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PR - GI > GASTRIC ACID DISORDERS + ULCERATION > Flashcards

GASTRIC ACID DISORDERS + ULCERATION Flashcards

1
Q

Dyspepsia

A

Upper abdominal pain
heartburn
gastric reflux
bloating
nausea and vomiting

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2
Q

Dyspepsia - red flags

A
  • Gastrointestinal Bleeding
  • Aged 55 Years +
  • Unexplained Weight Loss
  • Dysphagia
    GAUD
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3
Q

Uninvestigated dyspepsia

A

describes symptoms in patients who have not had an endoscopy.

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4
Q

Uninvestigated Dyspepsia - Treatment

A
  • PPI for 4 weeks first
  • Test for H. pylori if PPI didn’t work - treat if positive
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5
Q

Functional Dyspepsia (investigated but no cause present)

A

Test for H. pylori - treat if positive
Not infected: 3 weeks of PPI or H2 receptor antagonist

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6
Q

H.Pylori

A

Most common causes of peptic ulcer disease

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7
Q

H.pylori - when do you test pt?

A
  • uncomplicated dyspepsia who are unresponsive to lifestyle changes and antacids, following 4 week PPI
  • high risk of H. pylori infection (such as older people, individuals of North African ethnicity, and those living in a known high risk area)
  • Previously untested patients with a history of peptic ulcers or bleeds;
  • Prior to initiating NSAIDs in patients with a prior history of peptic ulcers or bleeds;
  • Patients with unexplained iron-deficiency anaemia after endoscopic investigation has excluded malignancy, and other causes have been investigated.
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8
Q

H.Pylori - diagnosis

A

Urea (13C) breath test
Stool Helicobacter Antigen Test (SAT)

PPI stopped 2 weeks before test
Abx stopped 4 weeks before test

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9
Q

H.Pylori - triple therapy treatment

A

Treated with Triple Therapy (PPI and 2 of the antibiotics):
- PPI: BD
- Amoxicillin: 1000mg BD
- Clarithromycin: 500mg BD
FOR 7 DAYS
- Metronidazole: 400mg BD

PAC
PAM
PCM

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10
Q

GORD

A

Gastro-Oesophageal Reflux Disease

(a/b-blockers, CBs, anticholinergics, benzos, bisphosphonates, corticosteroids, NSAIDs, nitrates, and TCAs)
AMENDMENTS
31/03/2024 - Uninvestigated dyspepsia: H.Pylori test can be done

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11
Q

GORD - risk factors

A

Increased with:
* Consuming Fatty Foods
Pregnancy
* Hiatus Hernia
* Family History
* Stress And Anxiety
* Obesity
* Drug Side-effects
* Smoking
* Alcohol

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12
Q

GORD - red flags

A

SAME URGENT REFERRAL
CRITERIA AS DYSPEPSIA

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13
Q

GORD - which drugs have a side effect of GORD?

A

a/b-blockers, CCBs, anticholinergics, benzos, bisphosphonates, corticosteroids, NSAIDs, nitrates, and TCAs, alendronic acid

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14
Q

GORD - non-drug treatment

A

1st line: lifestyle advice
Healthy eating
Weight loss (if obese)
Avoiding any trigger foods
Eating smaller meals
Eating the evening meal 3-4 hours before going to bed
Raising the head of the bed
Smoking cessation
Reducing alcohol consumption

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15
Q

uninvestigated GORD - treatment

A

Medicine review if taking a drug that exacerbates GORD
* PPI for 4 weeks first
* Test for H. pylori if PPI didn’t work - treat if positive

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16
Q

Confirmed GORD - treatment

A

treated with 4-8 weeks of PPI

17
Q

Dyspepsia - pregnancy

A

Dyspepsia symptoms in pregnancy are commonly due to gastro-oesophageal reflux disease (GORD)

18
Q

Dyspepsia in pregnancy - treatment

A
  • 1st line: Dietary and lifestyle advice
  • No response = an antacid or an alginate can be used.
  • If this is ineffective or symptoms are severe omeprazole or ranitidine (unlicensed)
19
Q

Antacids - examples

A

Magnesium-containing antacids: Laxative
Aluminium-containing antacids: Constipating
Calcium-containing antacids: Induces rebound acid secretion

20
Q

Simeticone (antifoaming agent) added to antacid →

A

relieves flatulence

21
Q

Alginates + antacid

A

increases the viscosity of stomach content
form a viscous gel (‘raft’) that floats on the surface of the stomach contents

22
Q

Antacids Interactions

A
  • Increase the stomach 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 impairing absorption
    Bisphosphonates, Tetracyclines, Ciprofloxacin
23
Q

Antacids and enteric coated capsules

A

Increase the stomach pH (more alkali) meaning enteric coated capsules are damaged before reaching the intestine

24
Q

Antacids and sodium

A
  • Check sodium content of antacid - not to be taken with lithium / in hypertension
    > Low sodium: co-magaldrox
25
Q

Antacids and other drugs

A

Antacids not to be taken with other drugs due to impairing absorption
Bisphosphonates, Tetracyclines, Ciprofloxacin

26
Q

Proton Pump Inhibitors - examples

A

Omeprazole Esomeprazole Lansoprazole Rabeprazole

27
Q

PPI - side effects

A

Osteoporosis - risk of bone fractures due to low B12
Increased risk of C.diff
Masks symptoms of gastric cancer
- Hyponatraemia and hypomagnesaemia
- CAP

28
Q

PPI - osteoporosis

A

Increase risk of fractures / osteoporosis
* Due to hypomagnesaemia and low B 12

29
Q
A
30
Q

PPI - interactions

A

INTERACTION:
Es/omeprazole/ omeprazole + Clopidogrel
(use lansoprazole instead)

Increase conc of methotrexate, phenytoin, warfarin and digoxin

31
Q

Eso/ omeprazole + clopidogrel

A
  • Suitable alternatives: pantoprazole least likely to interact and lansoprazole and rabeprazole also suitable
32
Q

Important safety information for PPIs

A

SCLE
 Advise to avoid exposing the skin to sunlight
 Consider SCLE
 Consider STOP PPI
 Symptoms should resolve on PPI withdrawal

33
Q

Symptoms of SCLE

A
  • lesions – especially in sun exposed areas of the skin
  • accompanied by arthralgia
34
Q

H2 Receptor Antagonists - examples

A

Ranitadine Cimetidine Famotidine Nizatidine

35
Q

H2 receptor antagonists - Side effects

A

Diarrhoea, headache, dizziness, rash, and tiredness

36
Q

H2 receptor antagonists - cancer

A

Caution: may mask symptoms of gastric cancer
Rule out alarm features of cancer before treatment

37
Q

H2 receptor antagonists - Interactions

A

Reduced absorption of -azole antifungals

38
Q

Cimetidine

A

CYP450 enzyme inhibitor

39
Q

CKS guidelines for suspected cancer pathway referral (for an appointment within 2 weeks) if:

A
  • aged 40 and over with unexplained weight loss and abdominal pain
  • aged 50 and over with unexplained rectal bleeding
  • aged 60 and over with either iron-deficiency anaemia or changes in their bowel habit
  • Tests show occult blood in their faeces. §

PR - GI (13 decks)

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