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OSCE Year 3 > Indigestion and heartburn > Flashcards

Indigestion and heartburn Flashcards

1
Q

Describe the difference(s) between indigestion and heartburn and any other terms used to describe them

A
  • indigestion (dyspepsia) occurs after eating, excess acid is produced in the stomach
  • heartburn (acid reflux): excessive acidic contents of stomach escape back up to oesophagus due to weakened or malfunctioning sphincter (valve)
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2
Q

What causes the symptoms in indigestion and heartburn?

A

Acid contacts oesophagus lining, causing irritation and associated symptoms

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3
Q

If treatment hasn’t been successful, after what period of time should a patient be referred to their GP?

A

If symptoms not responded to treatment, refer to GP after:
7 days for heartburn
5 days for indigestion

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4
Q

List the symptoms of indigestion

A 
bloated feeling
churning stomach
stomach cramp
pain (though usually less than heartburn)
excess acid (leaving a nasty taste) 
dull stomach ache
wind
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5
Q

List the symptoms of heartburn

A 
severe pain in upper chest 
burning in the back of the throat 
taste of acid in the mouth
burning pain rising up the throat
stabbing pain in the chest
excess acid 
symptoms worse after eating food
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6
Q

Questions to ask patient with suspected heartburn or indigestion

A

Could you explain where the pain starts and where you feel it?
Describe to me how your symptoms progress through the day?
Is the pain waking you at night? (Duodenal ulcer)

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7
Q

Red flag symptoms for indigestion and heartburn

list them

A
  • symptoms persistent or recurrent (>2x in one week or lasting >5 days)
  • severe pain or pain radiating to arms
  • failed treatment or ADR
  • pain or difficulty swallowing, dysphagia, or on effort
  • regurgitation
  • bleeding in vomit or stool
  • unintentional weight loss
  • anaemia (fatigue, pale skin)
  • persistent vomiting
  • shortness of breath
  • children
  • first time symptoms in those aged 45+
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8
Q

Indigestion and heartburn danger elimination

how to make sure it’s not an MI/angina?

A

pain radiating down the arm or pain on exertion?

Do they have nausea, vomiting, sweating or clammy skin? Crushing pain?

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9
Q

Indigestion and heartburn danger elimination

Oesophagitis

A

blood-stained vomit/stools

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10
Q

Indigestion and heartburn danger elimination

duodenal ulcers

A

gnawing, hunger-like pain, relieved by eating then recurs, causes sufferer to wake, blood in vomit or stools

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11
Q

Indigestion and heartburn danger elimination

gastric/peptic ulcer

A

worse after eating,nausea, salivation, bloating, weight loss, loss of appetite

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12
Q

Indigestion and heartburn danger elimination

gastric cancer

A

loss of appetite
anaemia
blood in stools/vomiting
unexplained weight loss

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13
Q

Indigestion and heartburn danger elimination

gallstones

A

stones form in gall bladder and block the bile duct in the liver, severe pain in upper abdomen which can be confused with a duodenal ulcer

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14
Q

Indigestion and heartburn danger elimination

IBS

A

colon spasms
alternating constipation and diarrhoea
Pain in lower abdomen and sometimes upper so confused with heartburn

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15
Q

How do histamine 2 receptor blockers work in the treatment of indigestion and heartburn?

A

block the histamine receptors in parietal cells to decrease the amount of acid produced

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16
Q

How do PPIs work in the treatment of indigestion and heartburn?

A

PPI=protein pump inhibitor

Shuts down proton pumps in parietal cells, preventing the acid from being secreted into the stomach

17
Q

Lifestyle advice for indigestion and heartburn

A
  • raise the bed or use an extra pillow as symptoms are worse when horizontal or bending
  • stop smoking and reduce alcohol and caffeine intake
  • avoid spicy and oily foods, or avoid specific known trigger foods, or large, heavy and fatty meals
  • chemicals in fatty foods, chocolate, alcohol and coffee and smoking make heartburn worse
  • avoid tight, restrictive clothing e.g. belts
  • pregnant women also suffer from heartburn but this is due to the growing baby pushing internal organs upwards, including the stomach and its contents
18
Q

common age range for heartburn and indigestion

triggers for it?

A

Common in over 55 years of age
Common in overweight individuals
Triggers include: heavy meals, spicy foods, alcohol, smoking, NSAIDs (irritate stomach lining)

19
Q

Gaviscon original drug, symptoms
directions
formulations

A

Sodium alginate with calcium carbonate and sodium bicarbonate
GI acid reflux, heartburn, indigestion
Children 6-11: 5-10mL
Over 12s: 10-20mL
Take it after meals and at bedtime
Note: children 6-12 can only take this under medical supervision

20
Q

Gaviscon original warnings

A

check allergies
contains sodium and calcium so be careful if on salt diet
Do not give if patient has high blood pressure
Do not use if taking citrate salts

21
Q

Gaviscon original pregnancy and diabetes?

A

fine for both pregnant women and diabetics

22
Q

Counselling for gaviscon

A

Can have aniseed or peppermint flavourrs
Different types of gaviscon: double action, advanced etc.
Children 6-12: under medical supervision

23
Q

Rennie for use in indigestion and heartburn

Directions for use

A

1-2 tablets up to TDS, PRN
take before food
Maximum of 10 tablets/day
different flavours available

24
Q

Rennie for use in indigestion and heartburn

Side effects and warnings

A

Side effects: GI disturbances
Warnings: Not for children, only for over 12s
Fine in pregnant women

25
Q

Ranitidine for indigestion and heartburn
Drug class?
Symptoms/Licence?

A

H2 antagonist

Short term relief (2 weeks) of dyspepsia, hyperacidity, heartburn

26
Q

Ranitidine for indigestion and heartburn

directions for use

A

16+ and elderly: 1-2 tablets PRN
If symptoms persist after 1 hour, take another tablet.
No more than 2 tablets per 24 hour period.
Not to be taken for more than 6 days unless under the advice of a doctor or pharmacist

27
Q

Ranitidine for indigestion and heartburn

warnings

A

Not for under 16s
No more than 2 tablets in a 24 hour period
Not to be taken for more than 6 days unless under the advice of a doctor or pharmacist
Not to be used in pregnant or breastfeeding women
Do not use in hepatic or renal impairment
Caution if taking NSAIDS, antacids, sucralfate (for ulcers)
Check interactions
Do not drink alcohol

28
Q

Ranitidine for indigestion and heartburn Counselling

A

Not for under 16s
Do not drink alcohol
Work longer than antacids like Rennie- 8-9 hours duration
Try to take 1 hour before food

29
Q

Omeprazole drug class and symptoms it treats

A

PPI
Heartburn
Indigestion

30
Q

Omeprazole for heartburn and indigestion, directions for use

A

1-2 tabs OD for 2 weeks

10-20mg OD for 2 weeks according to response

31
Q

Omeprazole for heartburn and indigestion,

side effects

A 
abdominal pain 
constipation 
diarrhoea 
headache 
nausea
vomiting
32
Q

Omeprazole for heartburn and indigestion
suitability in pregnancy?
age restrictions

A

Fine for pregnancy and breastfeeding patients

Not for under 12s

33
Q

Pepto-Bismol liquid suspension
indication
doses

A

heartburn/indigestion, diarrhoea, upset stomach
Up to 8 doses in 24 hours
1 dose= 30mL,
repeat dose every 30-60 mins if needed

34
Q

Pepto-bismol suitability for pregnancy and breastfeeding

warnings

A

Ok to take in pregnancy, but must check with doctor first
Under 12s: must be under doctor’s advice
Warning: take for no longer than 2 days.

35
Q

How toes pepto-bismol work in the treatment of indigestion and heartburn? What the active compound in it?

A

contains bismuth subsalicylate which coats the lining of the stomach and prevents irritation and lessens nausea
Antacid

OSCE Year 3 (25 decks)

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