Dyspepsia And GORD Flashcards by Shay M

Dyspepsia symptoms

Upper GI symtpoms
Upper abdominal pain/discomfort
Acid reflux, heartburn
Nausea and vomiting

How well did you know this?

Not at all

Perfectly

Dyspepsia is causes by

Increased acid

How well did you know this?

Not at all

Perfectly

How long do symptoms of dyspepsia last

Usually 4 weeks

How well did you know this?

Not at all

Perfectly

Lifestyle management of dyspepsia

Smoking cessation
Sleep with raised head of bed
Stress/anxiety management
Avoid spicy foods, alcohol
Weight loss

How well did you know this?

Not at all

Perfectly

Red flags of dyspepsia

These would require what management?

55+ with new onset or not responding to treatment

Bleeding
Dysphagia
Recurrent vomiting
Weight loss

ENDOSCOPY

How well did you know this?

Not at all

Perfectly

Describe the 2 types of dyspepsia

Functional - symptoms present but no ulcers/ cause

Uninvestigated - symptoms present but not had an endoscopy yet

How well did you know this?

Not at all

Perfectly

Which drugs cause dyspepsia

Aspirin
NSAIDs
Alpha blockers
Beta blockers
CCB
Antimuscarinics
Bisphosphonates
Corticosteroids
Benzodiazepines
Nitrates
TCA

How well did you know this?

Not at all

Perfectly

How long can antacids/ alginates be used for

Short term use only

How well did you know this?

Not at all

Perfectly

Functional dyspepsia treatment

Lifestyle measure
Offer PPI/ H2 antagonist prn

Test for H.pylori and treat if present

How well did you know this?

Not at all

Perfectly

Uninvestigated dyspepsia treatment

Test for H.pylori and treat if present, if not present:

Offer PPI or H2 antagonist for 4 weeks

How well did you know this?

Not at all

Perfectly

Why do we leave a 2 week period between taking a PPI and testing for H.pylori

Washout period

How well did you know this?

Not at all

Perfectly

Whats a washout period in dyspepsia

Leaving a 2 week interval between stopping PPI and testing for H.pylori

How well did you know this?

Not at all

Perfectly

A patient has dyspepsia but is on NSAIDs, he cant stop these NSAIDs. What do you do

Switch to paracetamol or cox2 inhibitor

Reduce dose and use long term PPI/H2 antagonist alongside

How well did you know this?

Not at all

Perfectly

Whats are examples of a Cox 2 inhibitor, what risk is associated with them

Etoricoxib
Celecoxib

Risk if CV events

How well did you know this?

Not at all

Perfectly

In patients with uninvestigated dyspepsia unable to stop aspirin ……

Switch to alternative antiplatelet- clopidogrel, pyridamole

How well did you know this?

Not at all

Perfectly

What is GORD

Acid regurgitation/ heart burn

How well did you know this?

Not at all

Perfectly

Red flags of GORD

What causes them

Chest pain
Cough
Wheezing
Asthma
Hoaresness of voice

Caused by acid moving to the lungs

How well did you know this?

Not at all

Perfectly

Complications of GORD

Barretts oesophagus
Oesophagus inflammation
Anaemia due to blood loss
Aspiration pneumonia
Stricture
Ulceration
Bleeding

How well did you know this?

Not at all

Perfectly

Treatment of GORD

PPI, anatacids, alginates, H2 antagonist

How well did you know this?

Not at all

Perfectly

Treatment of GORD in pregnancy

Lifestyle
Low sodium antacids, alginates
Omeprazole or ranitidine

How well did you know this?

Not at all

Perfectly

Which PPI is the only safe one in pregnancy

Omeprazole

How well did you know this?

Not at all

Perfectly

When is Omeprazole used in GORD in pregnancy

Severe symptoms

How well did you know this?

Not at all

Perfectly

GORD infants treatment <12 yrs and > 12 yrs

<12 yrs - change freq and volume of feed, use thickner

> 12 yrs - treat like adults

How well did you know this?

Not at all

Perfectly

GORD counselling and patient advice

Eat small meals slowly and not at bedtime

Avoid precipitating factors

Sleep with head raised

Lose weight

How well did you know this?

Not at all

Perfectly

Which groups of patients would you avoid high sodium antacids

Pregnant Hypertension Liver or kidney failure Sodium restricted diet

Which antacid would you avoid in a constipated patient

Aluminium containing

What antacid would you avoid in diarrhoea

Magnesium containing

Which are more effective- liquid or tablet antacids

Liquid

Can you give antacids with other medication

Leave 2 hrs between as can affect absorption if other meds and can damage enteric coating in some MR tabs

Avoid sodium bicarbonate in those taking ……. Or have these conditions ……

Lithium High BP, salt restricted diet, fluid retention

Lithium and sodium bicarbonate interaction

Sodium bicarbonate reduces lithium concentration

Which antacids provide quick relief (how long?) But its effects dont last long

SCAM Sodium bicarbonate Calcium bicarbonate Aluminium hydroxide Magnesium hydroxide

What is low sodium content? Values

< 1mmol/ tablet or 10ml dose

Which antacids have low sodium content

MAM Co- magaldrox (MAALOX and mucogel) Co- simalcite (altacite plus)

What drugs are in co- magaldrox

Magnesium and aluminium

What drugs are in co simalcite

Simethicone and hydrotalcite

Which antacids have high sodium content

Sodium alginate with potassium bicarbonate- gaviscon advance

Gaviscon advance and normal gaviscon difference

Gaviscon advance has double sodium

PPI examples

Omeprazole Esomeprazole Lansoprazole

Monitoring requirements for PPI

Monitor serum magnesium when using other drugs causing hypomagnesia or with digoxin

PPI MHRA warning

May cause lupus (skin reactions) - lesions on skin when exposed to sun

A patient is on Omeprazole and develops lupus, what do you do?

Reduce or stop (reversible when PPI stopped)

Hypomagnasaemia symptoms

Convulsions Muscle pain/ weakness

PPI cautions

MC GOLF magnesium (causes hypomagnesia) Cancer (masks symptoms) GI infections - c.diff risk increased Osteoporosis (maintain vit D and calcium) Lupus Fractures

Omeprazole interactions

AVOID CLOE Clopidogrel interacts with omeprazole and esomeprazole - they decrease clopidogrels efficency Decreases METHOTREXATE clearance- use with caution or avoid Digoxin- monitor magnesium

Which PPI can u use in breastfeeding

All but with caution

H.pylori symptoms

Burning pain in stomach

Tests used to diagnose h.pylori

Stool antigen test Urea 13C- most common

Washout periods of h.pylori prevent false negatives, explain this

Wait 4 weeks after stopping antibx before getting tested Wait 2 weeks after stopping PPI before getting tested

Duration of antibx treatment for h.pylori

7 days - 1st and 2nd line 10 days - 3rd line

Treatment used for h.pylori in non penicillin allergy

Triple therapy for 7 days otherwise refer 1. PPI + amoxicillin + metronidazole or clarithromycin 1. PPI + amoxicillin + tetracycline (if metro or clarithromycin recently used) 2. PPI + bismuth + 2 antibx not used before or with rifabutin or furazolidone

Treatment for H.pylori in penicillin allergy

1. PPI + metronidazole + clarithromycin 1. PPI + metronidazole + tetracycline + bismuth (if clarithromycin recently used) 2. PPI + metronidazole + levofloxacin All used for 7 days each

What is bismuth subsalicylate

Anti diarrhoeal drug

Rifabutin and furazolidone are….. Used in…..

Antibiotics used in h.pylori

Clarithromycin + ciclosporin interaction

Increases concentration of ciclosporin

Cimetidine and phenytoin interaction

Increases concentration of phenytoin

PPI doses in H.pylori

Omeprazole 20-40mg BD rabeprazole 20mg BD Esomeprazole 20mg BD lansoprazole 30mg BD Pantoprazole 40mg BD

GI protectors and chelators protect ….. Describe an example

Protect stomach lining Sucralfate is a chelate. It contains sucrose and aluminium and is given late (bedtime). Given 1hr before meal or enteral feeds

Sucralfate - be careful in which patients and why

Intensive care as they can cause bezoar formation which is a solid indigestible mass which blocks enteral feeding tubes

Whats a bezoar formation

Solid indigestible mass

H2 receptor antagonist examples

Ranitidine Famotidine Cimetidine

H2 receptor antagonist MOA

Heal gastric/ duodenal ulcers Relieves GORD symptoms

Avoid H2 receptor antagonists in which syndrome What is it and what can be given as an alternative

Zollinger ellisone syndrome (stomach tumour causing increased acid) PPI more effective

Which h2 receptor antagonist is safe in pregnancy

Ranitidine Famotidine and cimetidine- avoid unless essential and benefit outweighs risk

H2 receptor antagonist caution!!

Masks symptoms of GI cancer

SE of h2 receptor antagonist

Diarrhoea Constipation Dizziness Headaches Myalgia Fatigue

What is misoprostol Indication Caution

Synthetic prostaglandin analogue - helps heal duodenal and gastric ulcers Caution in child bearing women, exclude pregnancy and ensure contraception is in place - teratogenic