdominal symptoms arising from FIVE main conditions: non-ulcer dyspepsia (indigestion), reflux (heartburn), gastritis, duodenal ulcers and gastric ulcers. Most patients presenting in a pharmacy will have non-ulcer dyspepsia, reflux or gastritis. It is important to be aware of the alarm symptoms that would indicate the presence of a duodenal or gastric ulcer to ensure that patients are treated appropriately.

24
Q

Dyspepsia Assessment

A

Assessment of a person with unexplained dyspepsia should include:

  • Asking about any alarm symptoms that may suggest a complication or other serious underlying pathology.
  • Asking about lifestyle factors and associated stress, anxiety, or depression.
  • Reviewing the person’s medication, including drugs that can cause or exacerbate dyspepsia, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Considering an alternative diagnosis.
  • Considering arranging a full blood count, to check for anaemia and/or a raised platelet count, which may suggest underlying malignancy.
25
Q

Managment for dyspepsia

A

Initial management of a person with unexplained dyspepsia should include:

  • Offering advice on lifestyle modification.
  • Managing any associated stress, anxiety, or depression.
  • Reducing or stopping any drugs that may cause or exacerbate dyspepsia, if possible and appropriate.
  • If symptoms persist, a full-dose proton pump inhibitor (PPI) should be prescribed for 1 month or testing for Helicobacter pylori infection should be arranged, if the person’s status is not known or uncertain.
    • Ideally, a carbon-13 urea breath test or stool antigen test should be used — ensuring the person has not taken a PPI in the past 2 weeks, or antibiotics in the past 4 weeks.
    • If the person tests positive for H. pylori infection, first-line eradication therapy should be offered.
      • If symptoms persist or recur, the alternative strategy should be offered.

For people with persistent or recurrent symptoms following initial management:

  • Alternative acid suppression therapy with a histamine (H2)-receptor antagonist (H2RA) may be considered.
  • Long-term acid suppression therapy can be considered if symptoms have previously responded.
  • H. pylori re-testing should not be offered routinely but may be considered in some circumstances.
    • If the test is positive, second-line eradication therapy should be offered.
26
Q

What are mouth ulcers?

A

Mouth ulcers are painful sores that appear in the mouth that are normally harmless. They tend to clear up by themselves within a week or two. Mouth ulcers are common and can usually be managed at home, without the requirement to visit the dentist or GP.

27
Q

Causes of ulcers

A

Various factors have been suggested to precipitate aphthous ulcers including:

  • Oral trauma.
  • Anxiety or stress.
  • Certain foods (including chocolate, coffee, peanuts, and gluten-containing products).
  • Stopping smoking.
  • Hormonal changes related to the menstrual cycle.
28
Q

Treatment both lifestyle and pharmacological

A
  • do not eat very spicy, salty or acidic food
  • do not eat rough, crunchy food, such as toast or crisps
  • do not drink very hot or acidic drinks, such as fruit juice
  • do not use chewing gum
  • do not use toothpaste containing sodium lauryl sulphate
  • Management of aphthous ulcers includes:
  • Avoidance of precipitating factors, and,
  • Symptomatic treatment for pain, discomfort, and swelling e.g. a short course of a low potency topical corticosteroid, an antimicrobial mouthwash, or a topical analgesic.
29
Q

What is colic?

A

Colic is excessive crying in an otherwise health baby and usually starts when a baby is a few weeks old and stops at around 4-5 months of age.

30
Q

Causes of Colic?

A

The exact underlying cause of infantile colic is not known, and it may reflect part of the normal distribution of infant crying. Other possible causes include abnormal gastrointestinal motility, changes in intestinal microflora, or psychosocial factors.

31
Q

Symptoms of Colic

A
  • Excessive, inconsolable crying which starts in the first weeks of life and resolves by around 3–4 months of age.
  • Crying which most often occurs in the late afternoon or evening.
  • Drawing its knees up to its abdomen or arching its back when crying.
32
Q

Assessment of colic

A

If infantile colic is suspected, the diagnosis should be made following exclusion of other possible causes of symptoms, and assessment should include history and examination of both the infant and parents/carers, including:

  • Features of the crying episodes.
  • Birth history, weight gain or loss.
  • Red flag symptoms which may suggest a more serious underlying cause.
  • Feeding and sleeping patterns.
  • Parental responses to crying, coping strategies, and support available.
  • Associated insomnia, stress, anxiety, depression, or postnatal depression.
  • Maternal diet if breastfeeding.
  • Signs of organic illness in the infant; possible sources of infant discomfort; weight and serial measurements; developmental stage; and possible signs of child maltreatment.
  • Parental interaction and handling of the infant.
33
Q

Management of Colic

A
  • Reassurance that it is a common problem that should resolve by 6 months of age.
  • Advice on strategies to help soothe the crying infant, such as holding, rocking, or bathing the infant; and ensuring an optimal winding technique is used.
  • Ensuring parents/carers access appropriate support such as friends, family, health visitor or nursery nurse; and rest whenever possible.
  • Encouraging the mother to continue breastfeeding wherever possible.
  • If symptoms are severe or persist after 4 months, an alternative underlying cause for symptoms should be considered.
34
Q

What is oral thrush?

A

Oral candidiasis is most commonly caused by Candida albicans and is a fungal infection

35
Q

Symptoms

A

It can occur in babies and adults. The mouth is generally red with white patches which are difficult to remove. Removal often leads to red patches that bleed.

36
Q

Risk factors of oral candidas?

A

Comorbidities that increase the risk of candidal infections include:

  • Diabetes mellitus
  • severe anaemia
  • immunocompromise (such as due to chemotherapy, radiotherapy, HIV infection, and AIDS)
  • poor dental hygiene
  • local trauma; smoking
  • the use of broad spectrum antibiotics, or inhaled or oral corticosteroids, or cytotoxics
  • malnutrition.
37
Q

Treatment for oral thrush

A

If treating an immunocompetent person, a topical antifungal should be prescribed for 7 days.

  • Miconazole oral gel is recommended first-line for children aged 4 months and over (unlicensed for use in a child aged younger than 4 months, or 5–6 months for an infant born pre-term). Care should be taken when applying the gel to the mouth of infants and young children due to the risk of choking.
  • If miconazole oral gel is unsuitable, nystatin suspension (unlicensed for use in neonates) should be offered.

If topical treatment is ineffective, infection is extensive or severe, or the person is significantly immunocompromised:

  • For people aged 16 years and older, oral fluconazole should be prescribed for 7 days after which response to treatment should be reviewed. If the infection has not completely resolved, consideration should be given to treating with oral fluconazole for a further 7 days (referral should be arranged if the infection persists after this); swabbing to identify the causative organism; seeking specialist advice, or arranging referral to a dermatologist. Clinical judgement should be used, taking into account the severity of infection (there should be a low threshold for early referral if infection is severe), the level of immunocompromise, and the response to treatment.
  • For children younger than 16 years of age, or if fluconazole is contraindicated, specialist advice should be sought.
38
Q

When to refer in oral thrush

A

Referral should also be arranged, or specialist advice sought, if:

  • The person has recurrent episodes of oral candidiasis.
  • The person has breakthrough candidal infection while receiving preventive treatment (which may indicate candidal resistance).
  • There is doubt about the diagnosis.
  • Referral for biopsy should be considered for people with chronic plaque-like candidiasis which is unresponsive to treatment, as it carries a risk of malignancy.
39
Q

What OTC preparation is available for oral thrush in a pharmacy?

What is the treatment course for this preparation?

A

Daktarin Sugar Free 2% Oral gel (Miconazole base)

Apply 2.5mL (1.25mL for under 2’s) 4 times a day after food and continue treatment for a week after symptoms cleared

40
Q

What drugs interact with miconazole?

A

Warfarin and hydrocortisone

41
Q

What is thread worm and who is infected?

A

Threadworm or pinworm (Enterobius vermicularis) is a parasitic worm which infests the human gut.

Threadworms most commonly affect children but can affect whole families. It is an infection that is limited to humans and is not transferable to or from animal

42
Q

How is threadworm transmitted?

A

ransmission occurs by the faeco-oral route when threadworm eggs are ingested.

Eggs can be ingested by hand to mouth transfer (after scratching) from the faeces/perianal area of an infected person or by handling contaminated surfaces such as toys, bedding or clothing.

43
Q

Symptoms of threadworm

A
  • Infestation often presents with intense perianal itching, which is typically worse during the night.
  • Some people may be asymptomatic and only become aware of infection when small white thread-like worms (which may be slowly moving) are seen on the perianal skin or in the stools.
  • In females, the genital area can also be involved and presentation may include pruritus vulvae.
  • Nocturnal itching may lead to disturbed sleep and irritability.
44
Q

Diagnosis of threadworm

A

If the diagnosis is uncertain, the adhesive tape test for eggs may be useful. Transparent tape is applied to the perianal area first thing in the morning and then examined under a microscope to detect threadworm eggs. Stool examination is not generally recommended.

45
Q

Treatment of Threadworm

A

Treatment is recommended if threadworms have been seen or eggs detected. Treatment of all household members at the same time (unless contraindicated) should be considered.

  • For adults and children aged over 6 months, an anthelmintic (mebendazole) combined with hygiene measures is recommended — mebendazole is not licensed for children under the age of 2 years.
  • For children aged 6 months and under, hygiene measures alone for 6 weeks, are recommended.
  • For pregnant or breastfeeding women, the recommended treatment is hygiene measures for 6 weeks. Treatment with mebendazole is contraindicated in the first trimester of pregnancy and the manufacturer recommends avoidance throughout pregnancy and breastfeeding.
46
Q

How to deal with reinfestation of threadworm

A

If infestation recurs this is usually due to re-infection and not failure of anti-helmintic therapy:

  • Other causes of symptoms should be considered.
  • If the diagnosis is certain, re-treatment of the person and household contacts with mebendazole is recommended (unless contraindicated).
  • The importance of strict hygiene measures should be reinforced.
  • If the person has frequent recurrences advice should be sought from a paediatrician or consultant in infectious diseases.
47
Q

What are haemorrhoids

A

Haemorrhoids (also known as piles) is a condition caused by the enlargement of normal structures that are present in the upper anal canal and lower rectum.

48
Q

Factors that contribute to the development of haemorrhoids include?

A

Factors that contribute to the development of haemorrhoids include:

  • Constipation.
  • Straining while trying to pass stools.
  • Ageing.
  • Heavy lifting.
  • Chronic cough.
  • Conditions that cause raised intra-abdominal pressure (such as pregnancy and childbirth).
49
Q

Complications of harmmorhoids

A

Complications of haemorrhoids include ulceration; skin tags; maceration of the perianal skin; ischaemia, thrombosis, or gangrene; and rarely, perianal sepsis and anaemia from bleeding.

50
Q

Diagnosis of haemorrhoids and symptoms

A
  • A thorough history and physical examination is important to confirm the diagnosis of haemorrhoids and to exclude serious underlying pathology (such as colorectal cancer).
  • Bright red, painless rectal bleeding is the most common symptom. It typically occurs with defecation and is seen as streaks on the toilet paper, in the toilet bowl, and/or outside of the stool (but not mixed with it).
  • Other possible symptoms include anal itching or irritation; a feeling of rectal fullness, discomfort, or of incomplete evacuation on bowel movements; soiling; and anal pain (with prolapsed, strangulated internal haemorrhoids, or thrombosed external haemorrhoids).
51
Q

Management of Haemorrhoids

A

Management includes:

  • Ensuring stools are soft and easy to pass.
  • Prescribing laxative treatment if the person is constipated.
  • Giving lifestyle advice to aid healing of the haemorrhoid, such as minimizing straining and maintaining good anal hygiene.
  • Offering symptomatic relief with simple analgesia and/or topical haemorrhoidal preparations.

Seconary treatment can be surgical or non-surgical

52
Q

What is motion sickness caused by

A

Caused when the brain gets conflicting signals from ears, eyes and other scenasory signals

53
Q

Motion sickness non-pharmacological management

A
  • reduce motion – sit in the front of a car or in the middle of a boat
  • look straight ahead at a fixed point, such as the horizon
  • breathe fresh air if possible – for example, by opening a car window
  • close your eyes and breathe slowly while focusing on your breathing
  • distract children by talking, listening to music or singing songs
  • break up long journeys to get some fresh air, drink water or take a walk
  • try ginger, which you can take as a tablet, biscuit or tea
  • do not read, watch films or use electronic devices
  • do not look at moving objects, such as passing cars or rolling waves
  • do not eat heavy meals, spicy foods or drink alcohol shortly before or during travel
  • do not go on fairground rides if they make you feel unwell
54
Q

Treatment for motion sickness available OTC

A
  • Tablets - Kwells, Joyride
  • Ginger tablets
  • Acupressure bands
  • Patches
55
Q
A

Kirsty - Y3S2 (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions