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3819 > dyspepsia > Flashcards

dyspepsia Flashcards

1
Q

Define dysphagia

A

Difficulty swallowing

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2
Q

Define steatorrhoea

A

Excretion of abnormal quantity of fat in faeces

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3
Q

What is the R in GORD

A

reflux

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4
Q

What is the 2 overlapping sx in:
GORD, dyspepsia and H. Pylori

A

Heartburn, reflux

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5
Q

How to distinguish GORD from dyspepsia and H. Pylori

A

GORD involves dental sx like dental erosion, halitosis

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6
Q

How to distinguish dyspepsia from GORD and H. Pylori

A

Epigastric pain

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7
Q

4 causes of dyspepsia

A

Oesophageal sphincter, H. Pylori, delayed gastric emptying, functional dyspepsia

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8
Q

How do these drugs cause dyspepsia/abdominal discomfort?
Nitroglycerines (isosorbide), anticholinergics (atropine), theophylline, beta 2 agonists (salbutamol), benzo (diazepam)

A

Decreases the lower oesophageal sphincter tone

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9
Q

How do these drugs cause dyspepsia/abdominal discomfort?
Doxycycline, bisphosphonates,

A

Causes gastric irritations

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10
Q

2 easy drugs that cause dyspepsia

A

NSAIDs, Iron (ferrous sulfate)

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11
Q

How do these drugs cause dyspepsia/abdominal discomfort?
CCB (-ines), phosphodiesterase-5 inhibitors, tricyclic antidepressants

A

Effects oesophageal sensitivity and sensory perception in esophagus which can translate to discomfort

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12
Q

What testing is done to diagnose dyspepsia

A

TRICK, no tests, its the reporting of sxs

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13
Q

What should we rule out first, before giving PPI to a px?

A

H. Pylori

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14
Q

How to test for H. Pylori? (2)

A

Serology (blood) test, faecal antigen test, urea breath test

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15
Q

What conditions (2) is H. Pylori responsible for?

A

Gastric ulcers and duodenal ulcers

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16
Q

What are we looking for in serology (blood) test and faecal antigen test when testing for H. Pylori?

A

H. Pylori antigens

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17
Q

What can we find in a faecal antigen test that we can’t find in a serology (blood) test or urea breathe test?

A

We can find out the strain of H. Pylori

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18
Q

Which isotopes are we looking for when trying to detect H Pylori in a urea breath test?

A

C13 (carbon dioxide) and C14 isotopes

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19
Q

How does urea breathe test work when detecting H. Pylori

A

Px swallows a urea tablet with C. H Pylori metabolises urea into carbon dioxide and ammonia, so when px breathes out, we test to see if C13 (carbon dioxide) comes out

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20
Q

What 2 drugs need to be ceased before undertaking urea breathe test?

A

PPI and antibiotics

21
Q

What to do when px presents with any of these sx + dyspepsia?
>55yrs, unexplained weight loss, anorexia, anaemia, melaena (dark/sticky stools), dysphagis

A

Referral

22
Q

Some non-pharmacological strategies for dyspepsia (6)

A
  • Avoid alchi, caffeine, smoking
  • Reduce weight
  • Reduce meal size, take more freq meals instead
  • Drink fluids between meals, not cc
  • Avoid eating 2-3 hours before bed/rigorous activity
  • Elevate head of bed at night
23
Q

3 acid suppression medication therapies

A

Antacids, H2 antagonists, PPI

24
Q

What is another name for H/K-ATPase pump?

A

proton pump

25
Q

Explain parietal cells and acid production process

A

Eat, then stomach receptors stretch as it senses food which stimulates gastrin. Gastrin stimulates enterochromaffin-like cells which releases histamine, which produce cAMP, which fuels proton pump. Proton pump leads to exchange in H, which goes into stomach lumen where its exchaged for K (H+HCl)

26
Q

Where is acid produces

A

parietal cell

27
Q

What does acid secrete in the parietal cell

A

hydrochloric acid

28
Q

MOA of antacid

A

Neutralise acid thats secreted

29
Q

Define phenylketonuria

A

Inability to metabolise phenylalanine

30
Q

Why can’t you give antacids to people with phenylketonuria?
Hint: think about the definition of phenylketonuria

A

Antacids like Gaviscon contain phenylalanine

31
Q

What drug class does nizatidine belong to

A

H2 antagonist

32
Q

MOA of H2 antagonists
Hint: remember, H2 receptors fuel proton pumps

A

Competitively blocks H2 receptors in parietal cells and reduces gastric acid secretion, to slow down the fuel available in proton pumps

33
Q

How long do pxs go on H2 antagonists for?

A

4-8 weeks

34
Q

MOA of PPI

A

Irreversibly blocks proton pump

35
Q

How long are pxs on PPIs for

A

4-8 weeks

36
Q

Which drugs are PPIs?

A

pantop, omep, lansop, rabep, eso

37
Q

When to take PPI and antacids in regard to meals?

A

Antacids: 1-3hrs pc
PPI: 30-60 mins ac

38
Q

Sx’s of GORD should calm down after 4 weeks, but if it persists for 8 weeks, what should you consider the condition may be?

A

H. Pylori

39
Q

Best medication for eradication of H. Pylori

A

Triple therapy - PPI, clarithromycin, amoxicillin/metronidazole

40
Q

Which drug, when indicated for dyspepsia, works by manipulating pain perception, enhances gastric accommodation which relaxes the gut, and accommodates more content in stomach which releases epigastric discomfort?

A

TCAs - amitript

41
Q

MOA of prokinetics

A

Improves gastric emptying by enhancing esophageal peristalsis, which increases rate of movement in GIT

42
Q

Why is it good to enhance movement in GIT?

A

The less time contents are in GIT, the less time acid reflux can act on it, and less time for epigastric discomfort (as food isn’t just sitting in stom)

43
Q

What drug class is domperidone part of

A

Prokinetics

44
Q

What is the biggest risk in taking domperidone

A

Risk of prolonged QT intervals/arrhythmias

45
Q

When should a px use TCAs/prokinetics in dyspepsia

A

When they don’t respond to triple therapy

46
Q

In functional dyspepsia, what drug is best when the main sx is epigastric burning?

A

PPI

47
Q

In functional dyspepsia, what drug is best when the main sx is discomfort and bloating?

A

Prokinetic (domperidone)

48
Q

In functional dyspepsia, what drug is best when the main sx is anxiety/depression related?

A

TCAs

3819 (5 decks)

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