Gastric Acid Disorder And Ulcerations Flashcards
Dyspepsia where is it located?? What is it? What can it cause
Dyspepsia - upper abdominal pain,heartburn,gastric reflux,bloating, nausea and vomiting
Urgent referral -
- Gastrointestinal bleeding
- Aged 55+
- Unexplained weight loss
- Dysphagia
Drug treatment:
Univestigated dyspesia:
- PPI for 4 weeks
- Test for h.pylori if ppi doesn’t work - treat if positive (can be done without 4 weeks f ppi first)
Functional dyspepsia (investigated but no cause present)
- Test for h.pylori - teat if positive
- Not infected - 4 weeks of ppi of h2 receptor antagonist
Helicobacter pylori infection =
Most common cause of peptic ulcers
Diagnosis
- Diagnose with a urea 13c breath test or stool helicobacter antigen test SAT
- PPIs should have been stopped 2 weeks before test
- Antibiotics should have been stopped 4 weeks before test
Treated with triple therapy (ppi and 2 Abx)
PPI- Twice daily
Amoxicillin - 1000mg twice daily (use other 2 if penicillin allergy)
Clarithromycin - 500mg twice daily
Metronidazole - 400mg twice daily
For 7 days
Gastro-oesophageal reflux disease:
Increased with:
Which drugs?
- Fatty food
- Pregnancy
- Hiatus hernia
- Family history
- Stress and anxiety
- Obesity
- Drug side effects - (a/b blocker,cab,anti choline raids,bentos,biphosphnates,corticosteroids,NSAID,nitrates,tca)
- Smocking
- Alcohol
Same urgent referral as dyspesia
Offer lifestyle advice first:
Healthy eating
Weight loss if obese
Avoid triggering foods
Eat smaller meals
Eat evening meals 3-4 hours before bed
Raising head bed
Smokin cessation
Reducing alcohol consumption
Medical review if taking a drug that exacerbates what? How of uninvestiagted GORD treated? Wb confirmed
Medical review if taking a drug that exacerbated GORD
Univestigated GORD Treated the same as dyspepsia
Confirmed GORD treated with 4-8 weeks of PPI
Pregnancy
- Dietary and lifestyle advice
- Antacid or an alienate
- Omeprazole or ranitidine
Antacids:
Contain magnesium which acts as a what? Aluminium does what? Calcium does what?
- Magnesium contains antacids - laxatives
- Aluminium contains antacids - constipating
- Calcium containing antacid = induces rebound acid secretion
Simeticone
What can alingates and antacid do?
Simeticone (antifoaming agent)- added to antacid - relieves flatulence
Alginates and antacids increase the viscosity of stomach content - form a viscous gel (raft ) that floats on the surface of the stomach contents
Antacid interactions =
Which has lowest sodium
Antacids not to be taken with which drugs???
Increase the stomachs pH (more alkali)- meaning enteric coated capsules are damaged before reaching the intestine
Check sodium content of antacid - not to be taken with lithium/in hypertension
- Low sodium : co-magaldrox
Antacids not to be taken with other drugs due to imparting absorption: bisphophonates, tetracycline and ciproflloxacin
Ppi
omeprazole, esomeprazole, lanzoprazole,rabeprazole
