Disorders of gastric acid and ulceration Flashcards
What red flags should you look our for in patients suffering with dyspespia?
bleeding, recurrent vomitting, weight loss, dysphagia (problems swallowing) or if its unexplained, not responding to treatment and over 55
What lifestyle advise would you primarily give to a patient suffering from dyspepsia?
Avoid alcohol, smoking cessation,reduce weight, raise the head of the bed, avoid triggers such as fats, stoo medication that may cause dyspepsia
Aluminium containing antacids can cause __. What do you have to look out for in patients with renal impairment?
Constipation. Risk of aluminium accumulation
Mg containing compounds can cause __
Diarrhea
What cautions should you take in bismuth containing compounds?
Can cause neurotoxicity and encephalopathy if absorbed
What cautions should you take in calcium containing compounds?
Prolonged high doses can cause hypercalcemia and alkalosis and can precipitate milk-alkali syndrome
What is the purpose of simeticone added in with an antacid?
To relieve flatulence or hiccup in palliative care
What is the initial treatment for hpylori eradication?
One week triple therapy regimen which includes, clarithromycin and either amoxicillin or metronidazole with a PPI, the antibiotics can be mixed and matched if they have previously taken antibiotics of the same classes
What is the success rate of hpylori eradication therapy?
85%, failure usually indicates resistance or poor compliance
What should you change, if any, if the ulcer is large or complicated by haemorrhage or perforation?
Continue PPI only for up to 3 weeks
What are the alternatives for PPIs?
H2 receptor antagonist (ranitidine) or misoprostol (prostaglandin analogue)
What is the recommended treatment for pts on a non selective nsaid?
Treat ulcer with ppi and continue in healing phase
Treat ulcer with ppi and switch to misoprostol in healing phase
Treat ulcer with ppi and switch nsaid to Cox 2 selective inhibitor an continue ppi in healing phase
All the above
What is sucralfate?
A complex of aluminium hydroxide and sulfated sucrose protecting mucosa from acid pepsin attack in ulcers.
What is zollinger Ellison syndrome and what is the recommended treatment?
Tumour or hyperplasia in the islets cells in the pancreas overproduces gastric acid resulting n recurrent peptic ulcers. Ppi>H2 receptor antagonist
What are H2 receptor antagonists used for?
Functional dyspepsia (non ulcer), idiosyncratic with no alarm features, nsaid associated ulcers, reduce risk of acid aspiration in obstetrics patients
What should you look out for in pts taking H2 receptor antagonists?
Can mask signs and symptoms of gastric cancer
What are the restrictions for P supply of cimetidine/famotidine/ranitidine?
Sold for over 16yrs, no more than 2 weeks supply for relief of heartburn, dyspepsia, hyperacidity and for prevention of these symptoms when associated with food and drink or prophylactic treatment of nocturnal heartburn (cimetidine only)
What is misoprostol also used for without relation to GI disorders?
Abortion, use if pregnancy has been excluded in woman of child bearing age. Induces uterine contractions and teratogenic at first trimester . Manufacturer advises avoiding breastfeeding
A high dose PPI administered IV is given ___
Following endoscopic treatment of severe peptic ulcer bleeding to reduce rebleeds.
What condition is PPI's not used for? Hpylori eradication NSAID associated ulcers Dyspepsia GORD Ab cramps Zollinger Ellison Syndrome Peptic ulcer bleeding Cystic fibrosis
Ab cramps
What dose reduction is recommended after an NSAID induced ulcer has healed?
Trick qu, dose should normally not be reduced because asymptomatic ulcer deterioration may occur
At the start of summer a patient comes in with a skin rash on his forearms and complains about pains in his elbows after being out in the sun all week, upon looking at his PMR he has recently taken metformin for newly diagnosed DM, he is also on long term ramirpil for HT and takes naproxen with a PPI following a leg fracture a few months ago. How do you respond?
Possible SCLE, subcutaneous lupus erythematosus, dug induced SCLE can ocur weeks, months or even years after exposure to PPI, if a pt develops skin lesions in sun exposed areas with joint pain advise to avoid sun exposure, discontinue PPI unless it if for a serious acid related condition. On most cases symptoms resolve on PPI withdrawal, topical or oral steroid for SCLE if doesnt resolve within a few weeks. Pt may be at risk of same reaction with another PPI. The risk is very low
What monitoring requirements are recommenced for someone undergoing long term PPI treatment?
Serum mg conc as can cause hypomagnesaemia which is more common if tsking it for more than a year. risk increased if taking drugs with the same risk (digoxin)
GORD is non associated with what symptom? Heartburn Dysphagia Acid regurgitation Oesophagitis Weight loss Ulceration Strictures
Weight loss
