gastric acid disorders and ulcerations Flashcards
what is dyspepsia?
-upper abdominal pain, heart burn, gastric reflux, bloating
-nausea and vomiting
what are some urgent referrals symptoms for dyspepsia?
gastrointestinal bleeding
aged 55 years+
unexplained weight loss
dysphagia
what are the 2 types of dyspepsia?
-uninvestigated
-functional
what is uninvestigated dyspepsia?
-PPI for 4 weeks first
-test for H.pylori if PPI didn’t work treat if positive
what is the treatment for functional dyspepsia? (investigated but no cause present)
-test for H. Pylori treat positive
not infected: 3 weeks of PPI or H2 receptor antagonist
how do you test for H.Pylori?
-diagnosed with a urea (13C) breath test or stool helicobactor antigen test (SAT)
-ppi should have been stopped 2 weeks before test
-antibiotics should have stopped 4 weeks before test
how is H pylori treated?
triple therpY: PPI and 2 of the antibiotics
-PPI twice daily
-Amoxicillin 100mg twice daily (use other 2 in penicillin allergy)
-clarithromycin 500mg twice daily for 7 days
-metronidazole 400mg twice daily for 7 days
what can increase the chances of gastro-oesophageal reflux disease?
-consuming fatty food
-preganancy
hiatus hernia
-family history
-stress and anxiety
obesity
-drug Side effects
-SMOKING
-ALCoHOL
what drug side effects cause GORD?
(a/b-blockers, CCB, anticholinergics, bentos,bisphosphonates, corticosteroids, NSAIDs, nitrates and TCAs) -looses up the sphincter
what should be offered first for GORD?
lifestyle advice
what lifestyle advice can be given for GORD?
-healthy eating
-weight loss (if obese)
-avoiding any trigger foods
-eating smaller meals
-eating evening meal 3-4hrs before bed
-raising the head of the bed
-smoking cessation
-reducing alcohol consumption
what is the treatment for GORD?
Medicine review, some can exacerbate GORD
-UNINVESTIGATED good TREATED THE SAME AS UNINVESTIGATED DYSPEPSIA
-confirmed GORD treatment with 4-8weeks of PPI
HOW DO YOU TREAT good IN PREGNANCY?
dietary and lifestyle
antacid or an alginate
omeprazole or ranitidine
what are some antacids and their effects?
-magnesium-containing antacids= laxative
-aluminium-containing antacids= constipation
-calcium-containing= indices rebound acid secretion
how do simeticone work?
-antifoaminng agent added to antacid leading to relived flatulence
what do alginates + antacid do?
increase the viscosity of stomach content. form a viscous Gell (raft) that floats on the surface of the stomach content§
what are some antacid interactions?
-increase stomach pH (more alkali) meaning enteric coated capsules are damaged before reaching the intestine
-check sodium content of antacids-not to be taken with lithium/ in hypertension
-not taken with other drugs due to impairing absorption. e.g. bisphosphonates, tetracyclines, ciprofloxacin
what is the low sodium antacids ?
-co-magaldrox
what are some warnings for PPI?
-low risk subacute lupus erythematosus
-increases risk of fractures/ osteoporosis due to hypomagnesaemia
-increased risk of c.diff
-masks symptoms of gastric cancer
what are some interactions with specific drugs for PPI?
-es/omeprazole + clopidogrel (use lansoprazole)
-increases conc of methotrexate, phenytoin, warfarin and digoxin
what are H2 receptor antagonists examples?
-ranitadine, cimetidine, famotidine nizatidine
what are some cautions for H2 receptor antagonists?
-mask symptoms of gastric cancer=rule out alarm features of cancer before treatment
what are some side effects of H2 receptor antagonists?
diarrhoea, headache, dizziness, rash, tiredness
what are some interactions to be aware of?
cimedtine is an enzyme inhibitor
-reducted absorption of -azole antifungials
