Dyspepsia

Question 1

what is dyspepsia and what conditions

Answer 1

a group of upper abdominal symptoms i.e. belching nausea, upper abdominal pain, fullness , early satiety

conditions : indigestion(functional, GORD(oesophagitis, heartburn acid regurg), gastric / duodenal ulcer
gastritis

Question 2

endoscopy referral?

Answer 2

ALARM
anaemia
loss of weight
anorexia
Recently change, new onset 55+ and unresponsive to tx,
malaena (blood stools) , dysphagia, recurrent vomit

Question 3

Uninvestigated dyspepsia ?

Answer 3

1st line alginates/ antacids
2nd line PPI (if symptoms ineffective tx with antacid/alginate and its 4 weeks
ppi fail= h.pylori test

Question 4

investigated functional dyspepsia?

Answer 4

h.pylori 13c - urea test
give PPI or H2 antagonist for 4 weeks

Question 5

antacid / alginates MOA

Answer 5

antacid- neutralise stomach acid
alginate form viscous raft on stomach contents

Question 6

name antacids

Answer 6

aluminium salts (long acting- constipating
calcium salt( rebound acid secretion)
magnesium salts (laxating - long acting)
sodium, potassium salt

Question 7

low na preparations-

Answer 7

maalox and mucogel( co-magaldrox)
alcacite plus( simeticone with hydrotalcite)

liquid form is always better

Question 8

name alginate

Answer 8

alginic acid, sodium alginate

Question 9

how to take antacid/ alginate

Answer 9

take before main meals and at bed time, or when required

Question 10

interaction antacids

Answer 10

1)leave 2 hr gap reduced efficacy, tetracycline, quinolone and bisposphonates
2) damage e/c coating as ph inc gastric
3)high na content avoid in condition fluid retention i.e. HF, HTN, liver kidney fail or in sodium restricted diet i.e lithium

Question 11

counsel

Answer 11

lose weight if need ,small frequent meals ,dont eat trigger foods, raise bed 10-20 cm from chest, avoid spicy food alcohol , tight clothing around wist, smoking, eat 3- 4 hr before bed

Question 12

PPI MOA

Answer 12

blocks gastric acid secretion from hydrogen/potassium pumps along gastric parietal cell

greatest effect on acid secretion

Question 13

examples of PPI

Answer 13

esomeprazole
omeprazole (safe in pregnancy)
rabeprazole
lansoprazole (30-60 mins before food)

Question 14

Dose of PPI

Answer 14

lowest dose for shortest time

Question 15

which PPI has pom to P switch

Answer 15

omeprazole max 14 days use (short term)

Question 16

Instructions for PPI

Answer 16

Swallow tablet whole. dont crush or chew

indigestion remedies leave 2 hr gap before or after you take

Question 17

What 3 things do PPI increase risk of

Answer 17

1) gastric cancer
2) osteoporosis
3) c difficile

Question 18

s/e of ppi

Answer 18

constipation, nausea, diarrhoea, abd pain
2) small risk of SCLE
lesions may develop in sun exposed areas with arthralgia. covid sun. consider stop PPI

Question 19

long term use effects ppi

Answer 19

1) hypomagnesia (predispose to digoxin toxicity
2) fracture
3) rebound acid secretion

Question 20

interaction ppi

Answer 20

omeprazole is cyp450 enzyme inhibitor
1) clopidogrel; reduce ani platelet effect
2) MTx reduced clearance

Question 21

H2 receptor antagonist moa and examples

Answer 21

blocks h2 receptor on parietal cells

nizatidine
cimetidine (enzyme inhibitor)
ranitidine (safe in pregnancy)
famotidine

Question 22

s/e H2 antagonist

Answer 22

H/a , rash , dizzy , nausea other = psychiatric reactions hallucinations esp in elderly or v ill