Dyspepsia Flashcards
What is dyspepsia and what are some common symptoms
Dyspepsia- indigestion
Symptoms include: heartburn, bloating, belching, flatulence, nausea, feeling of fullness
Occurs after eating and comes in bouts (comes and goes)
1.What percentage of the UK population experiences dyspepsia at some point
40 %
What percent of dyspepsia suffers consult the GP each year and why?
Only 5% as it can be most;y treated with OCT medications
What organs make up the upper gut in relation to dyspepsia?
The oesophagus, stomach and duodenum
What are some conditions that exhibit dyspepsia symptoms
. Non-ulcer (functional) dyspepsia- no underlying disease to explain dyspepsia
. Gastritis- inflammation of the stomach lining
. Peptic ulcer- gastric/ duodenal(small intestine)
. Gastric/ oesophageal cancer
. IBS
. Medication ADRs
. Atypical angina (chest pain)
What are some trigger factors for dyspepsia (5)
. Smoking- chemicals in smoke relax sphincter muscles
. Pregnancy- hormones affect sphincter muscle tone
Size of baby pressing on stomach- pressure
. Heavy drinkers- alcohol irritates mucosal lining in stomach
. Overweight- obesity puts pressure on stomach
. Psychological/ Lifestyle factors- fast food, alcohol, stress/anxiety ,age
What postures can trigger dyspepsia symptoms?
Bending over, sitting hunched up, and lying down.
How does a hiatus hernia contribute to dyspepsia symptoms?
The top of the stomach pushes through a defect in the diaphragm, increasing stomach pressure and reducing pressure of the diaphragm on the oesophagus.
What types of drugs can trigger dyspepsia symptoms?
NSAIDs (non-steroidal anti inflammatory drug e.g. ibuprofen, aspirin) ,steroids and some antibiotics.
What foods can act as triggers for dyspepsia?
Spicy foods, alcohol, coffee, chocolate, and acidic foods, as they have relaxant effects on the sphincter.
How can large meals trigger dyspepsia symptoms?
Large meals increase pressure in the stomach.
What is the prevalence of peptic ulcers in the general population?
5-10%
What bacterium is commonly associated with peptic ulcers?
Helicobacter pylori (H. pylori)
What percentage of the population is infected with H. pylori at some point?
25%
Out of people infected with H. pylori, how many are likely to develop a peptic ulcer?
3 out of 20 infected individuals
What happens to H. pylori in individuals who do not develop ulcers?
It lives harmlessly in their system.
What are the two main types of peptic ulcers?
Gastric and duodenal
What are some summon symptoms of both gastric and duodenal ulcers (3)
. Intermittent upper abdominal pain
. A feeling of hunger
. Lack of appetite and weight loss
What is a unique symptom of duodenal ulcers
Pain radiates to the back
What can worsen the pain of a peptic ulcer ?
Eating food. Ulcer related pain is most likely to occur 2-3 hours after meals, often waking patients
How is peptic ulcer pain often relieved
Taking antacids such as gaviscon
What could indicate a more severe peptic ulcer?
Bleeding could suggest Perforation ( hole in GI tract wall) which is very dangerous as it can lead to infection
What are the alarm symptoms for oesophageal cancer ?
- dark/tarry stools (GI bleeding)
- persistent vomiting
- loss of weight
- altered bowel habit
What is dysphasia and what does it indicate ?
Dysphasia - pain and difficulty swallowing
May indicate stricture (scarring/ narrowing of oesophagus) , cancer and acid reflux
In which age groups is dyspepsia most common ?
It often occurs in young adults, while those over 50 may have other underlying pathologies
What should be considered if dyspeptic symptoms are persistent or recurrent?
.Review lifestyle and medication adherence, test or retest for H. Pylori
. Consider long-term proton pump inhibitor (PRI) use, and consider referring them to check if there aren’t any other underlying conditions.
Where is pain typically located in dyspepsia?
Above the umbilicus or in the central (epigastric ) area
Where is pain typically located in heartburn
Behind the sternum (breast bone in between lungs)
What might pain below the umbilicus indicate ?
Conditions like irritable bowel syndrome (IBS) or diverticulitis (conditions affecting large intestine)
Which conditions are associated with pain radiation in dyspeptic symptoms
Cardiovascular issues like myocardial infarction (MI, also known as a heart attack when blood flow to the heart is reduced ), angina , and biliary colic (gallstone blocks in the bile duct )
What are some key questions to ask for patents with dyspeptic symptoms (7)
. Age
. Duration/ recurrent - how long
. Location of pain
. Pain radiation
. How severe is the pain
. Other symptoms present?
. Lifestyle questions e.g diet, alcohol , stress
What should patients with dyspepsia avoid?
. Avoid bad posture
. Avoid alcohol And tea
. Avoid fatty and spicy food
. Avoid eating before bedtime
. Avoid tight belts/clothing
. Avoid smoking (reflux )
. Avoid eating quickly
How do alginates work in treating dyspepsia and what’s an example of?
Floats on top of stomach contents like a raft preventing them from entering the oesophagus
Example: gaviscon OCT
How do antacids work in treating dyspepsia and how long do they take to start working ?
.Neutralise stomach acid
. Relatively fast acting - 1 hour
What can be a side effect of taking antacids that contain:
- Magnesium salts
- Aluminium salts
- Calcium salts
- Bismuth salts
- Sodium bicarbonate , who is not recommend to take ?
- Magnesium -diarrhoea
- Aluminium constipation
- Calcium - constipation
- Bismuth salts- constipation
Sodium bicarbonate - metabolic alkalosis, people with hypertension not recommended to take this
How do H2 antagonists work in treating dyspepsia and how long do they take to start working
. Block action of histamine which usually signals cells in stomach to release HCL acid , therefore this limits the release of HCL
. Relatively fast acting ~ 1 hour
What is a proton pump inhibitor PPI and when are they recommended?
Inhibits H/ K-ATPase enzyme of parietal cells which usually secret HCL acid
- potent (strong affect) so usually only used as second line treatment for recurrent symptoms
What are some OCT examples of PPIs (3)
Omeprazole, pantoprazole, esomeprazole
What is simeticone
-reduces surface tension of gas bubbles to reduce bloating caused by gas
- defoaming agent found in many antacid preparations
How are patients with peptic ulcers
(H.pylori) treated/ what type of therapy?
Triple therapy recommended
PPI + 2 antibiotics ( amoxicillin/ clarithromycin /metronidazole) for 7/7 (1 week)
What is important to consider when starting antibiotics ? (2)
. Consider allergies
. Consider previous exposure to clairthromycin due to resistance
Why is GORD ( gastroesophegal reflux disease ) dangerous in children ?
. Sphincter muscle is not mature in young babies and thus there is not actual muscle to prevent the backflow (reflux) of the feed
As food and drink is mixed with acid from the stomach, it can irritate the lining of the GI tract, making it sore
What are signs of GORD in children (4)
. Sign of reflux - frequent spitting or regurgitation after feeds
. Babies not gaining weight after time
. Baby has frequent chest infections due to constant backflow of stomach contents into lungs
. Inside surface of oesophagus may becomes inflamed due to acid contact
When does treatment for GORD in children become necessary ?
- 80% of cases resolve in 1 year
- if acid reflux persists for longer then treatment is recommended
What are some practical measures that can be taken for children with GORD ?
. Avoid over feeding
. Avoid exposure to cigarette/ smoke
. Change nappies before feeding
. Burp more frequently
. Keep baby calm and upright 20-30 minutes after feeding
. Raise head of bed/cot
. Thickened feeds
What treatment is recorded to children with GORD
. Gaviscon infant sachets
What can be side effects of gaviscon infant sachets and what is the maximum amount that can be given to the baby per day?
. Constipation
. Max: 6per day
What can be side effects of gaviscon infant sachets and what is the maximum amount that can be given to the baby per day?
. Constipation
. Max: 6per day
How long should gaviscon infant sachets be used for ?
1-2 weeks
