Responding to symptoms Gastrointestinal Flashcards
1
Q
Gastro conditions
A
- Mouth ulcers
- Dyspepsia
- Nausea and vomiting (motion sickness covered in ENT)
- Constipation
- Diarrhoea
- Haemorrhoids
2
Q
Mouth ulcers
A
- Usually a single, irregularly-shaped ulcer
- Burning sharp pain biting
3
Q
Aphthous minor mouth ulcer
A
- Often in groups of up to five
- Small ulcers (<1cm)
- Feels uncomfortable
- Heal within 10-14 days
4
Q
Signs of mouith cancers
A
- Under tounge could be cancer also multiple mouth ulcers that are reoccouring
5
Q
Causes for mouth ulcers
A
- Iron deficiency anaemia
- Hypertensivity - preservatives food sodium laryl sulphate
- Psycological stress
6
Q
Aphous major
A
- 1-3 larger than 1cm may be painful eating
- Takes weeks to heal
7
Q
Herpetiform
A
- Groups of 10-50 small ulcers
- Very painful
- Heal within 10-14 days
8
Q
Treatment for mouth ulcers
A
- Saline and garggle with salt water
- Antiseptic - Rinse twince a day
- Can cause temporary yellow staining of teeth
- Can be used OTC from age 12
9
Q
Treatment for more painful mouth ulcer
Anti-inflammatory
A
- Use every 1.5-3 hours over the age of 6
10
Q
Treatment for mouth ulcer
Steroid hydrocortisone
A
One tablet dissolved on ulcer four times a day
Can be used OTC from age12
11
Q
When to refer mouth ulcer
A
- Lasts longer than 3 weeks
- Keeps coming back
- Painless and persistant
- Grows back bigger than usual
- At back of throat
- Bleeds or gets red and painful
12
Q
Dyspepsia
A
Complex of upper gastrointestinal tract symptom
13
Q
Symptoms
Dyspepsia
A
- Severe varies from patient to patient
- Upper abdomen pain and discomfort
- Burning sensation starting in stomach, passing upwards to behind the breastbone
- Gastric acid reflux
- Nausea or vomiting
14
Q
Dyspepsia
A
- Gastro-oesophageal reflux disease (GORD)
- Peptic ulcer disease
- Barrett’s oesophagus
- A premalignant condition
- Upper GI malignancy
15
Q
Gastric-oesophageal reflux disease
A
- Transient relaxation of lower oesophageal sphincter
- Increased intra-gastric pressure
- Delayed gastric emptying
- Impaired oesophageal clearance of acid
16
Q
Things that trigger GORD
A
- Smoking
- Alcohol
- Coffee
- Chocolate
- Fatty foods
- Being overweight
- Stress
- Medicines (calcium channel blockers, nitrates, NSAIDs)
- Tight clothing
- Pregnancy
17
Q
Peptic Ulcer Disease
A
- Ulcers may be present in stomach or duodenum
- Vomit from lower down darker in coulor higher up more red
- Confirm ulcers with endoscopy
18
Q
Causes for peptic ulcers
A
- Helicobacter pylori infection
- Medication mainly NSAID’S
- Zollinger-Ellison syndrome
19
Q
Dyspepsia management
A
- Most patients have mild non-pharmacological means and OTC treatments
- Non-pharmacological
- Antacids
- Alginates
- H2 receptor antagonists
- Proton pump inhibitors
20
Q
Non-pharmacutical Dyspersia
A
- Loss of weight
- Eating small frequent 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
21
Q
Antacids
A
- Compounds that neutralise stomach acid
- Sodium bicarbonate and calcium carbonate
22
Q
Alginate
A
- Form a ‘raft’ on top of stomach contents, creating a physical barrier to prevent reflux
- Some combine both together
23
Q
H2 receptor antagonist
A
- Ranitidine and famotidine
- Longer duration of action and longer onset of action than antacids
- Block H2 receptors in stomach to prevent acid production
24
Q
Proton pump inhibitor
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
- Omeprazole
25
When do refer for Dyspepsia
- Beware of patients frequently attending for dyspepsia remedies
- Dyspepsia remedies may mask signs of gastric cancer
26
Red flag symptoms of 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
27
# Causes
Nausea and vomiting
- Very young and old most at risk of dehydration
Pregnancy consider in women of childbearing potential
Duration adults >2 days cause for concern, young children (<2 years) any duration
28
Associated symptoms of nausea and vomiting
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
29
Management Nausea and vomiting
Most established vomiting will require referral
Motion sickness covered in ENT lecture
30
Constipation
- Bowel movement less than three times a week
- Difficult to pass stools
- Hard, dehydrated stools
- Women and older people (esp. >70 yrs) more frequently affected
31
Symptoms of constipation
- Abdominal discomfort
- Cramping
- Bloating
- Nausea
- Straining
32
Red flag symptoms for 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
33
Medication that 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
34
Non-pharmacological treatment for constipation
- Increase fibre intake
- Increase fluid intake
- Increase exercise
35
Pharmalogical treatment for constipation
- Bulk-forming, e.g. ispaghula husk, methylcellulose - fibre
- Osmotic, e.g. lactulose, macrogols
- Stimulant, e.g. senna, bisacodyl, sodium picosulfate, glycerin
- Faecal softener
36
Diarrhoea
- Most cases are short-lived, self-limiting and benign
- Acute: symptoms less than 14 days
- Persistent: symptoms more than 14 days
- Chronic: symptoms more than 4 weeks
37
Symptoms of Diarrhoea
- Three or more lose, watery stools in 24 hours
- Faecal urgency
- Abdominal cramps
- Abdominal pain
- +/- nausea and vomiting
38
Question for caution
- Young age and for a long time
- Severity: “explosive”, blood, pus
- Systemic symptoms: fever, nausea and vomiting
- Food intake and fluid intake, esp.in young
- Anyone else in household affected
- Foreign travel
- Any medicines already tried
39
Treatments for Diarrhoea
- Oral re-hydration therapy, e.g. Dioralyte
- Loperamide, e.g. Imodium
- Kaolin +/- morphine - can be abused due to morphine
40
When do you refer
- 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 treatment
- 1 day in < 1year old
- 2 days in < 3 year old or in older adults
- 3 days in older children and adults
41
Haemorrhoids
- Haemorrhoids are clusters of vascular tissue, smooth muscle and connective tissue arranged in three columns along the anal canal
- Are actually normal structures that help maintain continence in healthy people
- piles which are haemorrhoids in an abnormally swollen and symptomatic state
42
Risk factors for Haemorrhoids
- 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
