Dyspepsia and Haemorrhoids Flashcards
Dyspepsia
- Indigestion
- Concerns upper GIT
Rome IV criteria of dyspepsia
- prolonged persistence of food in stomach (postpranial fullness)
- early satiation (unable to eat full meal/full after eating small amount)
- epigastric pain
- epigastric burning
Symptoms of dyspepsia
- Upper abdominal pain
- Heartburn
- Acid reflux
- Bloating
- Belching (burping)
- Flatulence
- Intolerant to some foods
- Symptoms fluctuate
Aetiology of dyspepsia
- smoking
- alcohol
- obesity
- pregnancy
- lifestyle (lack of exercise/diet/stress)
When to refer for dyspepsia
- Signs of bleeding
- dysphagia (swallowing difficulty)
- unintended weight loss
- persistent vomiting
- iron deficiency anaemia
- epigastric mass
2 WEEK REFERAL RULE
Lifestyle measures
- Lose weight
- Stop smoking
- Reduce alcohol intake
- Avoid fatty foods and caffiene
- Raise head when sleeping
- Avoid tight fitting clothes
- Leave atleast 2 hours between eating and bedtime
- Dealing with stress
Alginates
GAVISCON
- Forms raft on stomach contents
- Protects gastric mucosa
- Symptomatic relief from reflux
- Gaviscon exacerbates hypertension so Gaviscon advanced is recommended as it has reduced salt and Cl-
Antacids
RENNIE AND TUMS
- Neutralise stomach acid
- Fast acting (1 hour)
- Impair absorption of other drugs
- Aluminium = constipation
- Magnesium = diarrhoea
- Use in combination to reduce effects
H2RA and PPI
- H2RA
- Block H2R in parietal cell
- fast acting (1 hr) - PPI
- Use lowest effective dose
- Blocks H+ K+ ATPase
GORD in children
- Sphincter muscles are not mature and prevent backflow of feed
- Food and acid mixes
- Irritates lining of GI making it sore
Symptoms of GORD in children
Spitting up/regurgitation of food, abdominal pain, general crankiness, frequent chest infection from inhaling stomach contents into lungs, surface of oesophagus becomes inflamed leading to scarring and narrowing
Gaviscon Sachets
- Thickens food
- Physical barrier to food coming back
- Simethicone forms raft on top of food
BREAST FEEDING:
- Mix sachet with 5ml of boiled and cooled water
- Add another 10ml of boiled and cooled water
- Give halfway through feeding
BOTTLE FEEDING:
- Mix sachet with 115ml of milk
Domperidone
- For when nothing else works
- Arrhythmias - ST elevation prolonged
- Baseline ECG
What is haemorrhoids?
- Swellings that develop inside and around the anal canal
- Bleeding is common
INTERNAL: - 2-3cm inside anus
- Often painless
EXTERNAL: - Lower part of anal canal
- Painful
Examined by GP using proctoscopy or two fingers by feeling around the area - Common due to ageing, during/after pregnancy, prolonged straining, genetic factors
Symptoms of haemorrhoids
- Bleeding on defecation
- Pain/discomfort
- Pruritus(Itch)/tender lumps around anus
- Mucus discharge
- Feeling of incomplete defecation
- Partial inconsistence
When to refer for haemorrhoids
- No response to OTC
- Longer than 3 weeks
- Excessive bleeding with changes in bowel habits/weight loss
- Blood in stools
Lifestyle measures for haemorrhoids
- Increase dietary fibre
- Increase fluid intake
- Good hygeine
- Avoid straining
- Suitable pain relief i.e. paracetamol
AnuSol
Topical
- Zinc oxide, Allatoin, Balsalm of Peru
- Emollient and protective properties
- Prevent local irritation
Local Anaesthetics
- Lidocaine, Cinchocaine, Proctadesyl
- Alleviates pain, itching and burning
- Use max for 5 days - can cause sensitisation of perianal skin
Topical corticosteroids
Hydrocortisone, AnuSol HC
- Reduces inflammation
- Alleviates pain
- Use max for 7 days
Astringent agents
Bismuth oxide and witch hazel
- Proteins are precipitated into the skin
- Forms a protective layer
- Reduces inflammation and irritation
Bulk forming laxative
Fybogel, Ispahgu
Injection sclerotherapy
- Phenol oil injected into submucosa of rectum
- Causes collapse inducing fibrotic reaction
- Atrophy of haemarrhoid
Rubber band ligation
- Strangles haemarrhoid
- No perfusion of blood to haemarrhoid
- Necrosis/death
Surgery
- Haemarrhoidectomy
- Stapled haemarrhoidectomy
