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GI SYSTEM - MEDIUM > Gastric acid and ulceration > Flashcards

Gastric acid and ulceration Flashcards

1
Q

What are symptoms of dyspepsia?

A
  • abdominal pain
  • fullness
  • early satiety
  • bloating
  • nausea
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2
Q

How do you treat uninvestigated dyspepsia?

A
  • Antacids for symptom relief
  • PPI for 4 weeks if symptoms persist
  • H. Pylori test if no response to ppi
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3
Q

How do you treat investigated dyspepsia?

A
  • H. Pylori test

- PPI or H2 antagonist for 4 weeks

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4
Q

Which antacids can cause constipation?

A

Aluminium

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5
Q

Which antacids can sometimes be a laxative?

A

Magnesium

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6
Q

What interacts with antacids?

A
  • Tetrracyclines
  • Quinolones (ciprofloxacin)
  • Bisphosphonates

Leave 2 hour gap

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7
Q

What can prolonged high doses of calcium containing antacids cause?

A

Hypercalcaemia

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8
Q

When should you avoid antacids?

A
  • In a sodium restricted diet e.g. lithium
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9
Q

What are examples of alginates and how do they work?

A
  • Alginic acid
  • Sodium alginate
  • Forms viscous gel raft on top of stomach to prevent reflux
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10
Q

How do PPIs work?

A
  • Inhibit gastric secretion by blocking the proton pump

e.g. lanso (30-60 mins before food)
omeprazole

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11
Q

How long before or after taking PPIs should you not take indigestion remedies?

A

2 hours

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12
Q

What cautions come with PPIs?

A
  • Mask symptoms of gastric cancer
  • Increase risk of fractures and osteoporosis
  • Increase risk of GI infections - c diff
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13
Q

What are the side effects of PPIs?

A
  • Abdominal pain
  • Constipation
  • Diarrhoea
  • Nausea
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14
Q

What can occur as long term effects of PPIs?

A
  • Hypomagnasaemia
  • Fractures
  • Rebound acid secretion
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15
Q

What interacts with PPIs?

A

Omeprazole

  • Clopidogrel - reduced antiplatelet effect
  • Mtx - decreased clearance of mtx
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16
Q

What are examples of H2 receptor antagonists?

A
  • Cimetidine
  • Ranitidine
  • Famotidine
  • Nizatidine
17
Q

What are the side effects of H2 receptor antagonists?

A
  • Headache
  • Rash
  • Dizziness
  • Diarrhoea
  • Psychiatric reactions
18
Q

What is the initial treatment for H. Pylori?

A
  • Triple therapy (1 week) - PPI (bd) + clarithromycin + amox or metronidazole

if a pt has been treated with metro or clarithro for other infections, use the opposite one when treating this

19
Q

What can be given as an alternative to metronidazole in the treatment of H Pylori?

A
  • Tinidazole
20
Q

How would you diagnose H. Pylori?

A
  • C-Urea breath test kits

- Do not perform within 4 weeks of treatment with antimicrobial

21
Q

Usually routine testing to confirm eradication of H Pylori is not needed. On which occasions would this be necessary?

A
  • gastric MALT lymphoma

- If pt has ulcer

22
Q

How do you treat NSAID-induced ulcers?

A
  • Withdraw NSAID if possible
  • PPI or H2 antagonist
  • Test for H. Pylori on healing - if positive then triple therapy
  • If history of upper GI bleed - give PPI and switch to paracetamol
23
Q

Which patients are at high risk of developing NSAID induced ulceration?

A
  • 65+
  • previous history
  • taking certain meds that increase GI complications
  • Co morbidities - liver, kidney, heart, diabetes
24
Q

What is given as prophylaxis treatment for NSAID induced ulcers?

A
  • PPI or H2 antagonist/misoprostol
25
Q

What would you do if a pt had 3 or more risk factors for developing an NSAID induced ulcer?

A
  • PPI with COX-2 selective NSAID
26
Q

What are symptoms of GORD?

A
  • heartburn
  • acid reflux
  • sometimes difficulty swallowing
  • ulceration
27
Q

How do you treat mild symptoms of GORD?

A
  • Antacids + alginates

- H2 receptor antagonist/PPI

28
Q

How do you treat severe symptoms of GORD?

A
  • PPI for 4-6 weeks

- Maintain remission with lower dose PPI, intermittent PPI or substitute with H2 receptor antagonist

29
Q

What would you give for GORD in pregnancy?

A
  • Antacids or alginates

- If ineffective - ranitidine

30
Q

How would you treat mild to moderate GORD in children?

A
  • Increase the volume of feed (e.g. with a feed thickener)

- alginate containing preparation

GI SYSTEM - MEDIUM (5 decks)

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