GI OTC Flashcards
What are the warning symptoms of chest? (10)
Chest pain
SOB
Wheezing
Ankle Oedema
Blood in sputum
Palpitations
Persistent Cough
Whooping Cough
Croup
Sputum mucous, colouredsd
What are the warning symptoms of the gut? (6)
Difficulty swallowing
Bloody vomit
Bloody diarrhoea
Vomiting with constipation
Weight loss
Sustained alternation of bowel habit.
What are the warning symptoms of the eye? (3)
Painful red eye
Loss of vision
Double vision (Diplopia)
What are the warning symptoms of the ear? (6)
Pain
Discharge
Deafness
Irritation
Tinnitus
Vertigo
What are the warning symptoms of the genitourinary? (6)
Difficulty in passing urine
Bloody urine
Ab/loin/back pain with cystitis
Urethral discharge
Vaginal discharge
Vaginal bleeding in pregnancy
What other warning symptoms do you need to be aware of? (3)
Neck stiffness
Rigidity with temperature
Persistent vomiting
What key questions is asked for patient presenting with abdominal pain? (7)
Where is the pain?
When did it start?
Is it constant or intermittent?
Has it moved +/or spread?
Have you had it before?
Is the area tender?
Have you taken anything which helps?
What symptoms would warrant a GP/A+E referral? (9)
Continous severe pain lasting > 1hr.
Mild/moderate lasting on/off for 7 days.
Swelling associated with hernias.
> 45 yrs vs 55 yrs + suffering persistent dyspepsia.
Recent unexplained weight loss.
Vomiting/constipation/diarrhoea + persistent abdominal pain.
Bloody vomit/stools (red/coffee grounds)
Abdominal pain + chronic back pain
Babies:
- Projectile vomiting
- Constipation
- Diarrhoea
- Indicative of gastroenteritis.
Give e.g. of medications that can cause gastric pain. (1)
NSAIDs.
Give e.g. of medicines that can cause constipation. (3)
Opioids
TCA
Iron
Give e.g. of medicines that can cause oesophageal ulceration. (3)
KCl
Alendronic acid
Doxycycline
What bacteria causes oral thrush? (1)
Candida infection
Where does candida infection normally exist? (3)
Mouth
GIT
Vagina
What factors can cause oral thrush? (6)
ABx
Diabetes
Pregnancy
Immunocompromised
Ill-fitted dentures
ICS
What are the symptoms of oral thrush? (3)
White raised patches on oral mucosa.
Bleeding tendency
Can be painful: babies refusing feeds, sometimes associated with nappy rashes.
What are the treatment options for oral thrush? (7)
- Anti fungal:
Miconazole 20mg/g (Daktarin oral gel)
- Tx choice from 4 months
- Dose is age related
Maintain good oral hygiene.
Apply after food
Continue tx for 7 days after symptoms have gone.
What counselling is given to patients with oral thrush? (3)
People with dentures
Inhaler technique
Application to babies.
What are the c/i of using Miconazole for oral thrush? (3)
Enzyme inhibitor:
Warfarin
Sulphonylureas
Phenytoin
Which patients warrants a GP referral if presenting with oral thrush? (2)
Pregnancy
Breastfeeding
What are the causes of mouth ulcers? (8)
Vitamin B/folic acid deficiency
Stress
Crohn’s disease, IBD
Nutrition
Trauma
Carcinoma
What are the symptoms of mouth ulcers? (5)
Shallow yellow/white ulcers on tongue, cheek and lip mucosa.
Painful can look swollen
Single/in clusters
Can be recurrent
Common complaint.
What are the treatment options for mouth ulcers? (4)
- Topical local anaesthetics/analgesics:
Anbesol liquid, Bonjela, Iglu pastilles:
- Limited use, short DofA, not taken before food. - Antiseptic mouth washes:
Chlorhexidine (Corsodyl mouthwash):
- Reduces secondary infection
- Accelerates healing. - Topical local anti-inflammatory/analgesics:
Benzydamine HCl (Difflam Oral Rinse):
- Can numb +/or sting
- Dilute with equal amounts of water if stinging occurs.
- Can use every 1.5-3 hrs prn, max 7 days.
- Rinse not to be used on children < 13 yrs. - Hydrocortisone 2.5mg Muco-adhesive buccal tablets:
- Effective at reducing inflammation and ulcer size - only used in previously diagnosed ulceration.
- > 12 yrs - keep in mouth and allow to dissolve slowly in close proximity to the ulcers QDS.
What are the alarm signs for mouth ulcers? (6)
Recurrent ulcers
Ulcer > 3 weeks old
If patient is:
- Pregnant
- Breastfeeding
- Diabetes
- Or ulcer due to infection
What symptoms should px report that may indicate oral cancer? (6)
Common in developing countries (smoking, alcohol consumption + poor oral health):
- A white/red patches on the gums , tongue or mouth lining.
- Small sore that looks like a mouth ulcer that fails to heal.
- Lump or mass that can felt on the lip or in the mouth/throat.
What is dyspepsia? (3)
Indigestion
Heart burn
Trapped wind
What are the causes of dyspepsia? (10)
Hurried meals
Overindulgence (food/drink)
Spicy food
Smoking
Overweight
Pregnancy
Medicines (NSAIDs, Digoxin, Iron)
HF
H.pylori.
What are the symptoms of indigestion? (6)
Epigastric discomfort shortly after eating/drinking
Feeling of fullness
Heartburn
Trapped wind
N+V
What are the treatment options for Indigestion? (4)
- Antacids:
Mg salts (Milk of Magnesia):
- Can cause diarrhoea
Al salts
- can cause constipation
Bismuth salts (Pepto-Bismol):
- Avoid if aspirin-sensitive, pregnant, not for < 16 yrs.
Combination prep.:
- Co-magaldrox. - Activated simeticone:
- Antifoaming agent
- Reduces surface tension of gas bubbles
- Windsettlers - Alginates:
- Useful to treat acid reflux
- Raft effect
- Combination with antacids
- Gaviscon, Peptac. - PPI:
- Omeprazole 20mg/10mg tablets
- For recurrent heartburn
- 20mg OD
- No improvement after 2 weeks =Refer
- Can use up to 4 weeks at 10mg dose
- Use lowest effective dose
- Available as GSL (esomeprazole)
What are the common interactions of antacids? (8)
Digoxin
Enteric coated tablets
Lithium serum levels reduced by sodium bicarbonate.
Tetracycline
Warfarin
Iron
Alendronic Acid
Avoid concomitant administration 2-4 hrs either side of dose.
What lifestyle advice is given to patients with indigestion? (7)
Small regular meals
Avoid meals late at night
Avoid highly spiced meals.
Avoid bending/stooping
Don’t wear tight clothes
Raise head of the bed
Take antacids about 1 hr after food.
When would you refer a patient with indigestion? (2)
GP Referral:
- 1st time dyspepsia 45 yrs +
Endoscopy Referral:
- > 55 yrs and with alarm signs or persistent unexplained symptoms:
- Persistent vomiting
- Appetite loss
- Difficulty swallowing
- Feeling of lump in throat
- GI bleeding.
What are the causes of IBS? (4)
Disturbance to normal motility of large bowel.
Diagnosed by elimination
Emotion
Stress
Food intolerances.
F>M 2x likely to experience IBS.
Adolescents + young people.
What are the symptoms of IBS? (5)
Young people:
- Bloating
- Alternative bouts of constipation/diarrhoea
- Abdominal Pain
Rectal fullness, incomplete evacuation.
What are the non-colonic symptoms of IBS? (3)
Nausea
Back Pain
Urinary frequency/urgency.
What are the treatment options for IBS? (3)
Should only offer IBS treatment OTC if the condition has previously been diagnosed by a Dr:
- Anti-spasmodic:
Intestinal smooth muscle relaxants
C/i = paralytic ileus
- Mebeverine (Colorado IBS)
- Hyoscine butylbromide (Buscopan IBS)
- Peppermint Oil (Colpermin) contains arachis oil. - Anti-diarrhoeals:
Loperamide (Imodium):
- Decreases bowel motility
- Reduces stool frequency and urgency
- Poor BBB penetration. - Bulking agent:
Ispaghula husk (Senokit High Fibre)
- Improves constipation and diarrhoea.
What counselling points should be given to patients with IBS? (6)
Food diary - record triggers
Ask if taking other medicines.
Try not to rush meals.
Eat balanced diet and plenty of fluids.
Take regular exercise
Relaxation
When would you refer a patient presenting with IBS? (5)
If symptoms persist for > 2 weeks despite treatment or if symptoms have changed:
- Bloody stools
- Not had IBS diagnosed by Dr
- Fever
- Unexplained weight loss
What are the causes of constipation? (11)
Change in lifestyle, eating habits.
Reduced fluid intake
Lack of exercise
Medication
Depression
IBS
Anal fissures
Haemorrhoids
Pregnancy
Refusal to obey urge to pass stool.
What are the symptoms of constipation? (4)
Decrease in bowel movement frequency.
Hard Stools
Straining
What is the normal bowel habit?
What are the treatment options for constipation? (6)
- Diet and lifestyle changes and increase fluids.
- Bulk forming laxatives:
- Ispaghula husk:
- Slow action (24-72 hrs)
- Taken with plenty of water
- Not taken at bedtime
- Not for frail elderly/bed bound
- Can alter medication absorption. - Stimulant laxatives:
Stimulate the nerve endings in the bowel wall:
- Anthraquinones: Senna (Senokot, Ex-lax)
- Act within 8-12 hrs. - Diphenylmethane derivatives:
- Bisacodyl (Dulcolax tablets + supps)
- Sodium picosulphate (Dulcolax-pico, Dulcolax Perles) - Osmotic laxatives:
Retains fluid in the bowel so stimulating peristalsis and forming a loose stool.
More powerful than bulk laxatives.
- Mg salts (Mg sulphate = Epsom salts, Mg Hydroxxide = Milk of Magnesia)
- Effective within 3 hrs
- Lactulose/Macrogol (polyethylene glycol 3350)
- Longer action = up to 72 hrs of regular dosing
- Sweet tasting
- C/i lactose/galactose intolerance.
- Caution in diabetes.
‘Babies and children < 14 yrs can take lactulose if their doctor recommends it. Don’t give lactulose to a child < 14 yrs unless their doctor has said it’s ok.’ - Glycerol (Glycerin Suppositories 1g,2g and 4g)
- Effective within 1-2 hrs. - Faecal Softeners:
- Docusate sodium (Diocytyl caps)
- Little if any straining required.
- Effective within 1-3 days.
What are the restrictions of stimulant laxatives? (6)
GSL = >18 yrs
P = 12 yrs
Pack size limits:
- Standard strength = 20
- Max. Strength = 10
- Syrup = 100ml
Inappropriate/overuse use = short-term occassional relief only.
What counselling is given to patients presenting with constipation? (7)
Improve diet, exercise, increase fluids.
Don’t take stimulant laxatives regularly.
Don’t take bulk laxatives at bedtime.
Pregnancy:
- Osmotic/bulk forming = safe
- Stimulant = c/i
Breastfeeding:
- Stimulant laxatives = c/i
Babies:
- Breastfeeding: May need extra water from a bottle.
- Bottle fed: Are they making feed with sufficient water.
Elderly:
- Increase fluids = dehydration
- Bulk laxatives = care in bed bound or inactive patients.
When would you consider referring a patient with constipation? (11)
Constipation +
- Illness and unable to work
- Children/babies who exhibit ill symptoms
- Bloody stools
- Continuous severe pain
- Weight loss
- Diarrhoea unless diagnosed IBS
- Self medication not effective after 4-5 days.
- Fever/night sweats
- N+V
What is haemorrhoids? (1)
Piles = Varicose dilatations of the veins in the lower part of the large intestine +/or anus becomes engorged with blood.
What are the causes of haemorrhoids? (7)
Anal infections (scratching/STI)
Sports (e.g. cycling)
Sitting/standing for long periods
Pregnancy
Constipation
Pelvic area lesion
Laxative abuse
What are the symptoms of haemorrhoids? (4)
Itching in perineal area
Not always but can be painful.
Can be sharp pain on defaecation
Bright red blood on stool and toilet paper.
What are the contributory factors to haemorrhoids? (5)
As per constipation:
- Increase in intra-abdominal pressure.
- Old age
- Dehydration
- Inadequate fibre in diet
- Medication
What are the treatment options for haemorrhoids? (2)
- Topical preparations (creams/ointments/suppositories)
Astringents
Local anaesthetics
Antipruritics
Heparinoids
Emollients
Antiseptics
(Anusol, Preparation H, Germoloids)
Treat symptom not cause. - Hydrocortisone (Adjunct)
- No > 7 days
- Not for pregnancy/BF
- Adults > 18 yrs
- Not used if broken skin or infection.
What counselling is given to patients with haemorrhoids? (7)
Hygiene
Diet
Not to scratch area
Avoid straining
Increase activity
Laxatives (faecal softeners)
What are the red flag symptoms of haemorrhoids? (5)
Duration > 3 weeks
Internal anal pain
Rectal Bleeding
Suspected drug induced constipation
Recurrent piles (regular recurrence)
What are the causes of nausea and vomiting? (8)
Viral/Bacterial/Bacterial toxins
Inner ear disorders
Migraine
Motion Sickness
Meningitis
Medication = Digoxin, Theophylline, NSAIDs.
Pregnancy
What are the treatment and counselling points for nausea and vomiting? (5)
Ensure px doesn’t become dehydrated - offer electrolyte replacement.
Sip water little and often.
Avoid dairy products + greasy food for 24 hrs.
Pregnancy - morning sickness:
- Frequent small meals
- Ginger
- Sea-bands
Re-introduce light diet when hungry.
What are the alarm symptoms indicate GP/A+E referral for N+V? (7)
Projectile vomiting = babies / adults
Vomiting stained with blood
Vomiting with associated weight loss
2 days often the cut off but consider the overall health of the patient
Babies < 12 months and symptoms > 24 hrs
Children < 3 yrs and elderly and symptoms for 48 hrs.
People with diabetes if persistent.
What is diarrhoea? (1)
Bowel movement = increase frequency and change in consistency.
What are the causes of diarrhoea? (6)
Bacterial/Viral
Diet changes/overindulgence
Medication
Food allergies
Secondary to a medical conditions e.g. diabetes, hyperthyroidism, IBS.
Stress
What are the treatment options for diarrhoea? (5)
- No treatment usually resolves itself.
- Must maintain fluid intake:
- Oral rehydration sachets (Dioralyte):
- Mix with recommended amount of water
- Will keep for 1hr or 24 hrs if in fridge.
- Sip little and often - Anti-diarrhoeal:
- Loperamide (Imodium caps):
- Decreases bowel motility
- For adults + children > 12 yrs - Morphine containing products (Kaolin + Morphine = Diocalm):
- Combined with an adsorbent
- Can be a problem of dependence
- Not recommended - Bismuth Salicylate (Pepto-Bismol):
- C/I aspirin allergy.
What counselling points is given to patients with diarrhoea? (5)
Ensure high fluid intake.
If recommending OTC product emphasise how to take correctly.
If no better after OTC tx or symptoms worsen = see GP.
Babies:
- Ensure bottles are properly sterilised and making feeds properly.
- Refer: < 12 months and symptoms > 24 hrs, < 3 yrs and elderly and symptoms for> 48 hrs, older adults and children > 72 yrs.
When would consider referring a patient presenting with diarrhoea? (3)
- Elderly:
- If symptoms persist for 48 hrs. - Refer if:
- Chronic diarrhoea
- Recurrent diarrhoea
- With fatigue/pain lasting > 2 days - Refer ALL patients if:
- Weight loss
- Bloody stool
- Persistent mucous in stool
- Symptoms change/worsen
- Alternating diarrhoea/constipation.
