GI Tract Flashcards
What is a mouth ulcer? + what could the patient recall?
- 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
What is the most common type of mouth ulcer?
Recurrent aphthous stomatitis
What are the types of aphthous stomatitis?
*aphthous minor (80% of cases)
*aphthous major (10% of cases)
*herpetiform (10% of cases)
Summarise what are the symptoms of aphthous minor
- Often in groups of up to five
- Small ulcers (<1cm)
- “uncomfortable”
- Heal within 10-14 days
Summarise what are the symptoms of aphthous major
Usually 1-3 ulcers
* Larger than 1cm
* Painful and may affect eating
* Can take weeks to heal
Summarise what are the symptoms of aphthous herpetiform
- Groups of 10-50 small ulcers
- Very painful
- Heal within 10-14 days
What could be the causes to mouth ulcers?
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
What are the treatment options for ulcers?
*saline solution
*antiseptic (chlorhexidine)
*anti-inflammatory benzydamine
*steroid hydrocortisone
How is saline used to treat mouth ulcers?
- Half a teaspoon of salt in a glass of warm water
- Rinse frequently until ulcers subside
- Any age
How is antiseptic chlorhexidine used to treat mouth ulcers?
- 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
How is benztdamine used to treat mouth ulcers?
Use every 1.5-3 hours
* Can be used OTC from age 6
How is hydrocortisone used to treat mouth ulcers?
- One tablet dissolved on ulcer four times a day
- Can be used OTC from age12
When should you refer a patient suffering with a mouth ulcer?
- 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
What is dyspepsia?
A complex of upper gastrointestinal tract symptoms typically present for 4 or more weeks
What are the symptoms to dyspepsia?
- 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
What are the common causes to dyspepsia?
- 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
What is GORD? + causes?
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
What are the trigger factors to GORD?
- Smoking
- Alcohol
- Coffee
- Chocolate
- Fatty foods
- Being overweight
- Stress
- Medicines (calcium channel blockers, nitrates, NSAIDs)
- Tight clothing
- Pregnancy
What are the causes to peptic ulcers (stomach)?PUD
- Helicobacter pylori infection
- Medication, mainly NSAIDs (others can cause them)
- Zollinger-Ellison syndrome (rare condition causing high acid secretion)
How can you confirm and treat a peptic ulcer?
- 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
What are the treatment options for dyspepsia?
- Non-pharmacological
- Antacids
- Alginates
- H2 receptor antagonists (block them)
- Proton pump inhibitors
Dyspepsia - non pharmacological treatment options?
- 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
What is an antacid + alginate?
antacid = compounds that neutralise stomach acid
alginate = form a raft on top of stomach contents, creating a physical barrier to prevent reflux
What are some examples of antacids + alginates?
antacid: pepto-bismol, Rennie
alginate: gaviscon advance
dual product: gaviscon dual action, peptac
What do PPIs do? + example + side effects?
- 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
When to refer a patient with dyspepsia?
- 55 years or over, especially with new onset
- Dyspepsia hasn’t responded to treatment
- Features including bleeding, dysphagia, recurrent vomiting or
unintentional weight loss
What are the associated symptoms with nausea and vomiting? + medication that can be used?
?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
What are the symptoms of constipation?
- abdominal discomfort
- cramping
- bloating
- nausea
- straining
When to refer someone with constipation?
- 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
What medications can cause constipation?
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
What are the pharmacological + non pharmalogical treatment options for constipation?
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
Diarrhoea - causes + types?
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
What are the symptoms to diarrhoea?
- Three or more lose, watery stools in 24 hours
- Faecal urgency
- Abdominal cramps
- Abdominal pain
- +/- nausea and vomiting
What to treat diarrhoea with? + when to refer?
*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
What are haemorrhoids? + risk factors?
- 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
What are the two types of haemorrhoids + their symptoms?
- 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)
What are the treatment options for haemorrhoids?
- 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)
When to refer a haemorrhoids patient to the gp?
*patients can feel a mass
*systemic symptoms
*extreme pain on defecation
*weight loss
*persistent change in bowel habit
*faecal incontinence
*over 40 years old
