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PMP103 - Practice Of Pharmacy > GI Tract > Flashcards

GI Tract Flashcards

1
Q

What is a mouth ulcer? + what could the patient recall?

A
  • Usually a single, irregularly-shaped ulcer
  • Patient can often recall the cause
  • Burn – hot/cold/chemical
  • Biting lining of mouth
  • Sharp surface of tooth/denture
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2
Q

What is the most common type of mouth ulcer?

A

Recurrent aphthous stomatitis

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3
Q

What are the types of aphthous stomatitis?

A

*aphthous minor (80% of cases)
*aphthous major (10% of cases)
*herpetiform (10% of cases)

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4
Q

Summarise what are the symptoms of aphthous minor

A
  • Often in groups of up to five
  • Small ulcers (<1cm)
  • “uncomfortable”
  • Heal within 10-14 days
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5
Q

Summarise what are the symptoms of aphthous major

A

Usually 1-3 ulcers
* Larger than 1cm
* Painful and may affect eating
* Can take weeks to heal

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6
Q

Summarise what are the symptoms of aphthous herpetiform

A
  • Groups of 10-50 small ulcers
  • Very painful
  • Heal within 10-14 days
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7
Q

What could be the causes to mouth ulcers?

A

Iron deficiency anaemia
* Vegetarian/vegan diet often implicated
* Heavy menstrual loss
* Hypersensitivity
* Preservatives in food (benzoic acid/benzoates)
* Foods (chocolate, tomatoes)
* Sodium lauryl sulfate
* Psychological stress

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8
Q

What are the treatment options for ulcers?

A

*saline solution
*antiseptic (chlorhexidine)
*anti-inflammatory benzydamine
*steroid hydrocortisone

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9
Q

How is saline used to treat mouth ulcers?

A
  • Half a teaspoon of salt in a glass of warm water
  • Rinse frequently until ulcers subside
  • Any age
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10
Q

How is antiseptic chlorhexidine used to treat mouth ulcers?

A
  • Rinse (or spray) twice a day
  • Not within 30 minutes of toothpaste
  • Can cause temporary yellow staining of teeth
  • Can be used OTC from age 12
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11
Q

How is benztdamine used to treat mouth ulcers?

A

Use every 1.5-3 hours
* Can be used OTC from age 6

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12
Q

How is hydrocortisone used to treat mouth ulcers?

A
  • One tablet dissolved on ulcer four times a day
  • Can be used OTC from age12
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13
Q

When should you refer a patient suffering with a mouth ulcer?

A
  • Lasts longer than 3 weeks
  • Keeps coming back
  • Painless and persistent
  • Grows bigger than usual
  • At back of throat
  • Bleeds or gets red and painful
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14
Q

What is dyspepsia?

A

A complex of upper gastrointestinal tract symptoms typically present for 4 or more weeks

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15
Q

What are the symptoms to dyspepsia?

A
  • Severity varies from patient to patient (most: mild + intermittent)
  • Upper abdominal pain or discomfort
  • Burning sensation starting in stomach, passing upwards to behind the breastbone
  • Gastric acid reflux
  • Nausea or vomiting
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16
Q

What are the common causes to dyspepsia?

A
  • Gastro-oesophageal reflux disease (GORD)
  • Peptic ulcer disease (gastric or duodenal ulcers)
  • Functional dyspepsia
  • Epigastric Pain Syndrome
  • Post-prandial distress syndrome (fullness and early satiety)
  • Barrett’s oesophagus
  • A premalignant condition
  • Upper GI malignancy
17
Q

What is GORD? + causes?

A

Gastric-oesophageal reflux disease (GORD)
1. Transient relaxation of lower oesophageal sphincter
2. Increased intra-gastric pressure
3. Delayed gastric emptying
4. Impaired oesophageal clearance of acid

18
Q

What are the trigger factors to GORD?

A
  • Smoking
  • Alcohol
  • Coffee
  • Chocolate
  • Fatty foods
  • Being overweight
  • Stress
  • Medicines (calcium channel blockers, nitrates, NSAIDs)
  • Tight clothing
  • Pregnancy
19
Q

What are the causes to peptic ulcers (stomach)?PUD

A
  • Helicobacter pylori infection
  • Medication, mainly NSAIDs (others can cause them)
  • Zollinger-Ellison syndrome (rare condition causing high acid secretion)
20
Q

How can you confirm and treat a peptic ulcer?

A
  • Can only confirm ulcers with endoscopy
  • H. pylori infection managed with eradication therapy (2 antibiotics and a PPI)
  • Therefore, wouldn’t be managed OTC
  • However, patients frequently present asking for symptomatic relie
21
Q

What are the treatment options for dyspepsia?

A
  • Non-pharmacological
  • Antacids
  • Alginates
  • H2 receptor antagonists (block them)
  • Proton pump inhibitors
22
Q

Dyspepsia - non pharmacological treatment options?

A
  • Lose weight if overweight
  • Eating small, frequent meals rather than large meals
  • Eat several hours before bedtime
  • Cut down on tea/coffee/cola/alcohol
  • Avoid triggers, e.g. rich/spicy/fatty foods
  • If symptoms worse when lying down, raise head of bed (do not prop
    up head with pillows)
  • Avoid tight waistbands and belts, or tight clothing
  • Stop smoking
23
Q

What is an antacid + alginate?

A

antacid = compounds that neutralise stomach acid
alginate = form a raft on top of stomach contents, creating a physical barrier to prevent reflux

24
Q

What are some examples of antacids + alginates?

A

antacid: pepto-bismol, Rennie
alginate: gaviscon advance
dual product: gaviscon dual action, peptac

25
Q

What do PPIs do? + example + side effects?

A
  • PPIs block proton pumps in stomach wall to prevent gastric acid
    production
  • Takes 1-4 days to work fully, so may need to cover with antacids until
    it kicks in
  • Esomeprazole:
  • Common s/e: GI disturbances, headache, abdo pain
  • Can increase risk of GI infections such as Campylobacte
26
Q

When to refer a patient with dyspepsia?

A
  • 55 years or over, especially with new onset
  • Dyspepsia hasn’t responded to treatment
  • Features including bleeding, dysphagia, recurrent vomiting or
    unintentional weight loss
27
Q

What are the associated symptoms with nausea and vomiting? + medication that can be used?

A

?diarrhoea – may be gastroenteritis, question about food intake, could be rotavirus in
children
* ?blood in vomit – differentiate fresh blood from that of gastric/duodenal origin
* ?faecal smell – GI tract obstruction
* Medication: opioids, NSAIDs/aspirin, antibiotics, oestrogens, steroids,
digoxin, lithium, etc

28
Q

What are the symptoms of constipation?

A
  • abdominal discomfort
  • cramping
  • bloating
  • nausea
  • straining
29
Q

When to refer someone with constipation?

A
  • unexplained weight loss
  • rectal bleeding
  • family history of colon cancer or inflammatory bowel disease
  • signs of obstruction
  • co-existing diarrhoea
  • long-term laxative use
  • failed OTC > 1 week
30
Q

What medications can cause constipation?

A

Opioid analgesics
* Antacids – aluminium
* Antimuscarinics (anticholinergics)
* Anti-epileptics
* Anti-depressants
* Anti-histamines
* Anti-psychotics
* Parkinson’s medication
* Calcium-channel blockers
* Calcium supplements
* Diuretics
* Iron
* Laxatives

31
Q

What are the pharmacological + non pharmalogical treatment options for constipation?

A

non pharm:
*increase fibre intake
*increase fluid intake
*increase exercise
pharm:
bulk forming, ispaghula + methylcellulose
osmotic e.g lactulose, macrogols
faecal softener
stimulant e.g glycerin, Senna, bisacodyl

32
Q

Diarrhoea - causes + types?

A

90% of acute cases associated with viral or bacterial infection
* norovirus and campylobacter most common in the community
* may be parasites such as giardiasis following travel to certain areas
* Acute: symptoms less than 14 days
* Persistent: symptoms more than 14 days
* Chronic: symptoms more than 4 weeks

33
Q

What are the symptoms to diarrhoea?

A
  • Three or more lose, watery stools in 24 hours
  • Faecal urgency
  • Abdominal cramps
  • Abdominal pain
  • +/- nausea and vomiting
34
Q

What to treat diarrhoea with? + when to refer?

A

*oral rehydration therapy - dioralyte
*loperamide
*kaolin +/- morphine
-refer when-
* Duration longer than:
* 1 day in < 1year old
* 2 days in < 3 year old or in older adults
* 3 days in older children and adults
* Pregnancy
* Severe vomiting
* Fever
* Blood or mucous in stools
* Suspected reaction to prescribed medicine
* Suspected outbreak of “food poisoning”
* Recent foreign travel
* Persistent diarrhoea following antibiotic treatmen

35
Q

What are haemorrhoids? + risk factors?

A
  • Haemorrhoids are clusters of vascular tissue,
    smooth muscle and connective tissue arranged in
    three columns along the anal canal
  • Constipation and poor diet
  • Increased incidence between ages 45-65yrs
  • Pregnancy
  • Heavy lifting
  • Chronic cough
  • Certain toilet behaviours, such as straining or spending more time on
    a seated toilet than on a squat toilet
36
Q

What are the two types of haemorrhoids + their symptoms?

A
  • External haemorrhoids
  • lumps and bumps around the anus
  • itchy (irritation from faecal matter not being fully removed by wiping)
  • not usually painful unless severely swollen
  • Internal haemorrhoids
  • discomfort/pain
  • feeling of fullness in rectum
  • when prolapsed, itchy and irritating
  • not usually painful unless prolapsed and strangulated
  • Both may bleed (especially after passing stools)
37
Q

What are the treatment options for haemorrhoids?

A
  • Usually self-limiting and heal within a week or so
  • Life-style measure in relation to diet and fluid intake
  • Analgesia as needed
  • Topical preparation may contain astringents, local anaesthetics,
    corticosteroids or a combination
  • Can be internal (creams, suppositories) or external (creams, gels,
    ointments)
38
Q

When to refer a haemorrhoids patient to the gp?

A

*patients can feel a mass
*systemic symptoms
*extreme pain on defecation
*weight loss
*persistent change in bowel habit
*faecal incontinence
*over 40 years old

PMP103 - Practice Of Pharmacy (24 decks)

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