GI - mouth ulcers, cold sores, and heartburn Flashcards
What are some of the questions to ask when presenting with a suspected mouth ulcer?
- Look in the mouth, to see if it is a minor, major or herpetiform ulcer
- How long have you had this for? 3 weeks needs referral
- Do you have any other symptoms? Other GI symptoms needs referral
- Do mouth ulcers run in your family? Family history
- Have you recently stopped smoking? Can cause ulcers
- What is your diet like? Drink coffee, eat chocolate, spicy foods? Can cause ulcers
- Are you on any medication? NSAIDS, nicorandil
- Any recent trauma to your mouth? Injury/biting lips
- Are you under any stress or experiencing anxiety at the moment? Can cause ulcers
- Any chance your immune system could be working less effectively? Immunosuppression
- Do you have any deficiencies? Iron, folate or B12?
What are the types of ulcer you should look for?
MINOR - up to 5mm diameter, 7-14 days healing
MAJOR - 1cm diameter, 10-14 days healing, pain when eating and drinking, can scar
HERPETIFORM - multiple pinhead sized ulcers that increase in size and form larger groups, 10 days healing, painful
What treatment can the pharmacist offer for mouth ulcers?
- Chlorhexidine gluconate mouthwash
- rinse 10ml in mouth for 1 minute twice a day then spit
- continue two days after symptoms cleared
- can get teeth staining but its not permanent
- antiseptic to reduce chance of infection
- Hydrocortisone oromucosal tablets
- dissolve near ulcer to reduce inflammation
- over 12s only
- Bonjela
- to numb the area
- over 16s only
- Simple analgesia
- paracetamol/ibuprofen
- Difflam spray
What advice can the pharmacist offer for mouth ulcers?
- Use a soft bristled tooth brush
- Drink cool drinks through a straw
- Eat soft foods
- Make sure you are seeing the dentist regularly
- Improve your diet, try to reduce salty and spicy foods
What is the virus that causes cold sores?
Herpes Simplex Virus (HSV)
What are the stages of infection?
Tingling (prodromal phase)
*target for treatment
Papule formation
Papules fill with fluid, containing HSV
It is contagious until the papules scab over
Why is my cold sore reocurring?
Because HSV remains dormant in the root ganglion of the trigeminal nerve, and can then be reactivated by certain triggers
Triggers can be stress, UV rays, ill health, viral infection
When should you refer for cold sores?
- Over 14 days
- Cold sores in the mouth
- Severe and widespread
- Immunocompromised
- Spread to face
What treatments are available for cold sores?
- Antiviral creams can be given during the early prodromal phase Aciclovir *apply 5x daily for 5x days *e.g. virasorb cold sore cream Penciclovir *apply 8x daily for 4x days *apply five times daily for give days
- Cymex to hydrate area and prevent secondary infection
- apply sparingly every hour
- Bonjela
What advice could you give for a cold sore?
- High spf lip balm
- Hand hygiene before and after applying cream
- No kissing
- especially not babies as this can cause neonatal herpes
- Simple analgesia to ease pain and swelling
- Increase fluid intake
- No oral sex
- Dab cream on
- Do not share towels
What are the symptoms of heartburn?
- Burning and discomfort just below chest
- Unpleasant taste in mouth (stomach acid)
- Bloating
- Nausea
- Bad breath
- Hoarse voice
- Cough or hiccups reoccurring
What can cause heartburn?
- Diet (certain foods like coffee, spicy food and alcohol)
- Being overweight
- Pregnancy
- Stress and anxiety
- Some medicines - e.g. anti inflammatory painkillers
- Hiatus hernia
What treatment can you give for heartburn?
- Antacids
e. g. Rennies - Alginates
e. g. Gaviscon - H2 antagonists
e. g. Ranitidine - PPIs
e. g. Esomeprazole - need to see GP for prescription
What advice can you give for heartburn?
- Weight loss Importance of healthy eating and exercise - Eat small meals frequently - Improve your posture Avoid bending down, slumping in chairs, eat sitting upright - Elevate bed at the head end - Avoid tight clothing around stomach - Reduce takeaways, reduce coffee intake - Stop smoking - Reduce alcohol intake
When should you refer heartburn?
- Sudden, severe pain radiating to back and arms (MI)
- Difficulty swallowing
- Failure to respond to antacids after a week
- Weight loss
- Anaemia
- Children
- ALARM symptoms
- unable to swallow, painful swallowing, GI bleeding or anaemia, weight loss, chest pain
