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Clinical > Dyspepsia and GERD > Flashcards

Dyspepsia and GERD Flashcards

1
Q

what is dyspepsia

A

group of symptoms!! pain/discomfort in or around upper abdomen

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2
Q

rome 3 criteria defines dyspepsia as at least one of the following

A

posprandial fullness
early satiation (unable to finish normal meal)
epigastric pain/burning

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3
Q

symptoms of dyspepsia

A

bloating
nausea
anorexia
burping

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4
Q

functional dyspepsia

A

idiopathic- pahtophysiology not understood
normal endoscopy
majority of cases

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5
Q

organic dyspepsia

A

actual pathological or drug source

minority of cases

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6
Q

what causes gerd

A

retrograde movement of stomach contents in esophagus

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7
Q

what is gerd

A

chronic digestive disease

symptoms and esophageal damage from reflux

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8
Q

montreal classifications defines gerd as condtion from reflux of stomach contents causing troublesome symtoms, what is considered troublesome

A

mild symptoms two or more days a week

moderate/severe symptoms occur more than one day a week

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9
Q

what ph daamages esophagus

A

lower than 4

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10
Q

describe a defective LES

A

pressure gradient between LES and stomach is less than normal or absent
(normally resting tone of LES > intragastric pressure)

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11
Q

pathogenisis of GERD

A 
hiatal hernia 
impaired esophageal peristalisis 
delayed gastric emptying 
excessive gastric acid production 
bile reflux
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12
Q

complication of gerd (11)

A 
esophagitis 
stricture
barretts esophagitis 
esophageal cancer
worseing asthma or pneumonia 
ulcer
hemorrhage
anemia 
tooth decay 
gingivitis 
halitosis
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13
Q

factors that contribute to gerd and dyspepsia

A 
food and beverage
pregnancy 
lifestyle- obesity, smoking
advancing age
meds
disease states (hernia. sjogren, asthma)
posture 
stress and anxiety
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14
Q

how can food exacerbate symptoms

A 
decrease LES tone 
direct mucosal irritation 
irritation of preexisting ulcer
direct stimulation of mucosal sensory receptors 
gastric over distention 
delayed gastric emptying 
gas production
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15
Q

foods that reduce LES tone

A 
alcohol 
carbonated
caffeinated
high sugar/fat content 
garlic onion 
peppermint
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16
Q

foods with direct irritant effect

A

citrus
coffee
spicy
tomato

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17
Q

meds that have direct irritant effect

A

antibiotics
NSAIDS
iron
biphosphonates

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18
Q

reflux like symptoms

A

heartburn and acid regurgitation

belching and burping

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19
Q

ulcer like symptoms

A

epigastric pain/discomfort
pain relieved by food
pain wakens person from sleep

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20
Q

dismotility symptoms

A 
early satiety or postprandial fullness
N/V or retching 
bloating with no visible distention 
feeling of abnormal digestion 
worsened by food
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21
Q

main symptoms of gerd

A 
heartburn and regurgitation most common
hypersalivation 
noncardiac chest pain 
burp/belching
worsens when bendign over/ lying down 
occurs 1-2 hours after eating
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22
Q

frequent symptoms

A

2 or more days per week

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23
Q

episodic symptoms

A

mild and sporadic unpredictable

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24
Q

persistent/chronic symptoms

A

3 months or greater

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25
Q

red flags

A 
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
26
Q

differential diagnoses

A 
IBS
peptic ulcer
gastric/ pancreatic cancer
angina myocardial infraction 
gallstones
asthma
27
Q

goals of therapy

A 
relieve symptoms 
prevent recurrence 
heal esophageal muscosa
improve quality of life
prevent complications
28
Q

bismuth subsalicylate mechanism of action

A

suppresses h.pylori

29
Q

indication of bismuth

A

treatment of overindulgence of food and alcohol, diarrhea

30
Q

use of bismuth

A

adults and children over 12

2 tab or 30ml QID with meals and bedtime

31
Q

side effects of bismuth

A

darkening of tongue
grayish black stool
toxicity
tinnitus

32
Q

precautions of bismuth

A 
young children 
bleeding disorders
salicylate sensitivity 
meds that interact with salicylates 
not during pregnancy or breastfeeding
33
Q

omeprazole mechanism of action

A

inhibit hydrogen potassium ATPase, irreversibly blocking the final step in gastric acid secretion

34
Q

onset of omeprazole

A

2-3 hours but complete relief may take 1-4 days

35
Q

omeprazole indication

A

frequent heartburn in patients who have symptoms 2 or more days per week, not acute episodes

36
Q

dosage of omprazole

A

20 mg by mouth 30-60 min before eating for 14 days

may be repeated 4 months after if symptoms recur

37
Q

omeprazole drug interactions

A

CYP 2c19

decrease absorption of ph dependent drugs

38
Q

side effects of omeprazole

A

diarrhea, constipation, headache

long term may increase risk of osteoporosis, bone fracture, c.diff infection, hypomagnesamia and vitamin b12 deficiency

39
Q

types of antacids

A 
caco3
aloh 
mg salts
mg/al complexes
na bircarbonate
na citrate
40
Q

chemical names of h2bs

A

rantidine

famotidine

41
Q

proton pump inhibitors

A

omeprazole

42
Q

some combo products

A

famotidine with caco3 and mgoh
antacid/simethicone
antacid/alginate

43
Q

chemical names of foaming agents

A

alginic acid
alginates
gaviscon

44
Q

chemical name of antiflatulents

A

simethicone

45
Q

which agents prevent and relieve symptoms of dyspepsia/GERD

A

h2b

combo products

46
Q

which agents relieve symptoms of dyspepsia/GERD

A

antacids
h2b
combo products
foaming agents

47
Q

which agents relieve symptoms of bloating and gas

A

antiflatulents

48
Q

antacids mechanism of action

A

neutralize existin acid
doesnt affect amount or rate of gastric acid secretion
increase both gastric and duodenal ph

49
Q

h2b mechanism of action

A

competitively and reverely binds to h2 receptors in gastric parietal cells
dose dependent inhibition of gastric acid secretion

50
Q

foaming agents mechanism of action

A

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

51
Q

antiflatuents machanism of action

A

decrease surface tension of gas bubbles in stomach and intestine so they are broken and eliminated more easily

52
Q

what is ANC and what is it influences by

A

amoutn of acid buffered/dose over a specified period

influenced by ingredients, formulation, and manufacturer

53
Q

common dose of antacids

A

10-20ml or 2-4 tablets after meals and at bedtime

54
Q

duration of antacid action

A

as long as antacid is in the stomach

lasts 1 hour if given without food and 1-3 hours if given after food

55
Q

side effects of antacids

A

too many hell no

56
Q

which antacid do you use in renal failure, pregnancy, or breast feeding

A

calcium

57
Q

who shouldnt use mg and al antacids

A

renal dysfunction
elderly
not studied extensive in pregnancy

58
Q

who should you avoid sodium in

A

people with restricted sodium intake such as renal dysfunction, edema, cirrhosis, heart failure, HTN
pregnant or breast feeding

59
Q

how do antacids interfere with drugs

A

increase gastric ph interferes with absorption
increases urine ph interferes with elimination
bind to drug to form complexes
alteration of GI transit time

60
Q

drug interactions with antacids

A

enteric coated and buffered products
antibiotics
iron and digoxin
do not take oral meds within 2 hours of antacids

Clinical (16 decks)

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