Dyspepsia Flashcards
What is dyspepsia
umbrella term for group of upper abdominal symptoms
Dyspepsia symptoms
- vague abdominal pain above belly button
- bloating, belching, flatulence
- early satiety
- fullness
- nausea/vomiting
- heartburn
Dyspepsia referral (ALARM)
- A naemia
- L oss of weight
- A norexia
- R ecently changed or new dyspepsia unresponsive to treatment
- M alaena, vomiting, dysphagia
Ruling out Gastric ulcers (the symptoms)
Persistant gnawing, boring pain from one point in abdomen
Two types of peptic ulcers
- Gastric Ulcer
(pain aggravated by food) - Duodenal Ulcers
(pain when stomach is empty)
Ruling out Cardiovascular problems
- Pain radiating to jaw, back and arms
(confused with heart burn, can be heart attack) - Pain started by exercise not relieved by antacids
(angina)
OTC treatment (Antacids)
neutralise stomach acid
(Gaviscon, Tums, Rennies)
- immediate
- liquids more effective
OTC treatment (Alginates)
puts raft ontop of stomach contents
(Gaviscon)
- suitable in pregnancy
- first line of GORD
- take after each main meal and at bed, or PRN
Which medication interact with Antacids to impair absorption of other drugs
- Tetracyclines
- Quinolones
- Bisphosphonates
(leave 2 hours gap when taking)
Which conditions should antacids be avoided
- hypertension
- heart/kidney/liver failure
- sodium restricted diets
Why should antacids not be taken with these conditions
because it is high in sodium and can cause fluid retention
What do antacids do to the stomach
damages enteric coating of stomach by increasing pH
OTC treatment (H2 receptor antagonists)
acid suppressor
Ranitidine (Zantac 75)
- onset 1 hour lasting 9
- 16 years pus
- Max use 14 days
How to take Ranitidine
ONE 75mg tablet when symptoms occur
- if symptoms stay for another hour take another tablet
- max FOUR tablets in 24 hours
Side effects of Ranitidine
- headaches
- rashes
- dizziness
- diarrhoea
- masks symptoms of gastric cancer
- not recommended in pregnancy or breastfeeding
OTC treatment (proton pump inhibitors)
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
How to take OTC proton pump inhibitors
ONCE daily, swallow whole
- do not take with another acid suppressor (H2 antagonists)
Side effects of proton pump inhibitors
- abdominal pain
- nausea
- diarrhoea
- vomiting
- masks symptoms of gastric cancer
What drug interacts with PPIs to increase anticoagulant effect
Warfarin
What drug interacts with PPIs to increase risk of toxicity (narrow therapeutic range)
Phenytoin
What drug interacts with PPIs to reduce anti platelet effect
Clopidogrel
Advice for dyspepsia
- 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
