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Yr 3 Inflammatory and GI > Lower GI > Flashcards

Lower GI Flashcards

1
Q

What causes food to move from SI to caecum, colon and then into rectum?

A

Peristalsis

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2
Q

What do bacteria in large intestine produce

A

Vit. K and biotin (vit B7)

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3
Q

What is constipation

A

difficulty in opening bowel
going less than 3 times a weeks
straining more than 25% shits
Hard or pellet stools

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4
Q

What dietary factors can cause constipation

A

Low fibre
high fats
Alcohol
Caffeine
Low fluid intake

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5
Q

Name a bulking agent

A

Ispaghula husk
methylcellulose

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6
Q

Name a stimulant laxative

A

Bisacodyl
Senna
Dantron
Sodium picosulphate

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7
Q

Name a faecal softeners

A

Docusate
Glycerol
Arachis oil (enema)

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8
Q

Name a Osmotic Laxatives

A

Lactulose
Macrogols
Magnesium hydroxide and sulphate
Phosphate
Sodium citrate

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9
Q

What should you give a patient who has hard stools with faecal loading/ impaction?

A

High dose oral macrogol or stimulant
if not work- glycerol and/ or Bisacodyl supps

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10
Q

What should you give a patient who has soft stools with faecal loading/ impaction?

A

stimulant
then docusate or sodium citrate enema

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11
Q

What should you give a patient who has acute constipation?

A

lifestyle advice
bulk forming
(and/ or) osmotic: macrogol
stimulant

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12
Q

What can you give opioid induced constipation?

A

Osmotic and stimulant
Naloxegol (PAMORA drug)
AVOID BULK FORMING

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13
Q

What are lifestyle advice points for constipation?

A

30g a day fibre
good fluids
wholemeal bread
increase exercise

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14
Q

What can you give a pregnant woman who has constipation?

A

Bulk forming lax.
Can add/ switch to osmotic lax
SENNA NOT OTC FOR PREGNANCY
glycerol supp.

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15
Q

What can you give a child who has constipation

A

Macrogols and interventions
Can use stimulant lax.
Add lactulose if macrogol not tolerated

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16
Q

Name some osmotic laxatives

A

Macrogol
lactulose
Mg Hydroxide
Docusate (and a stim)

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17
Q

What is prucalopride

A

selective serotonin 5HT4 receptor agonist for constipation

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18
Q

What is linaclotide

A

drug used for constipation with IBS

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19
Q

How do Bulk-forming lax work?

A

Polysaccharides increase osmolality in gut when broken down therefore retention of water
Causes a bulkier stool
This distends colon
Promotes peristalsis

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20
Q

How do osmotic laxatives work?

A

Osmotic agents increase water retention as poorly absorbed
Absorbed into stool making softer

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21
Q

How do stimulant laxatives work?

A

Stimulates local reflexes of myenteric nerve plexus of guy
Irritate nerve endings in intestine
Motor effect-> increase propulsion/ motility

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22
Q

What does senna do? How does it work?

A

anthraquinone laxative
Combines with sugars- forms glycosides
Bond hydrolysed by colonic bacteria to release an irritant- sennosides A and B
Absorbed and has action on myenteric nerve plexus
Assumption that incr. PGE
Also decreases colonic water absorption

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23
Q

How do stool softeners work?

A

Surface wetting agents/ surfactants
Decrease surface tension allowing water to penetrate
Soften stool
Has some stim action

Arachis oil creates barrier between stool and intestine wall

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24
Q

How does a PAMORA work?

A

Competitive antagonist at intestinal mu-opioid receptors
Prevents opioid activation of intestinal mu-opioid receptors
Targets opioid induced side effects

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25
Q

How does prucalopride work?

A

5HT4 receptor agonist
activation increases ACh increases parasympathetic drive (rest and digest)
Increases peristalsis

26
Q

What is acute diarrhoea?

A

more than 3 loose stools a day for no more than 14 days

27
Q

What causes diarrhoea

A

change in balance of absorption and secretion of water due to osmotic force
or
enterocytes secreting fluid causes activation of ion transporters- can cause cytokine secretion to produce prostaglandins which stim. secretion

28
Q

explain the differences between invasive and non-invasive bacteria causing diarrhoea

A

invasive- attacks mucosal cells
may contain blood and pus
fever

non-invasive-
Bacteria produce enterotoxins that disrupt secretion
watery

29
Q

How do you diagnose diarrhoea

A

Accompanying symptoms
Rapid set
no stool formation
Faecal studies
Serum albumin
intestinal biopsy

30
Q

What drugs may cause diarrhoea

A

Antibiotics
laxatives
metformin
antacids
digoxin
ferrous sulphate
NSAIDs
Beta blockers
cholestyramine (for high lipids-bile salts)

31
Q

What is the treatment for acute diarrhoea

A

Loperamide- PRESCRIBED = 4mg, 2mg after each loose stool- 5 days max. Max 16mg
- GSL/OTC = 48 hrs max. Max 12g a day

Bland foods- soup, bread, pasta, rice

32
Q

What is oral rehydration therapy

A

Dioralytes
Corrects dehydration

33
Q

What can you give someone who is breastfeeding or pregnant for diarrhoea?

A

ORT and fluids
Loperamide for breastfeeding AVOID IN PREG.

34
Q

How does loperamide work?

A

Synthetic opioid analogue- doesn’t pass BBB
Binds to mu-receptors in gut wall
Inhibits ACh and prostaglandin release therefore decreasing parasympathetic activity

35
Q

What medicines should be stopped during vomiting, diarrhoea, fever, sweats etc: (sick day)

A

STOP
ACE inhibitors (prils)
ARBs (sartans)
NSAIDs
Diuretics
Metformin

36
Q

C. Diff infection risk factors

A

broad spec. antibiotic use
Stay in hospital
over 65

37
Q

Treatment for c. diff

A

Vancomycin 125-500mg every 6hrs for 10 days

38
Q

Symptoms of IBS

A

Abdominal cramps
Diarrhoea/ constipation etc
Flatulence
acid indigestion
Eating may worsen symptoms

39
Q

How do you diagnose IBS

A

abdominal pain for 6 months
Relief by defecation
Bloating
Mucus
Worsened by eating etc

40
Q

What is IBS-C

A

more than 25% type 1/2
less than 25% type 6/7

41
Q

What is IBS-D

A

more than 25% type 6/7
less than 25% type 1/2

42
Q

What is IBS-M

A

more than 25% type 1/2 and more than 25% type 6/7

43
Q

What is IBS-U

A

IBS but cant be categorised

44
Q

What is an antispasmodic? what’s it used for?

A

IBS
Smooth muscle relaxants
Mebevrine / peppermint / hyoscine butyl bromide (more antimuscarinic side effects)

45
Q

What is used to treat IBS-c

A

laxatives
(not lactulose tho as can increase gas and worsen symptoms)

46
Q

What is used to treat IBS-d

A

Loperamide but must be over 18 for GSL and diagnosed with IBS
2 weeks max

47
Q

What is linaclotide used for

A

Moderate/severe IBS-C if had for over a year and other laxatives not work

48
Q

How do antispasmodics work

A

Block voltage gated sodium channels
Prevents build up of calcium
Decreases smooth muscle cell contraction

49
Q

How does linaclotide work

A

guanylate cyclase-c agonist
leads to increased production of cGMP
causing CTFR ion channel causing increased secretion of chloride and bicarbonate into intestine causing increased GI transit

GC-C-> cGMP -> CFTR action -> increase intestinal chloride and bicarb

50
Q

Red flags for IBS

A

weight loss
rectal bleeding
loose stools for more than 6 weeks when over 60yrs old

51
Q

What causes diverticulosis

A

muscular hypertrophy causing narrowing of lumen and forms small chamber with high pressure

52
Q

What causes diverticulitis

A

Faecal material collects in diverticula and causes obstruction
bacterial overgrowth and vascular compromise
causes increase in luminal pressure resulting in inflammation

53
Q

Management of diverticulosis

A

Weight loss, smoking cessation, high fibre, bulk-forming laxatives

54
Q

what is diverticular disease

A

intermittent pain in LLQ
worsened by eating- relieved by shitting
tender on palpitation LLQ

55
Q

What is the management for diverticular disease

A

high fibre
bran and bulk forming laxative
lifestyle advice
avoid NSAIDS and anti-motility drugs like codeine

56
Q

What is the management for diverticulitis

A

co-amoxiclav or trimethoprim and metronidazole 5x a day

57
Q

What is exocrine pancreatic insufficiency

A

Lack of pancreatic digestive enzymes being secreted into duodenum
Lack of amylase, lipase, protease

58
Q

What can exocrine pancreatic insufficiency be cause by

A

pancreatitis
diabetes
coeliac disease
tumours
cystic fibrosis

59
Q

Symptoms of exocrine pancreatic insufficiency

A

malnutrition
lack of growth in children
low zinc conc and selenium so lowered immune function and healing
muscle loss
diarrhoea
cramping/bloating
fatty stools- steatorrhea

60
Q

treatments of exocrine pancreatic insufficiency

A

creon
pancrex v
Pancreatic enzyme replacement

Yr 3 Inflammatory and GI (15 decks)

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