GI tract Flashcards
What are the symptoms of indigestion (dyspepsia)?
- Discomfort of pain in the stomach
- Bloating; Burping; Nausea
- Heartburn
What are the ain causes of dyspepsia/indigestion?
- Over eating; spicy foods, smoking, alcohol
- pregnancy
- ulcers
- anxiety/ stress
What are the symptoms of gastro-oesophageal reflux disorder?
- Heartburn - pain in the middle of the chest
- Sour mouth - contents of stomach coming back up
What are the main causes of gastro-oesophageal reflux disorder?
- Over eating; spicy foods, smoking, alcohol
- Pregnancy
- Certain drugs
- Ulcers
- Anxiety/ stress
What are ulcers?
Areas where damage has occurred to the mucosal membrane of the oesophagus, stomach or duodenum
What are the symptoms of an ulcer?
- pain
- bleeding
What are the causes of an ulcer?
- Bacterial infection H. pylori
- NSAIDS
- Smoking
- Zollinger-ellison syndrome
- Anxiety/ stress
Which drugs are used for ulcers, GORD and indigestion?
- antacids
- antisecretory drugs & mucosal protectants:
- histamine H2 antagonist
- proton pump inhibitor
- chelates & complexes
- prostaglandin analogues
- Antibiotics ( for ulcers only !)
What are the actions of antacids?
- Act locally to neutralise acid in the stomach
- As pH now less acidic, this also decreases pepsin activity
What is the preparation of antacids?
- They can come as liquids or tablets
- They contain calcium, aluminium and magnesium salts
Examples are: Rennies, Maalox, Gaviscon
what are the 2 types of antacids?
- simeticone
- alginates
how do simeticone antacids work?
- alters surface tension of small bubbles of gas to allow formation of large bubbles which can then be got rid of
how do alginates antacids work?
– react with gastric juices to form a raft that floats on top and protects oesophagus from stomach contents
aluminium may cause ______
constipation
magnesium may cause ______
diarrhoea
take ___ hour after or before food
1
leave a ____ hour gap between other oral medication and antacids
2
can cause electrolyte imbalance so always monitor….
for calcium, phosphate, magnesium and aluminium levels
this position can help…
Sleep on left side or with head/shoulders propped up with pillows
H2 Receptor Antagonists examples are…
Cimetidine (Tagamet®); famotidine (Pepcid®); nizatidine (Axid®); ranitidine (Zantac®)
H2 Receptor Antagonist actions…
Block H2 receptors on parietal cells in stomach
Reduce acid production in the stomach
Proton pump inhibitors examples…
Lansoprazole (Zoton®), Esomeprazole (Nexium®) Omeprazole (Losec®), Pantoprazole (Protium®), Rabeprazole (Pariet®)
Proton pump inhibitor actions …
In acidic pH form two reactive molecules
Binds permanently to proton pump
Proton pump never pumps acid again!
Helicobactor Pylori Infection is …
- H. pylori is a gram negative bacteria that causes inflammation of the stomach lining
- Routine treatment of ulcers includes treatment for H. pylori
Helicobactor Pylori Infection treatment is ..
-2 Antibiotics + reduction in acid secretion
- know as “triple therapy” for 7-14 days
-Antibiotics:
Clarythromycin; Amoxycillin; Metronidazole; tetracycline
If patient has a penicillin allergy do not give …
amoxicillin
NSAIDS induce..
NSAID induced ulcers – NSAIDs inhibit Cox-1 which produces prostaglandins
Antispasmodics site of action is
the intestine
Antispasmodics reduce …
Reduce gut motility
Relax smooth muscle
Antispasmodic drugs are used to treat …
Irritable bowel syndrome
Diverticular disease
Side effects of antispasmodic drugs are ..
- Dry mouth
- Constipation
- Caution when using in elderly patients as may cause confusion
what are the 3 Different Classes of Laxative?
Bulk forming
Stimulant
Osmotic
Bulk forming laxatives actions are…
Increase of faecal mass, stimulating peristalsis
take a few days to work
a patient needs to maintain / increase fluid intake
Examples of bulk forming laxatives are …
Ispaghula husk (Fybogel® ;Regulan®), methylcellulose (Celevac®), sterculia (Normacol®)
Stimulant Laxatives actions are
Increase peristalsis, moving stool through large intestine
For acute use – can cause lazy bowel
Examples of stimulant laxatives are
Bisacodyl, dantron, senna (Sennokot®), sodium picosulfate
How do osmotic laxatives work ?
Poorly soluble, not absorbed, draw water into gut
Makes stools softer and easier to pass
Lactulose & Macrogols – takes a couple of days to work
Examples of osmotic laxatives are…
Lactulose, macrogols (Movicol®),
Magnesium salts
Phosphates (Carbolox®) / Sodium Salts (Microlax®) (Rectal Use)
Side effects of osmotic laxatives are …
Abdominal cramps
Wind
Diarrhoea
Female, 25 has symptoms of burning in the middle of her chest and acute pains in the stomach. She is on phenytoin for epilepsy but otherwise healthy what drug is she likely to be on?
Gaviscon (antacid + alginate)
A 45 year old man has abdominal cramps and has been going to the toilet every 30mins-1hr. He has no nausea and vomiting but is feeling very faint What is the man likely to receive A. proton pump inhibitor B. lactulose + fluids C. loperamide + oral rehydration
c.
