Gastro-Intestinal Disorders Flashcards
What is the diagnostic for dyspepsia?
Upper abdomen discomfort.
What is the treatment for dyspepsia?
Nexium, Rennie’s, ranitidine
etc.
What non-pharmacological advice can be given for dyspepsia?
Often triggered by foods so keep a food diary (dairy is common) Alcohol, smoking, caffeine, and stress have all got some evidence to suggest that they exacerbate it - check smoking status and if they do, signpost to NRT.
When should dyspepsia be referred?
If the patient has been taking an NSAID without PPI protection - may be an ulcer (if so symptoms often improve after eating). Dark and tarry stools. Persisting vomiting. Unexplained weight loss.
What are the diagnostics for GORD?
Umbrella term consisting of:
‘Heartburn’.
Oesophageal inflammation (making swallowing more difficult).
What is the treatment for GORD?
Rennie’s, Gaviscon (antacid
with alginate).
When should GORD be referred?
If patient age > 45 with other symptoms (must refer for
an endoscopy to eliminate H.pylori).
If over 45 with significant dyspepsia despite pharmacological intervention with H2 antagonists and/or antacids
Severe pain around the heart may even be angina/heart attack!
What is the diagnostic for a peptic ulcer?
Stomach pain common.
What is the treatment for a peptic ulcer?
PPI such as esomeprazole
as nexium
When should a peptic ulcer be referred?
If PPI does not help.
If suspected H.pylori.
If the patient is taking NSAIDs long-term especially with no protection.
What are the diagnostics for IBD?
Diarrhoea, fever, abdominal pain,
malaise, lethargy, unexplained weight loss, feeling bloated, not being able to fully evacuate bowels. Diagnosed by ruling out other diagnoses, e.g. no ulcer present, not H.pylori.
When should IBD be referred?
Immediately.
What are the diagnostics for constipation?
Inability to evacuate bowels, some discomfort upon trying. Small, pellet-like stools. Must be categorised as a change in the sufferer's usual routine.
What is the treatment for constipation?
Lactulose, senna, macrogol.
When should constipation be referred?
Red blood in stool - may be an
anal fissure or external haemorrhoids (potentially even cancer if it has persisted for longer than a week).
Nausea, vomiting, or unexplained weight loss.
Fluctuates with diarrhoea (this would probably be IBS, which we can treat with buscopan, but the patient must be diagnosed with it beforehand to be able to buy it as per the product license).
Bowel obstruction (potentially due to hernias, carcinomas, inflammation).
What may cause constipation?
Multiple causes:
Iatrogenic (drug-induced) such as opioids (common with codeine), antacids, diuretics
Lifestyle (not drinking ~1.5-2L of water)
Disease (IBS etc.)
Pregnancy.
What is the diagnostic for haemorrhoids?
Blood in stools.
What is the treatment for haemorrhoids?
Anusol cream, ointment, suppository Anusol HC (the only way that hydrocortisone is licensed to be used around the anogenital region).
When should haemorrhoids be referred?
If undiagnosed.
If blood is bright (not dark).
If long-term (NHS choices states that surgery may even be required).
What are the diagnostics for diarrhoea?
Liquidy stools.
Sometimes also abdominal pain, vomiting, unexplained weight loss.
What is the treatment for diarrhoea?
Loperamide, dioralyte.
What non-pharmacological advice can be given for diarrhoea?
Suggest a high-fibre diet.
Avoid triggers such as caffeine and
spicy food.
Continue to feed breastfed babies on demand, if bottle-fed then stop for 24 hours and move to ORT (dioralyte).
Adults should drink bland, sugarless drinks.
When should diarrhoea be referred?
If chronic.
If the patient is young (<6 months after 24 hours; <2 years after 48 hours if diarrhoea has not passed).
Blood and/or mucus in stools.
What may cause diarrhoea?
Caused by over-hydration,
may be drug-induced (NSAIDs, antibiotics, iron-containing compounds, antacids), food poisoning.
What are the diagnostics for infant colic?
Inconsolable crying. Flushed face. Happens around the same time every day. The child appears to be in pain.
What is the treatment for infant colic?
Colic drops.
Gripe water.
Simeticone.
What may cause infant colic?
May be due to lactose
intolerance (so ask if the child is being breast-fed or bottle-fed).
