The Patient Flashcards

Question

What happens during diarrhoea?

Answer 1

Reduced longitudinal smooth muscle activity so retain contents of the intestine longer so exposed to epithlium to increased water absorption

Answer 2

A neurone in the Myenteric plexus

Answer 3

Binds to µ opiod receptors of the MP and reduced contraction of the muscles

Answer 4

Constipation

Answer 5

When released into the intestine the emulsify lipids to lead to absorption Vitamins A,D,E,K are absorbed this way

Answer 6

In the liver

Answer 7

Bile duct duodenum Ileum Back into the liver

Answer 8

Persistent or recurrent pain or discomfort in upper abdomen

Answer 9

Lifestyle factors Medication Diseases

Answer 10

Symptoms/complications resulting from reflux gastric contents into oesophagus, oral cavity or lung due to lower oesophageal sphincter relaxation ``` Obesity Genetic Lifestyle Medication Age ```

Answer 11

Open sores that develop on the inside lining of the oesophagus, stomach or upper portion small intestine >5mm diameter with associated inflammation Imbalance in agents that protect the epithelium and those which attack Gastric or duodenal

Answer 12

``` Upper abdominal pain, tenderness, discomfort Heartburn/reflux Bloating Early satiety Nausea and vomiting ```

Answer 13

Pain radiates to back Mainly occurs at night Aggravated by food Lose weight

Answer 14

Epigastric pain Anytime – empty stomach Relieved by food/antacids Gain weight

Answer 15

``` Anemia Weight loss Anorexia Recurrent problems (>55) Melaena/haematemesis Swallowing problems ```

Answer 16

Neutralise acids | Use when requires, between meals and bedtimes, 4+ times daily

Answer 17

Mg - laxative effects Al - constipation effecr Ca - possible rebound acid secretion/hypercalcaemia

Answer 18

less than 1 mmol

Answer 19

Impaired absorption of other drugs Raises pH so may damage enteric coatings May affect pH dependent renal excretion

Answer 20

Increase viscosity of stomach contents | Form a raft that floats on top of stomach contents and protects mucosa

Answer 21

Reduce gastric acid output by blocking histamine H2 receptor bloackade

Answer 22

``` GORD Maitainance treatment NSAID prophylaxis Functional dyspepsia Stress ulcer prophylaxis ```

Answer 23

Ranitidine Cimetidine Famotidine

Answer 24

Warfarin Phenytoin, carbamazepine, valproate Theophylline Sildenafil

Answer 25

Block gastric H,K-ATPase, inhibiting gastric acid secretion | (final pathway in gastric acid production)

Answer 26

``` Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole ```

Answer 27

Once or twice generally

Answer 28

Dyspepsia GORD Treatment of gastric and duodenal ulcers Maintenance treatment NSAID prophylaxis Excessive gastric acid secretion stress ulcer prophylaxis, peri-operatively

Answer 29

``` Gastric cancer H Pylori infection Pneumonia C diff infection Bacterial overgrowth, reduced calcium absorption leading the hip fracture ```

Answer 30

Antireterovirals Methotrexate Citalopram Omeprazole reduces efficacy of Clopidogrel

Answer 31

Antibodies Urea breath test Stool antigen test Mucosal biopsies

Answer 32

Some drugs can give false positives or false negatives

Answer 33

2 day, BD course of PPI plus 2 antibiotics 1st line - PPI full dose BD, Amoxicillin 1g BD, Clarithromycin 500mg BD or Metronidazole 400mg BD If penicillin allergy, just PPI+Clarithromycin 500mg BD and Metronidazole 400mg BD If penicillin allergic and previous clarithromycin exposure/treatment failure - PPI+ combination of two or more bacterials (bisulth, tetracycline, quinolone, metronidazole, clarithromycin)

Answer 34

Clarithromycin and statins | Metronidazole and alcohol

Answer 35

``` Age > 60 Multiple NSAIDs Smoker H pylori infection Concurrent medication including steroids, anticoagulants Higher dose/longer duration ```

Answer 36

Inhibition of prostaglandin synthesis impairs mucosal defences so there is an erosive breach of the epithelial barrier Acid attack deepens into frank ulceration Low pH encourages passive absorption of NSAID so trapped in mucosa

Answer 37

Reduced gastric blood flow Reduced mucus and bicarbonate production Leads to decreased cell repair

Answer 38

Stop NSAID id possible Test for H Pylori Treat with full dose PPI or H2 receptor antagonist for 8 weeks If H Pylori present give eradication therapy AFTER If they need to stay on the NSAID, give gastroprotection - low dose PPI, H2 receptor antagonist, Misoprostol

Answer 39

It is a prostaglandin analogue Preventing NSAID induced PUD SE - diarrhoea c/i - pregnancy as its a uterine stimulant

Answer 40

Less sphincter tone so more likely to get reflux | Mechanical and hormonal factors

Answer 41

GIT is still developing | Usually resolves by 12-18 months

Answer 42

``` Change frequency and volume of feed Feed thickener or thickened formula feed Use alginate instead of thickened feeds H2 receptor antagonist PPI ```

Answer 43

Dietary and lifestyle changes Antacid or alginate (but avoid sodium bicarbonate or magnesium trisilicate) If symptoms severe or persist give Ranitidine or Omeprazole

Answer 44

A tennis court

Answer 45

Pilcae Epithlium Enzymes

Answer 46

Folds Covered with finger like projections called villi (1mm high) Villi lined with epithelial cells that have microvilli

Answer 47

1 cell thick | So minimal barrier to transfer of molecules from lumen

Answer 48

Convert non-absorbable macromolecules to absorbable small molecules

Answer 49

sucrose -Glucose and fructose Lactose - glucose and galactose maltose - glucose and glucose

Answer 50

SGLT1 Transporter in basolateral membrane Glucose binds to glucose transporter High conc of sodium ions outside too -Sodium ions bind to transporter Transporter has a conformational change and flips to face inside the cell Glucose and sodium ions move into the cell

Answer 51

GLUT5 transporter in basolateral membrane | Also sodium dependent

Answer 52

Digested to smaller peptides then to AA Small peptides - PEPT1 transporter H+ dependent

Answer 53

Drug UPTAKE transporters are very efficient

Answer 54

``` Cephalosporins Penicillins Enalapril α-Methlydopa-phenylalanine Val-acyclovir ```

Answer 55

``` quinidine verapamil imatinib Valproic acid α-Methlydopa-phenylalanine Val-acyclovir ```

Answer 56

Pravastatin Rosuvastatin Atorvastatin Fexofenadine

Answer 57

Eject compounds from the cell - drugs enter enterocytes and are actively effluxed into the gut lumen Uses ATP Can be detrimental to drug absorption

Answer 58

P-gp | BCRP

Answer 59

HIV PI Immunosuppressants Antibiotics Cardiotonics (digoxin, quinidine) Verapamil, Quinidine, Imatinib are OCTN2 substrates so there is a competition between uptake and efflux

Answer 60

Drug leaks onto surrounding tissue and causes necrosis (conc drug)

Answer 61

All increased toxicity Etoposide Doxorubicin Paclitaxel

Answer 62

Ritonavir Atorvastatin Talinolol Increase in digoxin AUC and side effects

Answer 63

``` Arterial blood (20% hepatic artery) Venous blood (80% portal vein ```

Answer 64

``` Metabolism Synthesis Immunological Storage Homeostasis Production of bile Clearance ``` Need to learn the substrates of these

Answer 65

Cholestatic Hepatocellular Leas to fibrosis and cirrhosis

Answer 66

Bile sites in bile ducts and causes damage Intrahepatic - bilary ductules Extrahepatic - mechanical obstruction Increase in liver enzymes Impaired biliary excretion and reduced absorption of fatty substances Accumulation - damage of hepatocytes - jaundice and itching

Answer 67

``` Injury to hepatocytes by toxins or viruses Fatty infiltration - steatosis Inflammation - Hepatitis Necrosis if it persists Increase in liver enzymes ```

Answer 68

Persistent, extensive hepatocyte damage -active formation and deposition of collagen formation of scar tissue (fibrosis) Disruption of blood flow and more scar tissue Erratic regeneration nodules can form Lead to cirrhosis (extensive damage)

Answer 69

Stenosis and hepatitis (cells change shape, fat deposits and inflammation) Cirrhosis - blood doesn't flow through well

Answer 70

5-20mmol/L

Answer 71

RBC breakdown

Answer 72

Haemolysis Hepatocellular damage Cholestasis

Answer 73

Aspartate transferase | 0-40iu/L

Answer 74

Alanine transferase 5-30 iu/L Liver specific enzymes

Answer 75

Alkaline Phosphatase | 30-120 iu/L

Answer 76

γ-Glutamyltransferase 5-55 iu/L Levels increase by enzyme inducers

Answer 77

One of the proteins produced by the liver 35-50 g/dL Lower - oedema

Answer 78

Clotting factors produced by the liver

Answer 79

If 2 X ULN then considered abnormal Trends not isolation LFTs aren't always abnormal in patients with cirrhosis Abnormal LFT's aren't always due to liver disease

Answer 80

``` Many asymptomatic Initially general Abdominal pain Jaundice Pale stool and dark urine Pruritus Spider naevi Finger clubbing Bruising and bleeding Gynaecomastia Liver palms ``` In the end stage: Ascites Oesophageal and gastric varices Encephalopathy

Answer 81

Accumulation of fluid in the peritoneal cavity leading to a sowellen abdomen

Answer 82

``` Fluid/sodium restriction Diuretics Daily weight Daily U+E's Paracentesis (fluid drained off) ```

Answer 83

Infection of the ascitic fluid without an obvious intra-abdominal source of sepsis

Answer 84

Treat with broad spectrum IV antibiotic 3rd gen cephalosporins, co-amoxiclav, tazocin (for at least 5 days) Norfloxacin/Ciprofloxacin as prophylaxis after iv antibiotic course if getting recurring infections

Answer 85

Theories but not clear Liver not working well so accumulation of toxins, increase BBB permeability, more neurotransmitters int he brain so cause these behavioral changes Spectrum of neuropsychiatric changes including changes in mood and behaviour, confusion, poor sleep rhythm and eventually delirium and coma

Answer 86

Laxatives - for ammonia (Lactulose 20-30ml BD-TDS) Antibiotics - kill bacteria producing ammonia (Rifaxamin 550mg BD) Supplement urea cycle

Answer 87

Build up of pressure in portal vein caused by increased resistance to flow and disruption of hepatic architecture and compression of hepatic venules by regenerating nodules Varicies enable blood to bypass the liver

Answer 88

``` A medical emergency Vomiting loads of blood Resuscitation Endoscopy Balloon tamponade Terlipressin iv 1-2mg bolus then every 2-6 hrs until bleeding stops Octreotide infusion Antibiotics PPI ```

Answer 89

Propranolol 20-40mg BD Splanchnic vasoconstriction Cardiac output results in reduced portal pressures

Answer 90

Build up of bile salts

Answer 91

``` Colestyramine UDCA Antihistamines Topical Resisant cases - Ondansetron Rifampicin Naltrexone, Naloxone ```

Answer 92

``` Alcohol Viral infection NAFLD Inherited and metabolic disorders Immune disease of the liver Vascular abnormalities Cancer Biliary tract disorders Other infections ```

Answer 93

``` Predictable Reproducible Dose dependent Tend to occur rapidly e.g. within hours Tend to cause necrosis, acute liver failure ```

Answer 94

Not predictable Not reproducible Not dose dependent Tend to take longer to occur Can result from metabolic idiosyncrasy or immunoallergic reaction Can cause any type of liver injury e.g. increased LFTs, jaundice, fever, rash, eosinophilia

Answer 95

Cholestasis – OCP, warfarin, azathioprine, flucloxacillin ALF – allopurinol, cyclophosphamide, NSAIDS, MDMA, Steatosis – amiodarone, corticosteroids, TPN Fibrosis and cirrhosis – methotrexate Vascular disorders – OCP, azathioprine Acute hepatitis – phenytoin, isoniazid Chronic hepatitis - isoniazid

Answer 96

``` Delirium, marked tremor Fear and delusions, restlessness and agitation Fever Rapid pulse Dehydration Seizures ```

Answer 97

sedatives and vitamin supplementation Chlordiazepoxide + Pabrinex IV Oral vitamin B co strong and thiamine

Answer 98

Works on GABA receptors to minimise symptoms

Answer 99

``` Most common Faecal Oral route Mild, self-limiting Can clear when young Doesnt progress to chronic liver disease or carrier status ```

Answer 100

Enveloped DNA virus Highly contagious (blood, saliva, urine, semen, vaginal fluids ) Young more likely to get chronic hep Leading cause of HCC (hepatic cellular carcinoma) Diagnose by Hep B surface antigen

Answer 101

Oral antivirals – entecavir or tenofovir LONG TERM Pegylated Interferon Aiming for “functional cure” – HBsAg loss, undetectable serum HBV DNA +/- HBsAb seroconversion Vaccination is available

Answer 102

Delta virus Can only replicate in presence of Hepatitis B virus Acquired in blood, saliva, urine, semen, vaginal fluids Combination of HBV and HDV increase risk of progression to chronic hepatitis and cirrhosis

Answer 103

Pegylated interferon and oral antivirals as HBV

Answer 104

Similar to Hep A Oral-Faecal Often mild Doesn't progress

Answer 105

``` Blood bourne Six genotypes Diagnose by antibodies, HCV RNA and genotype Many people undiagnosed as asymptomatic Silent Killer ```

Answer 106

Curable as doesn't integrate into cells DNA Looking for a sustained virological response viral eradicatiom Finate courses of treatments developed over years 1997-Interferon alpha 2b 2000 – Pegylated Interferon 2001 – Pegylated Interferon and Ribavirin 2011 – First generation directly-acting antivirals (DAAs) – Boceprevir and Telaprevir – added to Pegylated Interferon and Ribavirin regimens 2014 – Second generation DAAs – Sofosbuvir, Sofosbuvir/Ledipasvir, Daclatasvir – “interferonfree” regimens 2015 - Ombitasvir/Paritaprevir/Ritonavir with or without Dasabuvir introduced 2016 – Velpatasvir/Sofosbuvir – “pan-genotypic”, Elbasvir/Grazoprevir introduced 2017 – Sofosbuvir/Velpatasvir/Voxilaprevir and Glecaprevir/Pibrentasvir introduced. Both pan-genotypic

Answer 107

Crohns- Whole of GI tract from mouth to anus can be affected-patchy UC - mucosa of colon and rectum - diffuse

Answer 108

``` It is not fully understood Genetic Envrionmental Immunological factors Gut microbes Smoking Infection Diet Medication ```

Answer 109

``` Abdominal Pain Diarrhoea - watery, bloody, mucus Tiredness and fatigue Urgency Weight loss Anaemia Fever Nausea and vomiting Abdominal bloating and distension ```

Answer 110

Swollen joints-arthritis Eye problems - episcleritis, iritis, uveitis Erythema nodosum – swollen fat under skin causing redness, bumps and lumps Pyoderma gangrenosum – skin ulceration Primary sclerosing cholangitis

Answer 111

Strictures - narrowed segments of bowel causing blockages, acute dilation and perforation Fistulas - new little abnormal channels forming lined with granulation tissue

Answer 112

``` Blood tests Stool cultures (rule out C diff ect) Coeliac screen Faecal calprotectin Abdominal imagine Endoscopy including capsule endoscopy Colonoscopy Bisopises take to differentiate ```

Answer 113

Truelove and Witt's

Answer 114

``` Looks at lots of different parameters: Number of liquid or soft stools Severity of abdominal pain General well-being Presence of complications Fever Use of loperamide Presence anaemia Body weight Abdominal mass absent or present ```

Answer 115

No - they aren't good at maintaining remission

Answer 116

They target the immune system

Answer 117

There is some overlap but no as different parts of the GIT are affected

Answer 118

No, often a combination of drugs is used

Answer 119

Enema>foam>suppository

Answer 120

``` Antibiotics if infection/complication Corticosteroids Aminosalicylates Immunomodulating agents Antibiotics Novel treatments ```

Answer 121

Prednisolone Hydrocortisone Budesonide Prednisolone 40mg OD, reduced by 5mg/week If acute-severe, iv hydrocortisone 100mg QDS in hospital then switch to oral prednisolone

Answer 122

Sulfasalazine Mesalazine Balsalazide Olsalazine

Answer 123

Thiopurines – Azathioprine and Mercaptopurine Methotrexate, Ciclosporin, Tacrolimus Biologics – Infliximab, Adalimumab, Vedolizumab, Ustekinumab

Answer 124

Faecal Microbiota Transplant | Probiotics

Answer 125

Induce remission but do not prevent progression of disease or development of complications Dampen inflammatory reaction so you can add another drug to aid remission If flare up is severe, give iv

Answer 126

Side effects Infection risk Osteoporosis risk Steroid treatment card

Answer 127

``` Suppositories Foams Enemas Tablets Granules ```

Answer 128

Sulfasalazine Side effects - headache, nausea, rashes These limited the dose you could use

Answer 129

Balsalazide Olsalazine Mesalazine

Answer 130

They all release in different places in the GIT

Answer 131

Arthralgia, abdominal pain, diarrhoea, dizziness | Blood dyscrasias

Answer 132

``` Renal function (baseline, 3 months then annually – more frequent if impairment) Blood dyscrasias ```

Answer 133

If you can't get control on steroids - first line immunomodulators for IBD Induce and maintain remission Steroid sparing 3-6 months for full effects

Answer 134

Mercaptopurine Then converted to TGN (active metabolite) TMPT then converts to MeMP (not active and can cause side effects)

Answer 135

Azathioprine - 2-2.5mg/kg/day | Mercaptopurine - 1-1.5mg/kg/day

Answer 136

TMPT levels - prior to, repeated one month after or if not responding to treatment Low - reduce dose (risk myelosuppression) High - risk hepatotoxicity as more going down this metabolic pathway Full blood count weekly (4 weeks) then at least every 3 months

Answer 137

Hypersensitivity reaction – immediate withdrawal Myelosuppression (bone marrow suppression) Neutropenia and thrombocytopenia GI – nausea, vomiting, diarrhoea Liver disorders

Answer 138

For maintainance if Azathioprine can't be used | Co-prescription of folic acid

Answer 139

Can induce remission in mild-mod UC if not responsive to other treatments

Answer 140

To induce remission in severe-acute UC refractory to steroids

Answer 141

Monoclonal antibodies Bind to cytokine - Tumour Necrosis Factor-α (TNF- α) and inhibit inflammatory effects Infliximab and Adalimumab Ustekinumab and Vedolizumab

Answer 142

Murine and human amino acid sequences so can get an infusion related reaction

Answer 143

Faecal Microbiota Transplant Probiotics New biolohics Small molecule inhibitors of RNA and intracellular cytokine pathways

Answer 144

``` Bowel resection Strictureplasty Colectomy Proctocolectomy with ileostomy Fistula treatment Abscess drainage ```

Answer 145

Calcium and vitamin D to prevent osteoporosis

Answer 146

Infliximab - iv infusion | Adalimumab - sc injection

Answer 147

Lymphoma/malignancy

Answer 148

Blocks IL-12 and IL-23-Inhibits inflammatory effects in gut Initial IV infusion then SC injection Risk of reactivation of infections and malignancy

Answer 149

Leucocyte adhesion inhibitor IV infusion Risk of reactivation of infections and malignancy

Answer 150

Composition of gut microbes thought to be abnormal so we try and replace this Use a healthy donor and transfer gut microorganisms into intestinal tract of recipient via colonoscopy or ec tablets Clinical trials ongoing

Answer 151

``` Intestinal blockage Bleeding Perforation Fistula Abscess Toxic megacolon ```

Answer 152

Not strict definition A change in bowel habits for that person More frequent and looser stools

Answer 153

Acute - < 14 days Persistent - > 14 days but less than 28 days Chronic > 28 days

Answer 154

``` Increased osmotic load in gut lumen Increase in secretion Inflammation of intestinal lining Increased intestinal motility (can be more than one) ```

Answer 155

``` Infection or ingestion of toxins Bacterial e.g. Campylobacter, Escherischia coli, Salmonella Viruses e.g. rotavirus or norovirus Drug Parasites Anxiety ```

Answer 156

Most cases are self limiting and resolve within 72 hours

Answer 157

Experienced by travellers or holiday Usually within the first few days of trip Can last a bit longer but usually resolves within 7 days Some infections (e.g. giardiasis and amoebic dysentery) can cause persistent or recurrent diarrhoea or systemic complications

Answer 158

Enterotoxigenic Escherichia coli (ETEC), Campylobacter Salmonella Enterohaemorrhagic E coli and Shigella, Viruses, protozoa and helminths

Answer 159

Same as acute diarrhoea but can also have bloody diarrhoea (dysentery)

Answer 160

More symptomatic relief as per acute. So antibiotic prophylaxis rarely recommended Hygiene, food and drink advice give: wash hands - soap Antiseptic wipes/gel Avoid local water even for teeth Avoid ice cubes, dairy products, ice cream, home distilled drinks and salads Fresh foods- cook, boil, peel Avoid fish and shellfish unless fresh and sure uts not been near sewage Clean, hygenically run esablishments

Answer 161

Recurrent or persistent diarrhoea

Answer 162

IBS IBD Malabsorption syndromes (e.g. coeliac disease, lactose intolerance) Metabolic disease (e.g. diabetes, hyperthyroidism) Laxative abuse

Answer 163

``` Stool frequency Nature e.g. blood, mucus Occurrence – isolated or recurrent Duration Onset Timing Food Recent travel Medication ```

Answer 164

``` > 72 hours in healthy adults > 48 hours in elderly > 24 hours if diabetic Associated severe vomiting and fever History of change in bowel habit Blood or mucus in stools Suspected ADR Alternating diarrhoea and constipation in elderly Weight loss Recent hospital treatment or antibiotic treatment Evidence of dehydration Severe pain/rectal pain ```

Answer 165

``` Oral Rehydration Therapy Loperamide Morphine Diphenoxylate Adsorbents Antibiotics ```

Answer 166

Enhance the absorption of water and electrolytes Replace electrolyte deficit adequately and safely Contain alkalinising agent to counter acidosis Prevent the possible induction of osmotic diarrhoea - slightly hypo-osmolar (about 250 mmol/litre) Simple to use in hospital and at home Palatable and acceptable, especially to children Readily available

Answer 167

Sodium and potassium-to replace essential ions Citrate and/or bicarbonate-to correct acidosis Glucose or another carbohydrate e.g. rice starch

Answer 168

200-400ml after very loose motion

Answer 169

Synthetic opioid analogue - µ (mu) opioid receptor agonist Direct action on opiate receptors in the gut wall Inhibits gut peristalsis

Answer 170

Initially 4 mg (2 caps), followed by 2 mg for up to 5 days, dose to be taken after each loose stool; usual dose 6–8 mg daily; maximum 16 mg per day.

Answer 171

Active ulcerative colitis Antibiotic associated colitis Conditions where inhibition of peristalsis should be avoided Conditions where abdominal distension develops Avoid: Bloody/suspected inflammatory diarrhoea Significant abdominal pain

Answer 172

Abdominal cramps Dizziness Serious cardiac adverse reactions associated with high doses

Answer 173

Only when there is a confirmed infection - stool sample taken and causative organism identified first Can use in severe infection (fever > 39oC and prolonged symptoms, in the elderly or immunocompromised)

Answer 174

Risk antimicrobial resistance Prolong symptoms as many cause GI side-effects Pre-dispose to Clostridium difficile Worse diarrhoea

Answer 175

Direct action intestinal smooth muscle | 0.5-1mg - debated if it is effective for diarrhoea

Answer 176

Synthetic derivative of pethidine – opioid effect to slow gut Comes as a combination product:co-phenotrope (diphenoxylate hydrochloride 2.5mg/atropine 25mcg) Side effects in high amounts

Answer 177

Adsorb microbial toxins and micro-organisms in gut and flushes out Kaolin (Kaolin and Morphine) Bismuth subsalicylate

Answer 178

``` Plenty of clear fluids Avoid drinks high in sugar Avoid milk and milky drinks Eat light, easily digested food Gastroenteritis – infections. Precautions including not returning to work until symptom free for 48 hours, hygiene advice and cleaning of sanitary equipment Check meds as absorption can be reduced ```

Answer 179

A live, oral vaccine that protects young children against gastro-enteritis caused by rotavirus infection.

Answer 180

the first at 2 months of age, (must be given between 6–14 weeks of age) the second at 3 months of age the second dose should be given after an interval of at least 4 weeks Course should be completed before 25 weeks of age

Answer 181

2-3% of the adult population

Answer 182

Pseudomembranous colitis

Answer 183

Had antibiotics that have killed of normal gut flora so environment there is supportive of C diff growing – also need spore there (May already have or may acquire spore from the hospital) C diff needs to produce particular toxin and not all C diff’s produce this toxin

Answer 184

``` Antimicrobial choice Antimicrobial duration Acid-suppressing medicines Age - co-morbidities Length of stay Recent hospitalisation ```

Answer 185

Depends onseverity STOP antimicrobials and acid supressing med if possible Stop antimotility meds Maintain adequate fluid balance Targeted C diff treatment Infection control - alcohol gels and isolation

Answer 186

``` Oral metronidazole - first line (mild-mod) Oral vancomycin (severe or mild-mod) Oral fidaxomicin (severe recurrent or risk of recurrent) ```

Answer 187

400mg TDS for 10-14 days

Answer 188

125mg every 6 hours | can give up to 500mg every 6 hours

Answer 189

200mg BD for 0 days

Answer 190

Combination therapy of IV Metronidazole and oral Vancomycin | Iv

Answer 191

Probiotics Faecal Microbiota Transplant Intravenous Immunoglobulin

Answer 192

Passage of hard stools less frequently than normal Typically less than three bowel movements in one week But varies between people

Answer 193

All people of all ages | More common in women, especially if pregnant, and older people

Answer 194

``` Abdominal discomfort and distension Abdominal cramping Bloating Nausea Difficulty passing stool ```

Answer 195

No anatomical or physiological cause known

Answer 196

Induced by a particular condition or medicine

Answer 197

``` Inadequate fluid intake Inadequate dietary fibre Dieting Changes in lifestyle Suppressing the urge to defecate ```

Answer 198

``` Coeliac disease Depression Diabetes GI obstruction IBS Parkinson’s disease Hypercalcaemia Hypokalaemia Hypothyroidism ```

Answer 199

Antacids containing aluminium and calcium Antihypertensives – diuretics, calcium channel blockers Antidepressants – tricyclics and some monoamine oxidase inhibitors Antimuscarinics – procyclidine, oxybutynin Antiparkinsonian medicines – levodopa, dopamine agonists, amantadine Opioid analgesics Iron

Answer 200

A laxative

Answer 201

Bowel habit Examination Try to identify cause Rome III diagnostic criteria

Answer 202

Restore normal frequency defecation Achieve regular, comfortable defecation Avoid laxative dependence Relieve discomfort

Answer 203

Change primary cause - diet, fluids, lifestyle | Laxatives

Answer 204

Bulk-forming Stimulant Osmotic Faecal-softening

Answer 205

Increase faecal mass through water binding to stimulate peristalsis

Answer 206

Take several days for full effect

Answer 207

Maintain a good fluid intake as they work through water binding

Answer 208

In people prone to constipation (elderly)

Answer 209

Ispaghula husk | Methylcellulose (also a softener)

Answer 210

Increase intestinal motility via muscle contractions | Work on cells in smooth muscle to stimulate peristalsis

Answer 211

A few hours - take before bedtime, will work by morning

Answer 212

Abdominal cramps | Prolonged use - diarrhoea, fluid and electolyte imbalance

Answer 213

Senna Bisacodyl Dantron (terminal illness)

Answer 214

Work within colonic lumen to retain and draw water into intestine by osmosis and stimulate peristalsis

Answer 215

A good fluid intake

Answer 216

Macrogel powders: 1-3 days Lactulose: 2-3 days Phosphate enema or suppository: 15-30 mins Magnesium hydroxide sachets: 3-6 hours

Answer 217

Clearing prior to bowel procedures | e.g. colonoscopy

Answer 218

Stimulate peristalsis by increasing faecal mass: they lower surface tension and allow water and fats to penetrate faeces

Answer 219

Docusate sodium: 1-3 days Gylcerol suppository: within 1 hour Arachis oil enema: within 30 mins

Answer 220

If the patient has a nut allergy

Answer 221

Faecal impaction haemorrhoids Rectal prolapse Anal fissures

Answer 222

Autoimmune condition affecting the small bowel Genetic predisposition Body’s immune system attacks itself when gluten is eaten – thinks gluten is foreign material Reaction varies between people BUT NOT ALLERGIC REACTION - NO ANAPHYLACTIC SHOCK

Answer 223

Serology - look at levels of immunoglobulins person to person Endoscopy for SI biopsy (Repeat biopsy on gluten-free diet) (Gluten challenge (>10g per day, 6/52)

Answer 224

Not every person has symptoms and they vary person to person - mild to severe Headaches Diarrhoea Abdominal pain Lethargy

Answer 225

Few hours to a few days

Answer 226

symptoms can affect any area of the body and lead to other conditions

Answer 227

Long term malabsorption and osteoporosis Refractory coeliac disease – symptoms WITH gluten free diet Ulcerative jejunitis Enteropathy associated T cell lymphoma Autoimmune disease

Answer 228

The more you risk triggering another autoimmune disease

Answer 229

``` No cure Lifelong gluten free diet Reintroduce gluten=immune system reacts and gut lining becomes damaged again Research underway to develop a vaccine Looking at modifying the immune system ```

Answer 230

Fresh meat, fish, cheese, eggs, milk, fruit and vegetables (watch for contamination) Specially-manufactured wheat starch

Answer 231

``` Taste Expensive Difficult to eat out No agreed international consensus on permissible levels Range of symptoms with ingestion Nutritional aspects ```

Answer 232

Bread and flour mixes only

Answer 233

Chronic condition At least 6 months of abdominal pain and bowel symptoms (diarrhoea, constipation or combination of both) Cause unclear and can differ patient to patient

Answer 234

Poorly understood so cant treat underlaying cause Treatment aimed at symptomatic relief: Dietary changes and exercise Antispasmodics (e.g. mebeverine, hyoscine, peppermint oil) Anti-diarrhoeal (e.g. Loperamide short courses) Laxatives (e.g. bulk-forming, stimulant, osmotic) Probiotics

Answer 235

No, may have different symptoms at different times so swap treatments around

Answer 236

They relax smooth muscle They are well tolerated Peppermint oil capsules can also be used TDS

Answer 237

Mebeverine MR capsule | 200mg BD

Answer 238

Served by renal artery and renal vein

Answer 239

Outer - cortex (brown) | Inner - medulla (dark grey)

Answer 240

The back of the abdominal wall (NOT in peritoneal cavity)

Answer 241

Regulate blood volume/pressure Osmolarity - maintain iron levels Acid base balance

Answer 242

Metabolites (urea which is a product of AA breakdown) | Ingested chemicals, drugs

Answer 243

``` Erythromycin hormone involved in RBC production Vitamin D3 (Ca2+ homeostasis) ```

Answer 244

Rickets - softer bones which bend under pressure

Answer 245

Afferent arteriole - bigger Efferent arteriole Afferent bigger to increase pressure to aid filtration into bowmans capsule

Answer 246

Blood - afferet arteriole - glomerulus - (some filtrates into bowmans capsules) - efferent arteriole

Answer 247

The capillaries surrounding the nephron

Answer 248

Molecules from plasma into Bowman's Capsule

Answer 249

Molecules secreted from vasa recta peritubular capillary INTO the tubule (then pass out into urine)

Answer 250

Valuable compounds back into blood from the nephron

Answer 251

Capillary endothelium stcik to a basement membrane made of proteins and carbs, with capsule cells (podocytes) wrapped around the capillary

Answer 252

Large -pass straight through capillary Small - filtered and pass straight through gaps (blood vessels are leaky, and gaps occur between cells and between podocytes)

Answer 253

30 kPa and smaller

Answer 254

The kidney is damaged

Answer 255

They are not filtered, unlike some drugs that are unbound and pass to urine

Answer 256

Warfarin = 99% bound

Answer 257

Volume of fluid filtered per unit time (per hour or day) | Measure of how well the kidneys are functioning

Answer 258

Drastic changes | e.g. kidney stones, polycystic kidney disease

Answer 259

GFR decreases

Answer 260

Water, ions, drugs

Answer 261

Kidney cancer Kidney cysts Obstructive kidney stones

Answer 262

Elimination

Answer 263

Age | Disease

Answer 264

Reduce the dose Not as much drug being cleared Higher levels in the body Can result in toxicity

Answer 265

Measure Glomerular Filtration Rate

Answer 266

Rate at which fluid in the plasma is filtered

Answer 267

Administered IV Polymer of fructose and freely filtered Not reabsorbed nor secreted by the nephron/metabolised by kidney so amount of inulin filtered is the amount excreted in the urine

Answer 268

Produced by muscles and freely filtered | How much in urine = how much has been filtered + 10% that has been secreted by the nephron

Answer 269

Volume of plasma from which a substance is completely removed per unit time

Answer 270

``` V = rate urine production (vol/time) [Ux] = urine conc of x [Px] = plasma conc of x ```

Answer 271

``` OAT OATP OCT MRP BCRP P-gp ```

Answer 272

No - negligible

Answer 273

Uptake - OCT1, OAT1 | Efflux - MRP2, MRP4, ABCG2

Answer 274

Uptake - OAT3 | Efflux - ABCG2

Answer 275

Uptake - OAT3 | Efflux - ABCB1

Answer 276

Uptake - OATP1 | Efflux - ABCB1

Answer 277

To treat diabetes | Plasma levels of glucose in the blood will drop

Answer 278

SGLT2 found in kidney

Answer 279

Dapagliflozin (Forxiga)

Answer 280

Water by passive diffusion

Answer 281

H+ secretion

Answer 282

HCO3- (carbonic acid) | Acts as a buffer

Answer 283

Via the circulatory system

Answer 284

Respiratory Acidosis (Build up of protons in the plasma)

Answer 285

Increase proton secretion

Answer 286

pH affects ionisation of drug and therefore membrane permeability

Answer 287

Aldosterone

Answer 288

Outer cortex of the adrenal gland

Answer 289

Increased Na+ channels in the apical membrane | Increases Na, K pumps in the basolateral membrane

Answer 290

The renin-angiotensin system

Answer 291

Low Na in the body – sensed by cells in the kidney Cells produce renin in response Renin converts Angiotensinogen to Angiotensin I which is inactive Angiotensin I comes into contact with Kidney and lung Capillary cells ACE converts AGI to AGII AGII circulates until it gets to adrenal cortex and tells it to make aldosterone

Answer 292

``` Heart failure (+ diuretic) High blood pressure ``` e.g. Captopril. fosinopril

Answer 293

Oedema, hypertension, congestive heart disease To increase the amount of water lost through the kidneys e.g. Spironolactone, Amiloride

Answer 294

It is an aldosterone analogue Binds to same receptor so aldosterone cannot bind and trigger response Less channels and pumps - more sodium and water passes out of the body

Answer 295

Na+ channel blocker | Binds to sodium channels in apical membrane so more sodium and water stays in the fluid and is passed out of the body

Answer 296

Hypertensive patients | Reduced with age

Answer 297

60-70% | Na+/ H+ exchanger

Answer 298

Concentration of interstitial fluid increases as LoH descends so osmotic potential increases

Answer 299

20-30% | Na/K/Cl transporter

Answer 300

Low permeability

Answer 301

Impermeable to water

Answer 302

ADH binding to the vasopressin receptors in aquaporin channels causes their insertion into the apical membrane. Can remove as much as 15% of filtered water, making the urine considerably hypertonic to plasma. Na+ reabsorption mediated by aldosterone occurs

Answer 303

through direct action on nephron cells or changing composition of the filtrate

Answer 304

Inhibit Na+/K+/2Cl- carrier in thick ascending limb | They cause vasodilation before the onset of diuresis

Answer 305

Furosemide Bumetanide Torasemide

Answer 306

Angiotensin II usually constricts arteries but loop diuretics reduce response to diuretics Increased vasodilating PG's present endogenous Na+/K+/ATP inhibitor decrease

Answer 307

NSAIDs ↓ diuretic action of furosemide (PG inhibition/ competition for OAT)

Answer 308

``` Acute pulmonary oedema Chronic heart failure Liver cirrhosis + ascites Nephrotic sysndrome Renal failure Hypertension (+reduced renal function) Hypercalcaemia ```

Answer 309

``` Hypotension Hypokalaemia Metabolic alkalosis Gout Hearing loss ```

Answer 310

Increase in sodium which enters collecting duct – drives sodium potassium exchange pump Increase in potassium entering epithelial cells the and increase in potassium leakage into filtrate/urine large conc of Na+ remaining in filtrate (because ther is less reabsorption in LoH) → drives Na+/K+ pump

Answer 311

Through the GI tract Furosemide absorbed in stomach/ upper small intestine

Answer 312

<1 hr orally | 30 minutes iv

Answer 313

Albumin | If glomerulus is damagesd, less protein available to bind to so have to give more which causes more side effects

Answer 314

Via PCT excretion

Answer 315

In urine - they enter the filtrate

Answer 316

90 minutes

Answer 317

Inhibit Na+/ Cl- cotransporter – blocking sodium reabsorption

Answer 318

They act on the distal tubule but more Na reabsorption occurs in the ascending LoH

Answer 319

Chlortalidone Inapamide Metolazone Bendroflumethiazide

Answer 320

A vasodilator effect

Answer 321

Renin angiotensin system kicks in - increases blood pressure

Answer 322

Hypertension Mild to moderate heart failure Oedema treatment Nephrogenic diabetes insipidus

Answer 323

Thiazide-like diuretics better tolerated than loop diuretics

Answer 324

Increase urinary frequency Erectile dysfunction Hypokalaemia Impaired glucose tolerance

Answer 325

Increase intake in diet - fruit juice, instant coffee, bananas Give K+ supplements alone or combined with the diuretic Use K+ sparing diuretics

Answer 326

No just orally

Answer 327

2.5mg daily Peak 4-6 hrs Duration 8-12 hrs

Answer 328

25mg daily | A thaizide-like diuretic

Answer 329

They are aldosterone agonists so block Na+ reabsorption and Na+/K+ exchange in collecting tubule

Answer 330

Spironolactone | Eplerenone

Answer 331

Primary hyperaldosteronism Ascites caused by liver cirrhosis Oedema Severe heart failure

Answer 332

Adjunct in patients with left ventricular failure after MI

Answer 333

Hyperkalaemia GI upset Gynaecomastia (more with spironolactone) Menstrual disorders/testicular atrophy

Answer 334

Canrenone | Half life = 16 hrs

Answer 335

Block Na+ channels in the collecting tubules, where there is little sodium reabsorption

Answer 336

Hyperkalaemia | Not safe to use in patients with renal impairment or on drugs which increase potassium

Answer 337

Partially metabolised in liver | Well absorbed orally

Answer 338

Amiloride and Furosemide | Oedema

Answer 339

Amiloride and hydrochlorothiazide | Hypertension/ congestive HF/ oedema

Answer 340

They increase the osmolarity of filtrate - draw water in | Increase excretion of water and Na+

Answer 341

PCT, ascending LoH and CD

Answer 342

Cerebral oedema Raised intra-ocular pressure Acute renal failure Given with loop/ thiazide diuretics to maintain K+ balance

Answer 343

Hyponatraemia Headache Nausea + vomiting

The Patient Flashcards

(384 cards)