Disorders of gastric acid and ulceration Flashcards
Symptoms of dyspepsia
upper abdominal pain, reflux, bloating, heartburn, nausea/vommiting
Dyspepsia symptoms in pregnancy are often due to what?
GORD
Non drug treatment of dyspepsia
- healthy eating
- weight loss
- avoiding trigger food
- small meals
- eating 3 to 4 hours before going to bed
- raising head of bed
- smoking cessation
- reducing alcohol
Red flag dyspepsia symtoms
GI bleed, unexplained weight loss, >55, Dysphagia
What drugs can cause dypepsia
Antimuscarinics, alpha blockers, aspirin, benzodiazepines, beta blockers, bisphosphonates, CCB, corticosteroids, nitrates, NSAIDS, theophyllne, TCA
What should patients with dyspepsia be tested for?
H pylori
First line treatment for uninvestigated dyspepsia
PPI for 4 weeks
What do magnesium / aluminium containing antacids do to bowel habit?
Magnesium = diarrhoea Aluminium = constipating
What is the issue with calcium continaing antacids?
can induce rebound acid secretion, hypercalcaemia, alkalosis, preciptiate milk-alkali syndrome
What symptom does simeticone relieve?
Flatulence
What is the brand name for sodium alginate + potassium bicarb?
Gaviscon advancew
What is the dose of simeticone in children 1 month - 1 year with colic?
Dentinox: 2.5mL to be taken with/after feed; max 6 doses a day
Infacol: 0.5-1mL to be taken before feeds
Two brand names of simeticone`
Infacol + dentinox
What risk factors contribute to a patient being high risk of developing gastric ulcers?
- NSAIDS (high dose)
- > 65
- other drugs that inc. GI risks
- co morbidities (CVD, HTN, diabetes)
- heavy smoker
- excessive alchol
- prolonged duration of NSAIDS
- H pylori
If a gastric ulcer develops due to NSAID use, what shiuld be done to treat it?
- PPI for 8 weeks
How long after starting H pylori eradicatin treatment should a patient be reviewed?
6 - 8 weeks
What type of NSAID causes the LEAST GI risk
COX 2 inhibitors
Why cant bismuth subsalicylate be used in chidren <16
reye syndrome risk
What is a caution with sucrafalte use?
Bezoar formation - caution in those on enteral feeds concomitantly + predisposing conditions e.g. delayed gastric emptying
How long should the gap between enteral feed administration + sucralfate be?
1 hour
Why should’nt H2 receptor antagonists be used for zollinger-ellison syndrome?
PPI are more effective
What can H2 antagonsits mask the synptoms of?
gastric cancers
Cimetidine can be sold OTC to patients above what age?
16 (provided not more than 2 week supply if sold)
Dose of cimetidine (single dose) for nocturnal heartburn
100mg
Oral preparations of Ranitidine are not licensed for children under what age?
3
When rantidine is sold OTC what is the max single dose that can be given?
75mg (max total daily dose of 300mg)
Example of a synthetic prostaglanding analgoue that has antisecretory properties used to help heal gastric ulcers
misoprostol
what drug class can be used for endoscopic treatment of severe peptic ulcer bleeding?
PPI (IV)
What condition can PPIs be used for the reduce degradtion of pancreatic enzyme supplements?
Cystic fibrosis
What is the MHRA warning alert associated with PPIs
small risk of SLE
What are some cautions of PPI use?
1) mask symptoms Gastric cancers
2) risk of osteoporosis
3) Risk of c.diffe
Is hypomagnesmia common immediately after starting PPIS?
no - usually occurs after 1 year of treatment
What electrolyte should be monitored when using PPI therapy
magensium ( + sodium(
What strength of omeprazole can be sold OTC to adults > 18years
10mg caps
Pantoprazole 20mg capsules can be sold OTC to what age group
> 18
complications of GORD
ulceration, oesophageal strictures, haemorrhage, aneamia due to chronic blood loss, aspiration pneumonia, barretts oesophageous
Sodium alginate wiht calcium carbonate and sodium bicaroate brand names
Peptac, Gaviscon, Rennie
What patients should be tested for H pylori
1) pt with uncomplicated dyspepsia and no alarm sx who are unresponsive to lifestyle change + 1/2 months of PPI
2) Pt at high risk (older, North African)
3) History of peptic bleed/ulcers
4) Prior to initiating NSAIDS in pt with history of ulcer
5) Pt with unexplained iron deficiency anaemia
What tests can be used for h pylori
Urea C13 breath test, stool H pylori antigen (SAT) or laboratory based serology
PHE recomends that C13 breath test / SAT should not be performed in what circumstance?
within 2 weeks of treatment wiht PPI or 4 weeks of an antibiotic (leads to false negatives)
What drug classes are used for H pylori eradication
1 PPI + 2 antibiotics
First line oral therapy for treatment of h pylori
PPI + amoxicillin and either clarithromycin or metronidazole for 7 days
If a patient with h pylori has recently had both clarithromycin and metronidazole, what other antibiotic can be tried?
tetracycline
If a patient has a penicillin allergy, what regime should be given for H pylori eradication
PPI + metro + clari for 7 days
