Lecture 21

Question 1

Indigestion (dyspepsia)?

Answer 1

Persistent/recurrent pain/discomfort in upper abdomen due to disorder of digestive function.
Often sign of GORD/ulcers

Question 2

Heartburn (gastro-oesophageal reflux diseases GORD)?

Answer 2

Digestive disorder involving lower oesophageal sphincter causing reflux of gastric contents (acid) into the oesophagus

Question 3

WWHAMM?

Answer 3

Who is it for ?
What are the symptoms ?
How long have symptoms persisted ?
Action already taken ?
Medication being taken (OTC + Rx) ?

Question 4

Treatment for indigestion?

Answer 4

Antacids: neutralise stomach acid, liquids/tablets, 1h after meal (e.g. calcium salts - fast acting, long duration)

De-flatulent: break up/release trapped wind (e.g. peppermint oil)

Histamine antagonists: reduce acid in stomach (e.g. ranitidine), rapid onset and long duration (12 hours)

Proton pump inhibitors: reduce acid secretion, 1-2h onset and long duration (24h - so once daily) (e.g. omeprazole)

Counselling points: small meals often, lose weight, reduce alcohol/smoking, avoids spicy food/stressful situations

Question 5

Treatment for GORD?

Answer 5

Same for indigestion: to neutralise/reduces acid

Rafting agents: Gaviscon to protect lining of oesophagus if reflux does occur

Counselling points: avoid bending, raise head of bed, change diet

Question 6

Indigestion danger symptoms?

Answer 6

Anorexia, unexplained weight loss, blood in vomit/stools, difficulty swallowing

Question 7

GORD danger symptoms?

Answer 7

Difficulty swallowing, pain aggravated by exercise, pain radiating to back/arms

Question 8

Indigestion: when to refer?

Answer 8

If first time >50, more than 5 days/recurrent symptoms

Question 9

GORD: when to refer?

Answer 9

If first time >50, more than 1 week/recurrent symptoms/radiating pain