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Responding to Symptoms > GI > Flashcards

GI Flashcards

1
Q

What are the referral symptoms for nausea and vomiting?

A
  • Severe abdominal pain
  • Weight loss (RED FLAG)
  • Blood in vomit (RED FLAG)
  • Vomiting in < 1 month old
  • Projectile in < 3 months
  • 24hrs vomiting in < 1 year old
  • Suspected pregnancy and intractable vomiting
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2
Q

What treatment is available OTC for nausea and vomiting?

A
  • Oral rehydration therapy (first line)

Anti-emetics (limited indications)

  • Prochlorperazine (migraine related)
  • Anti-histamines, Anticholinergics (travel sickness related)
  • Acupresure
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3
Q

What are the referral symptoms for diarrhoea?

A
  • Change in bowel habits in over 50s
  • Recent foreign travel
  • Treatment failure
  • Unable to drink fluid/dehydration
  • Blood/mucus in stools
  • Accompanied by bouts of constipation (IBS)
  • Sever abdominal pain
  • Weight loss
  • Symptoms lasting longer than 2-3 days in children and elderly
  • Symptoms lasting longer than 24 hours in diabetics
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4
Q

What treatment is available OTC for diarrhoea?

A
  • Oral Rehydration Therapy (first line)

- Anti motility drugs (loperamide, piperamide, bismuth, kaolin)

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5
Q

What practical advice do you give with ORT?

A
  • Drink normally

- Replace lost fluids using ORT

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6
Q

What doses of ORT do you recommend to different age groups?

A

Adults - 1-2 sachets in 200-400ml of water after every loose movement

Children - 1 sachet in 200ml water

Infants (3months-2years) - 1 to 1 and a 1/2 times the normal 24 hour feed volume (under medical supervision)

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7
Q

What anti-motility drugs are available OTC?

A
  • Loperamide, Piperamide
  • Bismuth
  • Kaolin
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8
Q

How does Loperamide work?

A

It acts on the mu-opiate receptors to increase the tone of both the small and large bowel, hence increasing intestinal transit time and re-absorption.

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9
Q

What advice would you give to a patient with diarrhoea?

A
  • Drink plenty of clear fluids
  • Avoid very sugary drinks
  • Avoid milk and milky drinks
  • Eat depending on appetite, consider avoiding food if it makes diarrhoea worse
  • Stay off work
  • Careful hygiene
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10
Q

What are the symptoms of a duodenal ulcer?

A

Pain, especially at night, 2-3 hours after food.

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11
Q

What are the symptoms of a stomach ulcer?

A

Sharp pain in the stomach area. 30 minutes after food

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12
Q

What are the referral symptoms for dyspepsia?

A
  • GI bleeding
  • Difficulty swallowing
  • Unintentional weight loss
  • Abdominal swelling
  • Persistent vomiting
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13
Q

What treatment is available OTC for dyspepsia?

A
  • Antacids
  • Alginates
  • Prokinetics (e.g domperidone aka motilium)
  • H2 Antagonists (e.g ranatidine and famotidine)
  • PPIs (e.g omeprazole and pantoprazole)
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14
Q

What is dimethicone?

A

It can be added to alginates to reduce the surface tension of the gastric contents

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15
Q

What is the downside of aluminium salts?

A

They can cause constipation

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16
Q

What is the downside of magnesium salts?

A

They can cause diarrhoea

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17
Q

How do antacids work?

A

They raise the pH of the stomach

18
Q

How do alginates work?

A

They swell in water to form a raft that sits ontop of the stomach contents

19
Q

How do prokinetics work?

A

They increase gastric emptying and raise lower oesophageal sphincter

20
Q

How do H2 antagonists work?

A

They suppress acid secretion

limited since only the histamine component of secretion is inhibited at the parietal cell

21
Q

How do PPIs work?

A

They suppress acid secretion at the proton pump in the parietal cells

22
Q

What lifestyle advice should you give to a patient with dyspepsia?

A
  • Dietary modifications
  • Smoking
  • Weight loss
  • Alcohol and caffeine intake
  • Posture
23
Q

What are the referral symptoms for constipation?

A
  • Blood/tar/mucous in stools
  • Greater than 14 days duration (with no cause)
  • Middle aged with sudden change in bowel habit (no cause)
  • Suspected depression
  • Weight loss
24
Q

What can you give OTC for constipation?

A
  • Lifestyle advice (first line)

- Laxatives

25
Q

What are the main types of laxatives?

A
  • Bulk forming (isphaghula)
  • Osmotic laxatives (lactulose)
  • Stimulant laxatives (Senna, Bisadoyl, Docusate sodium)
  • Softeners (Docusate sodium)
26
Q

How long after taking a laxative should you expect results? (refer if not)

A

3 days

27
Q

When should you normally take stimulant laxatives?

A

At night (results in the morning)

28
Q

How much bleeding should be referred with haemorrhoids?

A

Normally always unless sinister pathology has been excluded and the bleeding is minor.

29
Q

What are the referral symptoms for haemorrhoids?

A
  • Abdominal pain
  • Blood in the stools
  • Fever
  • Patients who have to reduce haemorrhoids manually (3rd or 4th degree)
  • Persistent change in bowel habit in middle aged patients
  • Severe pain associated with defecation
30
Q

What can you give OTC for haemorrhoids?

A
  • Dietary changes
  • Local anaesthetics (lidocaine)
  • Astringents (bismuth, zinc)
  • Anti-inflammatories (e.g hydrocortisone)
  • Protectorants (e.g shark liver oil)
31
Q

What is shark liver oil?

A

A protectorant used in haemorrhoids

32
Q

What are bismuth and zinc?

A

Astringents

33
Q

What are the referral symptoms for IBS?

A
  • Blood in stools
  • Children under 16
  • Middle aged patients who have had recent change in bowel habits
  • Fever
  • Patients with no history of IBS or no precipitating factors
  • Nausea and/or vomiting
  • Severe abdominal pain
  • Steatorrhoea (fat in faeces)
34
Q

What can you give OTC for IBS?

A
  • Antispasmodics (hyoscine, mebeverine, alverine, peppermint oil)
  • Laxatives (but not lactulose)
  • Anti-diarrhoeals (loperamide)
  • Probiotics?
35
Q

What laxative should you not give in IBS?

A

Lactulose

36
Q

What lifestyle advice should you give to patients with IBS?

A
  • Reduce fibre intake but increase intake of soluble fibre (oats, linseeds)
  • Exercise
  • Don’t recommend acupuncture or reflexology
37
Q

What type of laxative is ispaghula?

A

Bulk forming

38
Q

What type of laxative is lactulose?

A

Osmotic

39
Q

What type of laxative is senna?

A

Stimulant

40
Q

What type of laxative is Bisacodyl?

A

Stimulant

41
Q

What type of laxative is docusate sodium?

A

Stimulant (+ faecal softner)

Responding to Symptoms (7 decks)

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