B1 The pharmacology of dyspepsia

Question 0

What are the symptoms or what makes GORD worse?

Answer 0

1) patient complains of indigestion
2) burning feeling after eating
3) worsened by bending forwards
4) May be reflux of gastric contents into mouth

Question 1

What is GORD?

Answer 1

It’s gastro-oesophagus reflux disease, reflux of acidic stomach contents into the oesphagus

Question 2

What are the causes of GORD?

Answer 2

1) weak sphincter
2) relaxation of sphincter by drugs
3) increase in intra-abdominal pressure
- pregnancy
- obesity

Question 3

What is gastritis?

Answer 3

Inflammation/ irritation of stomach lining

Question 4

What makes gastritis worse?

Answer 4

1) alcohol
2) NSAIDs
3) infection

Question 5

What is peptic ulceration?

Answer 5

Lining of stomach or duodenal breaks down and acid attacks tissue. Infection may lead to chronic inflammation and gastric damage (gastritis) leading to ulceration

Question 6

What is Zollinger-Ellison syndrome?

Answer 6

Tumour secreting gastrin which stimulates gastric acid release

Question 7

What is a symptom?

Answer 7

A clinical change in a person suggestive of disease

Question 9

What is a sign?

Answer 9

A clinical change in a person, which may be observed by a clinician and indicate a disease

Question 10

Give some common symptoms

Answer 10

1) cough
2) tiredness
3) aches
4) chest pains
5) breathlessness
6) indigestion

Question 11

give some common signs

Answer 11

1) changes in skin colour
2) digital clubbing
3) heart murmurs
4) sounds on listening to lungs
5) changes to retina

Question 12

What can cause chest pains?

Answer 12

1) usually musculoskeletal
2) respiratory
3) gastric origin (indigestion, reflux oesophagitis
4) Angina
6) heart attack

Question 13

What are the signs of gastric origins?

Answer 13

1) relationship to food

2) relieved by antacids

Question 14

What are the signs/ symptoms of angina?

Answer 14

1) induced by exercise, emotion stress
2) pains down arm? pains radiating to jaw?
3) relieved by rest or GTN diagnosed in history/ ECG changes

Question 15

What are the signs/ symptoms of heart attack?

Answer 15

1) severe chest pains, not relieved by rest/GTN
2) Nausea
3) breathless
4) pains down arm/ jaw
5) diagnosed by ECG changes/ cardiac enzymes

Question 16

What can cause indigestion?

Answer 16

1) acid stomach/ dyspepsia
2) overeating
3) reflux oesophagitis
4) peptic ulcer
5) stomach cancer
6) cardiac origin

Question 17

What are the signs and symptoms of peptic ulceration?

Answer 17

1) epigastric pain (located by patient pointing)
2) hunger pain, relieved by eating
3) night pain, relieved by food, milk, antacids
4) waterbrash - appearance of water in mouth
5) nausea and less frequently vomiting
6) vomiting blood

Question 18

What questions may you ask when diagnosing dyspepsia?

Answer 18

1) symptoms
2) precipitating factors
3) relieving factors
4) medicines tried
5) medication on

Question 19

What can the warning signs be?

Answer 19

1) Aged over 55 years
2) weight loss
3) anaemia
4) dysphagia (difficulty in swallowing)
5) haematemesis (vomiting blood)
6) melaena ( tarry stools)
7) upper abdominal masses
8) persistent symptoms with repeat OTC remedies, onset of new symptoms

Question 20

What are the goals of treatment?

Answer 20

1) symptomatic relief or cure
2) suppression of acid release or activity and mucosal protection
3) cure may involve suppression of acid release to allow natural healing and if appropriate, eradication H.pylori infection

Question 21

What lifestyle changes might symptomatic relief cause?

Answer 21

1) avoidance of causative drugs
2) avoidance of causative food
3) smoking cessation
4) GORD - propping up bed, removing belts