GI system Flashcards
5.1 orlistat
symptoms:
• BMI >28kg/m2
Referral:
Do not give if taking
• levothyroxine
• amiodarone
• ciclosporin
• warfarin + DOACs
• acarbose
• anti-epileptics
take caution if taking
• oral contraceptives
• ADEK vitamin deficiency - 2 hour
difference
certain conditions
• diabetes mellitus
• hypertension
• high cholesterol
• chronic malabsorption syndrome
• cholestatis
• pregnancy or breast feeding
• kidney disease
• failure to lose weight after 3 months
OTC products:
POM TO P
orlistat
licensing: BMI >28kg.m2, 18+, 6 months
• in conjunction with a middle hypo caloric
lower-fat diet
• potent lipase inhibitor
• one 60mg capsule TDS before main meals
or up to 1 hour after
• omit dose if missed meal or meal
contained no fat side effects:
• oily stools and faecal incontinence
Advice:
• orlistat îs not a substitute for a healthy or
excerise
• 5 portions of fruit and veg
• 18-30g of fibre a day
• 2.5l of fluid
• exercise 30 mins/5 days a week
• alcohol 2-3 units a day interspersed
with several alcohol-free days
5.2 constipation
symptoms:
• small hard stools passed less
frequently than normal - less than 3
times a week • straining
• incomplete emptying
• abdominal cramps/bloating • nausea
referral:
• blood in stools
• unexplained weight loss/appetite
loss
• patients over 40 years with a sudden
change in bowel habit
• medication ADR - opioids, iron, TCA,
SSRIs, antimuscarinics, diuretics,
verapamil, antihistamines
• with lethargy, weight gain, thinning
hair, dry skin
• stimulant laxative abuse
• obstruction = vomiting, abdominal
distension and colic pain • constipation > 2 weeks
OTC products:
first line = lifestyle advice second line = boss laxatives Bulk-forming laxatives Osmotic laxatives
Stimulant laxatives
Stool softeners
SEE GI NOTES FOR LAXATIVE INFO
Advice:
• 5 portions of fruit and veg • 18-30g protein
• 2.5l fluids
• 30 min exercise/ 5 days
• toileting habits
5.2 constipation
symptoms:
• small hard stools passed less
frequently than normal - less than 3
times a week • straining
• incomplete emptying
• abdominal cramps/bloating • nausea
referral:
• blood in stools
• unexplained weight loss/appetite
loss
• patients over 40 years with a sudden
change in bowel habit
• medication ADR - opioids, iron, TCA,
SSRIs, antimuscarinics, diuretics,
verapamil, antihistamines
• with lethargy, weight gain, thinning
hair, dry skin
• stimulant laxative abuse
• obstruction = vomiting, abdominal
distension and colic pain • constipation > 2 weeks
OTC products:
first line = lifestyle advice second line = boss laxatives Bulk-forming laxatives Osmotic laxatives
Stimulant laxatives
Stool softeners
SEE GI NOTES FOR LAXATIVE INFO
Advice:
• 5 portions of fruit and veg • 18-30g protein
• 2.5l fluids
• 30 min exercise/ 5 days
• toileting habits
Dyspepsia
Symptoms:
• group of upper abdominal symptoms
• indigestion
• GORD
• gastritis
• gastric or duodenal ulcers
• vague abdominal pain above the belly
button
• bloating, belching, flatulence, early satiety
• fullness
• nausea and vomiting
• heartburn
Referral:
Anaemia (iron deficiency)
Loss of weight
Anorexia
Recently-changed or new, unexplained dyspepsia in over 55 years unresponsive to treatment
Malaemia, haematemesis, persistent vomiting, dysphagia
• ruling out peptic ulcers
• cardiovascular problems
• symptomatic treatment > 4 weeks
• refuse PPI, H2RA if due for endoscopy/C-
urea test in 14 days
• previous ulcers/GI surgery
• children
• regurgitation
• jaundice or severe liver disease
OTC products:
antacids - neutralise stomach acid
• immediate symptom relief in 15-30 min,
lasts 3 hours
• liquids are most effective and act quicker
than tablets
alginates - raft on top of stomach contents
• suitable in pregnancy - first line if GORD
• after each main meal and at bedtime OR
when required
antacid interactions - do not take at same leave, leave 2 hour gap e.g. tetracyclines, quinolones, bisphosphonates
H2 receptor antagonist - acid suppressor
• onset 1 hour, lasts 9 hours
• 16+, max use 14 days
not recommended in pregnancy or breastfeeding
PPI - acid suppressor
• onset 1-3 days, lasts 24 hours
• reflux symptoms - 18+ max supply 14
days - use 4 weeks
• OD - no other acid suppressor
not recommended in pregnancy or breastfeeding
refer to GP
• > 2 weeks OTC failure
• > 4 weeks continuous use
side effects:
• abdominal pain, nausea, diarrhoea,
vomiting, flatulence
• masks symptoms of gastric cancer
• long-term use: osteoporosis and
hypomagnesaemia
Interactions:
omeprazole is an enzyme inhibitor • warfarin
• phenytoin
• clopidogrel
Advice:
• smoking cessation
• avoid excess alcohol
• caffeine, chocolate
• avoid bending over, lying down or
slumping
• raising head of bed, take evening meal 3
hours before bed
• small frequent meals
• fatty or spicy food
• weight reduction
• avoid tight clothing
5.4 haemorrhoids
Referral:
symptoms:
• swollen veins
• dull pain on defecation or sitting
• slight rectal bleeding
• perianal itching and burning
• swelling and soreness in perineum
referral:
• blood in stools
• abdominal pain, nausea, vomiting,
fever, malaise, loss of appetite
• altered bowel habit
• tenesmus - urge to defecate when no
stool present
• severe sharp pain
• symptoms >3 weeks
• unresponsive > 1 week OTC failure
• constipating medication
OTC products:
• soothing agents e.g. anusol
• mild astringents e.g. preparation H
• local anaesthetics 12+ e.g. germaloids
• products with hydrocortisone 18+ e.g.
anusol plus HC - max 7 days, avoid in pregnancy/breastfeeding
Advice:
• increase dietary fibre
• treat constipation if present
• clean with attention to minor faecal
soiling
• pregnancy increases risk of
haemorrhoids
5.5 diarrhoea
duration of acute diarrhoea
• babies <3 months immediately
• under 1 year, diabetic, elderly > 1 day • under 3 years > 2 days
• refer everyone if > 3 days
signs of dehydration
• dry skin/reduced skin turgor
• sunken eyes
• dry tongue
• drowsiness/lightheaded
• less urine/dark urine
• depressed fontanelle in babies
Alarm symptoms
• blood or mucus in stool
• long standing change in bowel habit in
>50 years, weight loss
• suspected faecal impaction in elderly • severe vomiting, high-grade fever
• recent travel abroad
chronic diarrhoea > 3 weeks
medications associated • magnesium antacids • NSAIDs
• Iron
• laxatives
• antibiotics
• digoxin
• PPI
• diuretics
• SSRIs
OTC products:
First-line:
Symptoms: • • frequent, loose, watery stools • associated symptoms: •
• abdominal cramps •
• nausea
• flatulence
• dehydration •
oral rehydration therapy - all ages 1-2 sachets after each loose motion dissolve in 200ml of water
boiled and cooled water in babies under 1
loperamide 12+, 2 caps after each
loose motion, max 8 a day
• not for pregnancy or breastfeeding
Advice:
• stay hydrated - drink plenty of water
• eat plain, bland foods
• babies - dilute formula feeds to
quarter strength and build back up to
normal over 3 days
• feed more frequently than normal
• avoid drinks with high sugar
• avoid milk
5.6 IBS
symptoms:
• lower abdominal spasms
• bloating
• alternating constipation and diarrhoea
• aggravated by stress, depression,
anxiety, lack of dietary fibre
refer:
• children
• over 45 years first time symptoms
• blood in stools
• bowel obstruction
• unexplained weight loss
• fever, nausea, vomiting
• pregnant women
• suspected depression
OTC products:
antispasmodics
• mebeverine 18+
• alverine 12+
• peppermint oil 15+ - swallow capsule
whole, causes heartburn
antimuscarinics
• hyoscine 12+
• dicycloverine 12+
interactions - additive anticholinergic effects
constipation - bulk forming diarrhoea - loperamide
Advice:
• limit to 3 portions of fruit and veg
• increase soluble fibre intake
• avoid insoluble fibres
• eat regularly and avoid missing meals
• drink 8 glasses of water a day
• limit stress
• take probiotics
5.6 IBS
symptoms:
• lower abdominal spasms
• bloating
• alternating constipation and diarrhoea
• aggravated by stress, depression,
anxiety, lack of dietary fibre
refer:
• children
• over 45 years first time symptoms
• blood in stools
• bowel obstruction
• unexplained weight loss
• fever, nausea, vomiting
• pregnant women
• suspected depression
OTC products:
antispasmodics
• mebeverine 18+
• alverine 12+
• peppermint oil 15+ - swallow capsule
whole, causes heartburn
antimuscarinics
• hyoscine 12+
• dicycloverine 12+
interactions - additive anticholinergic effects
constipation - bulk forming diarrhoea - loperamide
Advice:
• limit to 3 portions of fruit and veg
• increase soluble fibre intake
• avoid insoluble fibres
• eat regularly and avoid missing meals
• drink 8 glasses of water a day
• limit stress
• take probiotics
