BNF for Pre-reg - Humza Yusuf Ibrahim Chapter 1 Gastrointestinal System TABLE OF CONTENTS Table of Contents 1 1 Chronic Bowel Disorders 1.1 Inflammatory bowel disease 2 1.1.1 Aminosalicylates 2 1.1.2 Mesalazine 2 1.2 Irritable bowel syndrome. 2 1.3 Clostridium difficile infection 2 2 Constipation 2 2.1 Light Liquid Paraffin 2 3 Diarrhoea 2 4 Disorders of gastric acid and ulceration 2 4.1 Dyspepsia 2 4.2 Gastro-oesophageal reflux disease 3 4.3 Gastric and duodenal ulceration 3 4.3.1 Helicobacter pylori infection. 4.3.2 NSAID-associated ulcers. 2 3 4.3.3 Antisecretory drugs and mucosal 3 protectants. 3 4.4 Sucralfate 3 5 Liver disorders and related conditions 3 5.1 Biliary disorders. 3 5.2 Oesophageal varices 3 6 Obesity 3 7 Rectal and anal disorders 4 8 Exocrine pancreatic insufficiency. 4 8.1 Pancreatin 4 Chapter 1 - Pg 1 Medium weighting
BNF for Pre-reg - Humza Yusuf Ibrahim Chapter 1 Gastrointestinal System 1 CHRONIC BOWEL DISORDERS 1.1 INFLAMMATORY BOWEL DISEASE Inflammatory bowel diseases include Crohn's disease (affecting any part of the digestive tract) and Ulcerative colitis (limited to the colon). 1.1.1 Aminosalicylates (sulfasalazine, meslazine, balsalazide, olsalazine) Side effects - Blood disorders Patients advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia. 1.1.2 Mesalazine There is no evidence to show that any one oral preparation of mesalazine is more effective than another. If it is necessary to switch a patient to a different brand of mesalazine, the patient should be advised to report any changes in symptom 1.2 IRRITABLE BOWEL SYNDROME IBS is a chronic condition, common in people aged between 20 and 30, mostly women. Symptoms include abdominal pain or discomfort, disordered, passage of mucus, and bloating. A high fibre diet, and exercise is important in self- management of IBS. Antispasmodics are also used as intestinal smooth muscle relaxants; e.g. alverine, mebeverine, peppermint oil, and the antimuscarinics dicycloverine, hyoscine, and propantheline. All antispasmodics should be avoided in paralytic ileus. 1.3 CLOSTRIDIUM DIFFICILE INFECTION Caused by colonisation of C. difficile in the colon. It often follows antibiotic therapy, and is a hazard of ampicillin, amoxicillin, co-amoxiclav, second- and third-generation cephalosporins, clindamycin, and quinolones. Treatment options include metronidazole, vancomycin, and fidaxomicin 2 CONSTIPATION Misconceptions about bowel habits have led to excessive laxative use. Abuse may lead to hypokalaemia. Pregnancy If dietary and lifestyle changes do not control constipation, a bulk-forming laxative is recommended first-line, osmotic, then stimulant may also be tried. 2.1 LIGHT LIQUID PARAFFIN Less suitable for prescribing Side effects anal seepage of paraffin and consequent anal irritation after prolonged use; lipoid pneumonia 3 DIARRHOEA Main aim is to reverse fluid and electrolyte depletion, especially important in infants, frail, and elderly. Oral rehydration preparations are used to replenish lost electrolytes. Antimotility drugs such as Loperamide are commonly used in uncomplicated diarrhoea, but not in children under 3. Routine prophylaxis against travellers' diarrhoea is not recommended, but ciprofloxacin can be used.