Gastrointestinal tract Flashcards
Omeprazole indication
OTC omeprazole 10mg is indicated for heart burn sufferers over the age of 18 who experience intermittent or relapsing symptoms.
Max daily dose: 20mg for max 4 weeks; 28 days supply
Counselling points for omeprazole
- Swallow with lots of water whole before a meal
- Symptomatic relief occurs after a day and reaches maximum effect within 3-4 days
- When there is improvement, can reduce the dose to 10mg
- Weight reduction
- Popping up the bed head
- Avoid provoking factors
- Care with use of NSAIDs and aspirin
- May cause drowsiness - avoid driving and use of machinery
- Refer if under the age of 18 and over the age of 45 with new onset of symptoms or over the age of 55 with unexplained dyspepsia
Irritable bowel syndrome symptoms
- Painful peristalsis
- Cramping
- Abdominal pain discomfort
- Bloating
- Flatulence
- Constipation
- Diarrhoea
- Feeling of incomplete defecation
- Passage of mucus
- Nausea
- Lethargy
- Insomnia
- Headaches
- Backpain
- Urinary incontinence
Red flag symptoms of IBS
Unintentional or unexplained weight loss
Rectal bleed
Family history
Anaemia
Persistent back pain
Recently altered bowel habit in over 60s
Advice for IBS
- Regular meals, avoid long gaps between meals
- 8 cups of fluid per day
- Restrict tea/coffee to 3 or less per day
- Reduce alcohol/fizzy drinks
- Reduce processed foods
- At least 3 portions of fruit/fibre intake
- Probiotics for at least 4 weeks
Abdominal discomfort treatments for IBS
1st line: Mebeverine/Alverine citrate
Hyoscine butyl bromide
Constipation treatment for IBS
Bulk forming laxative - Ispaghula or Stericulia
Avoid using stimulant/osmotic
Mode of action:
- Retains water
- Increases faecal bulk
- Stimulates peristalsis
Onset of action - 12-24 hours
Diarrhoea treatment for IBS
Loperamide (not available as OTC for under 12 years)
Take two 2mg capsules initially, then one capsule after each loose stool (max 16mg per day)
Tricyclic antidepressants in IBS
Reduce pain perception
Given at lower doses
Amitryptiline
Linaclotide for IBS
Moderate-severe IBS for constipation
290mcg OD taken at least 30 minutes before a meal
Diagnosis of constipation
- Straining during defecation
- Lumpy or hard stools
- Sensation of incomplete defecation
- Sensation of anorectal blockage of defecation
- Manual maneuvers to facilitate defecation
- Fewer than 3 spontaneous bowel movements per week
Fibre intake for constipation
30g per day
- Insoluble from fruits and oats
- Soluble (3g per day) from wholegrain foods and nuts
Osmotic laxatives
Lactulose, macrogols
- Increases water absorption in colon
- Increases faecal bulk
- Stimulates peristalsis
Onset of action - 4-48 hours
Stimulant laxatives
Senna and bisacodyl
- Stimulate colonic nerves
- Increase intestinal motility
- Stimulate peristalsis
Onset of action - 8-12 hours
Take at night
Stool softeners
Docusate sodium, glycerol
- Reduce surface tension
- Increase penetration of intestinal fluid into faeces
- Stimulate peristalsis
