Dyspepsia and GERD Flashcards
what is dyspepsia
group of symptoms!! pain/discomfort in or around upper abdomen
rome 3 criteria defines dyspepsia as at least one of the following
posprandial fullness
early satiation (unable to finish normal meal)
epigastric pain/burning
symptoms of dyspepsia
bloating
nausea
anorexia
burping
functional dyspepsia
idiopathic- pahtophysiology not understood
normal endoscopy
majority of cases
organic dyspepsia
actual pathological or drug source
minority of cases
what causes gerd
retrograde movement of stomach contents in esophagus
what is gerd
chronic digestive disease
symptoms and esophageal damage from reflux
montreal classifications defines gerd as condtion from reflux of stomach contents causing troublesome symtoms, what is considered troublesome
mild symptoms two or more days a week
moderate/severe symptoms occur more than one day a week
what ph daamages esophagus
lower than 4
describe a defective LES
pressure gradient between LES and stomach is less than normal or absent
(normally resting tone of LES > intragastric pressure)
pathogenisis of GERD
hiatal hernia impaired esophageal peristalisis delayed gastric emptying excessive gastric acid production bile reflux
complication of gerd (11)
esophagitis stricture barretts esophagitis esophageal cancer worseing asthma or pneumonia ulcer hemorrhage anemia tooth decay gingivitis halitosis
factors that contribute to gerd and dyspepsia
food and beverage pregnancy lifestyle- obesity, smoking advancing age meds disease states (hernia. sjogren, asthma) posture stress and anxiety
how can food exacerbate symptoms
decrease LES tone direct mucosal irritation irritation of preexisting ulcer direct stimulation of mucosal sensory receptors gastric over distention delayed gastric emptying gas production
foods that reduce LES tone
alcohol carbonated caffeinated high sugar/fat content garlic onion peppermint
foods with direct irritant effect
citrus
coffee
spicy
tomato
meds that have direct irritant effect
antibiotics
NSAIDS
iron
biphosphonates
reflux like symptoms
heartburn and acid regurgitation
belching and burping
ulcer like symptoms
epigastric pain/discomfort
pain relieved by food
pain wakens person from sleep
dismotility symptoms
early satiety or postprandial fullness N/V or retching bloating with no visible distention feeling of abnormal digestion worsened by food
main symptoms of gerd
heartburn and regurgitation most common hypersalivation noncardiac chest pain burp/belching worsens when bendign over/ lying down occurs 1-2 hours after eating
frequent symptoms
2 or more days per week
episodic symptoms
mild and sporadic unpredictable
persistent/chronic symptoms
3 months or greater
red flags
larynigitis pharyngitis choking/globus sensation hiccups water brash dental erosion chronic cough cardiac chest pain odynophagia dysphagia pain unrelated to meals sever symptoms nighttime symptoms wake them up radiating pain anemia jaundice hematemesis melena N/V diarrhea unexplained weight loss resp symptoms pediatrics
differential diagnoses
IBS peptic ulcer gastric/ pancreatic cancer angina myocardial infraction gallstones asthma
goals of therapy
relieve symptoms prevent recurrence heal esophageal muscosa improve quality of life prevent complications
bismuth subsalicylate mechanism of action
suppresses h.pylori
indication of bismuth
treatment of overindulgence of food and alcohol, diarrhea
use of bismuth
adults and children over 12
2 tab or 30ml QID with meals and bedtime
side effects of bismuth
darkening of tongue
grayish black stool
toxicity
tinnitus
precautions of bismuth
young children bleeding disorders salicylate sensitivity meds that interact with salicylates not during pregnancy or breastfeeding
omeprazole mechanism of action
inhibit hydrogen potassium ATPase, irreversibly blocking the final step in gastric acid secretion
onset of omeprazole
2-3 hours but complete relief may take 1-4 days
omeprazole indication
frequent heartburn in patients who have symptoms 2 or more days per week, not acute episodes
dosage of omprazole
20 mg by mouth 30-60 min before eating for 14 days
may be repeated 4 months after if symptoms recur
omeprazole drug interactions
CYP 2c19
decrease absorption of ph dependent drugs
side effects of omeprazole
diarrhea, constipation, headache
long term may increase risk of osteoporosis, bone fracture, c.diff infection, hypomagnesamia and vitamin b12 deficiency
types of antacids
caco3 aloh mg salts mg/al complexes na bircarbonate na citrate
chemical names of h2bs
rantidine
famotidine
proton pump inhibitors
omeprazole
some combo products
famotidine with caco3 and mgoh
antacid/simethicone
antacid/alginate
chemical names of foaming agents
alginic acid
alginates
gaviscon
chemical name of antiflatulents
simethicone
which agents prevent and relieve symptoms of dyspepsia/GERD
h2b
combo products
which agents relieve symptoms of dyspepsia/GERD
antacids
h2b
combo products
foaming agents
which agents relieve symptoms of bloating and gas
antiflatulents
antacids mechanism of action
neutralize existin acid
doesnt affect amount or rate of gastric acid secretion
increase both gastric and duodenal ph
h2b mechanism of action
competitively and reverely binds to h2 receptors in gastric parietal cells
dose dependent inhibition of gastric acid secretion
foaming agents mechanism of action
alginates precipitate in acid medium of stomach to form sponge like matrix of alginic acid
bicarbonate reacts with gastric acid to form co2 which is trapped in matrix and helps it float like a raft which acts as a barrier between contents of stomach and esophagus
antiflatuents machanism of action
decrease surface tension of gas bubbles in stomach and intestine so they are broken and eliminated more easily
what is ANC and what is it influences by
amoutn of acid buffered/dose over a specified period
influenced by ingredients, formulation, and manufacturer
common dose of antacids
10-20ml or 2-4 tablets after meals and at bedtime
duration of antacid action
as long as antacid is in the stomach
lasts 1 hour if given without food and 1-3 hours if given after food
side effects of antacids
too many hell no
which antacid do you use in renal failure, pregnancy, or breast feeding
calcium
who shouldnt use mg and al antacids
renal dysfunction
elderly
not studied extensive in pregnancy
who should you avoid sodium in
people with restricted sodium intake such as renal dysfunction, edema, cirrhosis, heart failure, HTN
pregnant or breast feeding
how do antacids interfere with drugs
increase gastric ph interferes with absorption
increases urine ph interferes with elimination
bind to drug to form complexes
alteration of GI transit time
drug interactions with antacids
enteric coated and buffered products
antibiotics
iron and digoxin
do not take oral meds within 2 hours of antacids
