Dyspepsia Flashcards

1
Q

What is dyspepsia

A

umbrella term for group of upper abdominal symptoms

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2
Q

Dyspepsia symptoms

A
  • vague abdominal pain above belly button
  • bloating, belching, flatulence
  • early satiety
  • fullness
  • nausea/vomiting
  • heartburn
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3
Q

Dyspepsia referral (ALARM)

A
  • A naemia
  • L oss of weight
  • A norexia
  • R ecently changed or new dyspepsia unresponsive to treatment
  • M alaena, vomiting, dysphagia
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4
Q

Ruling out Gastric ulcers (the symptoms)

A

Persistant gnawing, boring pain from one point in abdomen

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5
Q

Two types of peptic ulcers

A
  • Gastric Ulcer
    (pain aggravated by food)
  • Duodenal Ulcers
    (pain when stomach is empty)
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6
Q

Ruling out Cardiovascular problems

A
  • Pain radiating to jaw, back and arms
    (confused with heart burn, can be heart attack)
  • Pain started by exercise not relieved by antacids
    (angina)
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7
Q

OTC treatment (Antacids)

A

neutralise stomach acid
(Gaviscon, Tums, Rennies)

  • immediate
  • liquids more effective
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8
Q

OTC treatment (Alginates)

A

puts raft ontop of stomach contents
(Gaviscon)

  • suitable in pregnancy
  • first line of GORD
  • take after each main meal and at bed, or PRN
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9
Q

Which medication interact with Antacids to impair absorption of other drugs

A
  • Tetracyclines
  • Quinolones
  • Bisphosphonates

(leave 2 hours gap when taking)

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10
Q

Which conditions should antacids be avoided

A
  • hypertension
  • heart/kidney/liver failure
  • sodium restricted diets
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11
Q

Why should antacids not be taken with these conditions

A

because it is high in sodium and can cause fluid retention

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12
Q

What do antacids do to the stomach

A

damages enteric coating of stomach by increasing pH

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13
Q

OTC treatment (H2 receptor antagonists)

A

acid suppressor

Ranitidine (Zantac 75)

  • onset 1 hour lasting 9
  • 16 years pus
  • Max use 14 days
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14
Q

How to take Ranitidine

A

ONE 75mg tablet when symptoms occur

  • if symptoms stay for another hour take another tablet
  • max FOUR tablets in 24 hours
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15
Q

Side effects of Ranitidine

A
  • headaches
  • rashes
  • dizziness
  • diarrhoea
  • masks symptoms of gastric cancer
  • not recommended in pregnancy or breastfeeding
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16
Q

OTC treatment (proton pump inhibitors)

A

acid suppressor
(1 to 3 day onset, lasts 24 hours)

  • Omeprazole
  • Esomeprazole (Nexium)
  • Pantoprazole

Not recommended for pregnant or breastfeeding

18+
max supply 14 days

17
Q

How to take OTC proton pump inhibitors

A

ONCE daily, swallow whole

  • do not take with another acid suppressor (H2 antagonists)
18
Q

Side effects of proton pump inhibitors

A
  • abdominal pain
  • nausea
  • diarrhoea
  • vomiting
  • masks symptoms of gastric cancer
19
Q

What drug interacts with PPIs to increase anticoagulant effect

A

Warfarin

20
Q

What drug interacts with PPIs to increase risk of toxicity (narrow therapeutic range)

A

Phenytoin

21
Q

What drug interacts with PPIs to reduce anti platelet effect

A

Clopidogrel

22
Q

Advice for dyspepsia

A
  • smoking cessation
  • avoid excess alcohol, caffeine and chocolate
  • avoid bending over, lying down or slumping
  • evening meal 3 hours before bed
  • small frequent meals
  • avoid fatty or spicy food
  • reduce weight
  • avoid tight clothing