Gastrointestinal, Blood & Nutrition, Malignant Diseases, and Infections Lecture Review

What is Coeliac Disease?

An autoimmune disease where there is an intolerance to gluten, leading to the destruction of microvilli in the small intestine, and thus reduced absorption of nutrients.

What are common symptoms of Coeliac Disease?

Abdominal pain, bloating, constipation, and diarrhoea.

What is the primary treatment for Coeliac Disease?

A strict life-long gluten-free diet.

Which medications might be used short-term for Coeliac Disease while awaiting specialist advice?

Prednisolone.

What is a key characteristic of Crohn's Disease?

It is an autoimmune disease that can affect the whole GI tract.

What are common symptoms of Crohn's Disease?

Abdominal cramps, diarrhoea, and rectal bleeding.

Which class of drugs might be used in the treatment of Crohn's Disease, and what is a caution for one of them?

Aminosalicylates like mesalazine, balsalazide, olsalazine, and sulphasalazine. Sulphasalazine may stain soft contact lenses.

Name some immunosuppressants used for Crohn's Disease.

Azathioprine, mercaptopurine, and methotrexate.

What is a key difference between Ulcerative Colitis and Crohn's Disease regarding affected area?

Ulcerative Colitis affects only the colon, whereas Crohn's Disease can affect the whole GI tract.

What is the first-line treatment for acute mild-moderate Ulcerative Colitis affecting the proctitis, proctosigmoiditis, or left-sided areas?

Topical aminosalicylate.

What is the treatment for acute severe Ulcerative Colitis?

IV corticosteroid or Infliximab.

Which medications are used for maintenance treatment of Ulcerative Colitis?

Aminosalicylate, or oral azathioprine/mercaptopurine if there are two or more relapses in 12 months.

What are common triggers for Irritable Bowel Syndrome (IBS)?

Stress & anxiety, spicy/fatty food, and alcohol.

What are the common symptoms of Irritable Bowel Syndrome (IBS)?

Abdominal cramps, diarrhoea, constipation, and bloating.

What antimuscarinic drug is used to treat IBS and what are its side effects?

Hyoscine butylbromide (Buscopan), which can cause dry mouth, urinary retention, blurred vision, and constipation.

What is the treatment for anaphylaxis due to food allergies?

Adrenaline.

Name some common causes of constipation.

Drugs (opioids, iron, antidepressants), lack of fibre, medical conditions (IBS, hypothyroidism), and pregnancy.

What are 'red flag' symptoms for constipation that warrant referral?

Blood in stool, age ≥ 50 with new onset, anaemia, abdominal pain, or unexplained weight loss.

Which type of laxatives include ispaghula husk and methylcellulose, and what is their onset of action?

Bulk-forming laxatives, with an onset of action up to 72 hours.

Name two osmotic laxatives.

Lactulose and macrogols (Movicol).

What is a caution associated with stimulant laxatives like senna and bisacodyl?

Abuse can lead to hypokalaemia.

Which two laxatives are only to be used in terminally ill patients and cause red urine?

Co-danthramer and Co-danthrusate.

What causes Diverticulosis and what are its different types?

A low-fibre diet causes small pouches in the intestine. Types include Diverticulosis (no symptoms), Diverticular disease (abdominal pain), and Diverticulitis (infection + inflammation).

What medications should be avoided in the treatment of Diverticulitis?

NSAIDs and opioids.

What are the most common tests for Helicobacter pylori?

Urea ¹³C breath test and SAT (stool antigen test).

What is important counselling before Helicobacter pylori testing?

Stop PPI for 2 weeks and antibiotics for 4 weeks before testing.

What is the 'Triple Therapy' regimen for Helicobacter pylori?

PPI (BD) + Clarithromycin (1st line abx) + Amoxicillin / Metronidazole (1st line abx) for 7 days.

What are some important monitoring points and risks associated with PPIs?

Monitor for hypomagnesaemia and hyponatraemia. Increased risk of C. diff infection, fractures/osteoporosis, and drug-induced lupus (MHRA warning).

What is the function of iron in the body?

Iron forms haemoglobin, which is essential for oxygen transport.

What are the symptoms of anaemia?

Tiredness, shortness of breath (SOB), decreased exercise tolerance, and memory problems.

When is iron prophylaxis required?

During pregnancy, with heavy menstrual bleeding, in haemodialysis, and for low birth weight babies.

How long is iron typically given to patients in a deficient state?

For one month to reach required levels and continued for another 3 months to replenish iron stores.

Which vitamin enhances iron absorption?

Vitamin C.

What are some common side effects of oral iron preparations?

Diarrhoea/constipation, black stool, and GI irritation.

What is key counselling for patients taking oral iron preparations?

May discolour stool, best absorbed on an empty stomach but can be taken after food to decrease GI side effects.

What is the role of Magnesium in the body?

Energy production.

What causes Zinc deficiency?

Malabsorption and a poor diet.

What condition does Zinc treat?

Wilson's disease.

What is TPN (Total Parenteral Nutrition) and when is it used?

IV delivery of amino acids, proteins, fats, electrolytes, glucose. Used in chemotherapy, surgery, ileus, kidney failure, and GI disorders.

What is Phenylketonuria and what should be avoided in the diet?

A condition where phenylalanine cannot be broken down, so aspartame should be avoided.

What are the symptoms of Acute Porphyria and what should be avoided?

Severe abdominal pain, confusion, convulsion, diarrhoea. Barbiturates should be avoided.

What is the treatment for Acute Porphyria?

Haem arginate IV.

What is the role of Vitamin A and which food rich in it should be avoided in pregnancy?

Vision in dim light. Liver-rich foods should be avoided in pregnancy.

What is Vitamin B1 (Thiamine) used to prevent?

Wernicke’s encephalopathy in alcoholics.

What is Vitamin B12 used to treat?

Folate anaemia.

What is Vitamin B6 (Pyridoxine) used to prevent?

Isoniazid side effects.

What does Vitamin C prevent, and what are its symptoms?

Scurvy, with symptoms including bleeding gums.

What does Vitamin D prevent, and what are some risk factors for its deficiency?

Rickets. Deficiency risk factors include decreased sunlight, being >65 years, and African/Asian heritage.

What is the role of Vitamin K?

Needed for clotting factor production.

What are the fat-soluble vitamins?

Vitamins A, D, E, K.

What are Neural Tube Defects (NTDs) and what are the main risks associated with them?

Conditions like spina bifida, encephalocele, and anencephaly. Risks are maternal folate and B12 deficiency.

What is the recommended folic acid dosage for women at low risk of NTDs before conception and during early pregnancy?

400mcg before conception and until week 12 of pregnancy.

What is G6PD Deficiency, and what are its triggers?

A genetic condition mainly in men, common in Africans, Asians, and South Europeans. Triggers include certain drugs and fava beans.

Name some definite risk drugs for G6PD Deficiency.

Nitrofurantoin, ciprofloxacin, and co-trimoxazole.

How does Oral Rehydration Therapy (ORT) work?

It enhances Na⁺ absorption via carbs/glucose, replaces electrolytes, and contains an alkalising agent (sodium bicarbonate).

What is Hydroxocobalamin used for and at what dosage?

B12 deficiency (pernicious anaemia) prophylaxis, IM every 3 months.

What causes Folate Deficiency and how is it treated?

Decreased folic acid / B12. Treated with folic acid 5 mg for 4 months.

What is a good dietary source of folate?

Broccoli.

What are Epoetins used to treat, and what is a risk associated with them?

Anaemia. Risk: thrombocytopenia.

What is the characteristic of red blood cells in Sickle Cell Disease, and what drug reduces crises?

RBCs are abnormal (sickle) shaped, leading to decreased oxygen and pain. Hydroxycarbamide reduces crises and transfusion needs.

What are the main therapeutic uses of immunosuppressant therapy?

To prevent transplant rejection and treat chronic inflammatory & autoimmune diseases.

What key danger signs/risks are associated with immunosuppressant therapy?

Myelosuppression, increased risk of infection, and avoiding live vaccines.

What is a critical interaction with Azathioprine when co-administered with allopurinol?

The dose of Azathioprine must be reduced to ¼ due to increased haematological toxicity.

What pre-screening is required for Azathioprine and how soon should FBC be monitored initially?

Prescreen check of TPMT enzyme activity. FBC weekly for the first 4–8 weeks.

What is the key toxicity associated with Ciclosporin?

It is markedly nephrotoxic.

What specific instructions are given for prescribing Ciclosporin and Tacrolimus?

Both must be prescribed by BRAND.

What are contraindications for Ciclosporin?

Uncontrolled hypertension, recurrent infection, and malignancy.

What are some side effects of Tacrolimus?

Hyperglycaemia, hyperkalaemia, and bone marrow suppression.

What is a universal warning for all cytotoxic drugs regarding pregnancy?

All are teratogenic, especially in the 1st trimester.

Which cytotoxic drugs are exceptions to causing myelosuppression?

Vincristine and bleomycin.

What is a critical warning for Vinca alkaloids regarding administration route?

They are for IV use only; intrathecal administration is fatal due to neurotoxicity.

Define 'Neoadjuvant' and 'Adjuvant' chemotherapy.

Neoadjuvant is given before surgery to shrink the tumour. Adjuvant is given after initial treatment to prevent recurrence.

What is a common side effect of anthracyclines, and what does it cause?

Cardiotoxicity and red urine.

What is the mechanism of action of Methotrexate?

It inhibits dihydrofolate reductase.

What is the key dosing instruction for Methotrexate?

ONCE weekly dosing, specifically using only 2.5 mg tablets.

What common side effects indicate potential blood disorders due to Methotrexate?

Mouth ulcers, sore throat, and bruising.

What is the antidote for Methotrexate overdose?

Folinic acid (calcium folinate).

Which drugs should be avoided as OTC interactions with Methotrexate?

NSAIDs and aspirin.

What role does Tamoxifen play in early and localised advanced breast cancer?

It is used after surgery, alone or with chemotherapy.

What is the first-line endocrine therapy for advanced breast cancer?

Aromatase inhibitors.

What are the three types of influenza viruses and their severity?

Type A (most severe), Type B (milder), Type C (mild or asymptomatic).

What are the 1st and 2nd line antiviral treatments for influenza?

1st line: Oseltamivir (Tamiflu). 2nd line: Zanamivir (Relenza).

What is the spectrum of activity for Aminoglycosides, and which organisms are TAG effective against?

Broad-spectrum (Gram +ve & -ve). TAG (Tobramycin, Amikacin, Gentamicin) are active against Pseudomonas aeruginosa.

What is the preferred route of administration for Aminoglycosides and what duration should be avoided?

IV once