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Clinical 2.0 winter > Dyspepsia > Flashcards

Dyspepsia Flashcards

1
Q

what is dyspepsia

A

bad digestion
epigastric pain lasting a month
can be associated wiht other upper GI symptoms as long as epigastric pain is the primary concern

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2
Q

2 main dyspepsia categories

A

organic - peptic ulcer disease, gerd, barretts esophagus, cancer
functional - no cause we can find

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3
Q

what is peptic ulcer disease

A

group of ulcerative disorders that are dependent on acid and pepsin for their production

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4
Q

common symptoms of peptic ulcer disease

A

episodic epigastric pain

heartburn

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5
Q

cause of PUD

A

imbalanc ebetween mechanisms of ijury and protection

could be injured by acid, enzymes, toxins, drugs, bacteria

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6
Q

complications of PUD

A

perforation
penetration
hemorrhage
gastric outlet obstruction

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7
Q

risk factors for PUD

A

hpylori

nsaids

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8
Q

PUD and GERD treatment goals

A

symptom relief
accelerate healing
prevent and treat complications
prevent recurrence

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9
Q

PUD non pharms

A

avoid large bedtime meals (increases acid)

avoid nsaids, smoking alcohol, caffiene affect healing

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10
Q

use of antacids in PUD

A

symptomatic relief due to compliance issues

give 1 and 3 hr post meals and at night

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11
Q

cautions with antacids

A

sodium bicarb in CHF/cirrhosis
magnesium based in dialysis
constipation, diarrhea, drug interactions

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12
Q

role for H2 blockers

A

take long to work so not much use PPI much better

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13
Q

should you bother increasing dose of omeprazole

A

no only decreases acid by further 6%

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14
Q

efficacy of proton pump inhibitors

A

gold standard for ulcers

also role in hpylori eradication

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15
Q

what is considered refractory PUD

A

fail 8 week therapu in dunodenal
12 week in gastro
usually on BID PPI for recurrence

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16
Q

new recommondations for eradication of hpylori is

A

quad based therapy becuase of clarithromycin resistance in manitoba (PPI +amox/bismuth + metronidazole + tetracycline)

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17
Q

use for chronic prophylaxis of PUD

A

maybe in patients with severe PUD complication or significant comorbidity
if another blled could be catastrophic

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18
Q

PPI chronic use has what effect

A

increases gastrin level 2x which has proliferative effects on both ECL and parietal cells causing hyperplasia and hypertrophy(rebound hypersecretion)
cancres not seen in humans

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19
Q

PPI adverse effects

A

infections - cdiff, pneumonia
fractures
interaction with clopidogrel?

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20
Q

what is GERD

A

retrograde spilling of the gastric contents into the esophagus
chronically relapsing disorder

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21
Q

classical symptoms of gerd

A

regurgitation
heartburn
dysphagia
odynophagia ( pain when swallowing)

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22
Q

atypical gerd symptoms

A 
coughing 
wheezing 
globus sensation 
laryngitis
chest pain 
dental erosions
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23
Q

gerd risk factors

A

pregnnacy
obesity
increased age
hiatus hernia

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24
Q

complications of gerd

A

esophagitis and esophageal bleeding
esophageal stricture
barretts esophagus - very rare
esophageal cancer - very rare

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25
what is non erosive reflux disease
symptoms but no active imflammation
26
GERD and functional dyspepsia non pharms
``` smaller more frequent meals avoid smoking reduce alcohol and caffiene obtain ideal weight stress reduction blocks of wood at the head of the bed ```
27
use of antacids in gerd
symptom relief, breakthrough | give 1 and 3 hours post meals and at night as needed
28
how do prokinetics work
increase LESP and accelerate gastric emptying
29
recommendation for prokinetics in gerd
best agent cisapride but risk of cardiac arrythmias | metoclopramide good for nause but long term AE
30
gold standard for gerd
PPI
31
what is functional dyspepsia
dyspepsia for 3 months with no clearly identifiable pathogen motor and sensitivity changes in GI tract?
32
symptom subgroups of dyspepsia
ulcer like dysmotility like reflux like
33
functional dyspepsia GOT
symptom relief | prevent recurrence
34
role of antacids in functional dyspepsia
limited to no benefit
35
role of PPI in functional dyspepsia
little more of an effect than placebo | limit to once daily dosing
36
best evidence for treatment of functional dyspepsia
TCAs | consider if no benefit from PPI
37
prokinetic role in functional dyspepsia
found more effective than placebo but risk with long term use
38
how long to determine benefits of therapy in functional dyspepsia
4 weeks
39
signs of serious GI disease
``` over 50 vomit, bleeding anemia weight loss dysphagia anorexia jaundonce cancer history multiple treatment failures recent dramatic changes in symptoms ```
40
cancer risk is higher where
SE asia | south america
41
recommend endoscopy for who
>60 higher risk of malignancy | <60 with alarm features not recommended
42
treatment duration fo r h pylori
14 days
43
recommendation for <60with dyspepsia
test and treat for hpylori
44
who should be tested for hpylori eradication and how
serious GIi bleeding or other complications | urea breath test or stool antigen test
45
on demand dosing benefit
therapy that meets patients needs obtain a similar outcome at less cost potential for reduced adverse effects
46
on demand dosing risk
under treatment of disease (symptoms dont corelate with endoscopic findings) long term risk of complications unknown
47
4 things that warrant continuing a PPI
barretts esophagus chronic NSAID user with bleeding risk severe esophagitis documented history of bleeding GI ulcer
48
in which situations would you recommend deprescribing (decrease dose, use on demand, or stop)
mild-mod esophagitis GERD treated for 4-8 weeks peptic ulcer disease treated 2-12wks ICU stress ulcer prophylaxis beyond ICU admission uncomplicated hpyolri treated 2 wks and asymptomatic upper GI symptoms without endoscopy asymptomatic for 3 days
49
what do you monitor for at 4 and 12 weeks of deprescribing
heartburn, regurgitation, dyspepsoa, epigastric pain | loss of appetite, weight loss, agitation
50
non drug options to assist in deprescribing
avoid meals 2 hours before bedtime elevate head of bed weight loss avoid dietary triggers
51
alternative way to manage occasional symptoms
antacid, H2blocker | PPI, aliginate prn
52
what to do is symptoms relapse after deprescribing
if persist 3-7days test and treat for hpylori and consider return to previous dose
53
what is rebound hypersecretion
compensatory effect from PPIs blocking the proton pump stimulastes gastrin inducing ECL and parietal cells to try produce acid was linked to cancer in rats
54
how to manage rebound hypersecretion
wean over 1-3 months
55
are all PPIs equally effective
yes
56
causes of drug induced esophagitis
``` tetracycline doxycycline slow release potassium quinidine ASA and NSAIDs alendronate ```
57
treatment algorithm for functional dyspepsia hpylori negative
PPI ---- TCA ---- prokinetic ---- pharmacotherapy
58
typical resolution of ulcer symptoms
1 week
59
how can nsaid use be continued after an ulcer
if duodenal can put back on NSAID after health but with gut protection gastric ulcer try to keep off as long as possible celecoxib and a PPI the best protection
60
why do we take a PPI before food
proton pumps are normally sitting back but when we eat they get to the wall of the stomach and start pumping out acid, want the PPI in board when they are in this state

Clinical 2.0 winter (28 decks)

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