Responding to Symptoms – Gastrointestinal Flashcards

Question

What is Alginate? (treatment of dyspepsia)

Answer 1

Form a ‘raft’ on top of stomach contents, creating a physical barrier to prevent reflux Example: sodium alginate Usually contain sodium bicarbonate to help ‘raft’ to float to top of stomach

Answer 2

liquid and solid formulations

Answer 3

faster onset of action easier to take bulky bottles and viscous liquid

Answer 4

Portable and convenient More palatable (tastes better) Chew well then swallow

Answer 5

constipation

Answer 6

Pepto-Bismol®, Rennie®

Answer 7

Gaviscon Advance®

Answer 8

Gaviscon Dual Action®, Peptac®

Answer 9

Dose Usually a PRN dose After meals and before bedtime

Answer 10

Ranitidine and famotidine available OTC Longer duration of action and longer onset of action than antacids Block H2 receptors in stomach to prevent acid production For the short-term symptomatic relief of dyspepsia Also to prevent symptoms arising if associated with food or drink consumption when they cause sleep disturbances

Answer 11

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

Answer 12

"Nexium control" - branding GI disturbances, headache, abdo pain Can increase risk of GI infections such as Campylobacter

Answer 13

Can be sold OTC to adults aged 18 years old and over

Answer 14

Omeprazole (Losec®, Pyrocalm®) Dose: 20mg OD (come as 10mg tablets) Pantoprazole Dose: 20mg OD (come as 20mg tablets) Esomeprazole (Nexium®) Dose: 20mg OD (come as 20mg tablets)

Answer 15

Beware of patients frequently attending for dyspepsia remedies Dyspepsia remedies may mask signs of gastric cancer

Answer 16

55 years or over, especially with new onset Dyspepsia hasn’t responded to treatment Features including bleeding, dysphagia, recurrent vomiting or unintentional weight loss

Answer 17

Patients over 55 years with new onset symptoms Patients over 55 years with unexplained dyspepsia that hasn’t responded to 2 weeks of treatment Patients who have continuously taken remedies for 4 weeks (risk of rebound indigestion) Pregnant or breastfeeding Red flag symptoms: Unintentional weight loss Epigastric mass Stomach pain, pain/difficulty when swallowing Persistent vomiting Jaundice

Answer 18

Age: very young and old most at risk of dehydration Pregnancy: n&v common, consider in women of childbearing potential Duration: adults >2 days cause for concern, young children (<2 years) any duration

Answer 19

Pyloric stenosis in young children – stricture in stomach, projectile vomiting, differentiate from normal vomit

Answer 20

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

Answer 21

NSAIDs/aspirin, antibiotics, oestrogens, steroids, digoxin, lithium, etc.

Answer 22

Most established vomiting will require referral Motion sickness covered in ENT lecture

Answer 23

tends to occur in clusters and comes with cold-like symptoms. Vomiting without other symptoms in the young may be meningitis. Medication – important to differentiate that which you expect from the abnormal or signs of toxicity

Answer 24

Prevalence of around 8.2% of UK adults Sometimes difficult to define as need patient info on normal frequency for them Women and older people (esp. >70 yrs) more frequently affected

Answer 25

Bristol stool chart

Answer 26

bowel movement less than three times a week difficult to pass stools hard, dehydrated stools

Answer 27

Some people think you need to poo every day, but this is not the case. Women due to hormonal changes – also sometimes an issue in pregnancy. Older people due to more sedentary lifestyle, lower fluid intake, diet, delaying going to the toilet because of mobility

Answer 28

abdominal discomfort cramping bloating nausea straining

Answer 29

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

Answer 30

feeling bloated and full, pain (usually colicky tummy pain), feeling sick, vomiting large amounts (including undigested food or bowel fluid), constipation (shown by not passing wind and no bowel sounds) – so some of the “normal” symptoms, but worse and sometimes prolonged Failed OTC up to 2 weeks if dietary advice given first

Answer 31

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 (!)

Answer 32

- ^ fibre intake - ^ fluid intake - ^ exercise

Answer 33

1. Bulk-forming, e.g. ispaghula husk, methylcellulose 2. Osmotic, e.g. lactulose, macrogols Both take 2-3 days to work Bulk-forming – essentially undigestible fibre Osmotic – draw water into the gut and so important to be well hydrated

Answer 34

1. Stimulant, e.g. senna, bisacodyl, sodium picosulfate, glycerin 2. Faecal softener stimulate muscles in the lining of the gut, usually work within 6-12 hours (faster in the case of supp – 1hr) Faecal softener – allow liquids to penetrate hard stools, may help to lubricate gut, work in a couple of days orally – very quickly rectally

Answer 35

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 - MOST cases short-lived/ self-limiting and benign Acute: symptoms less than 14 days Persistent: symptoms more than 14 days Chronic: symptoms more than 4 weeks

Answer 36

Three or more lose, watery stools in 24 hours Faecal urgency Abdominal cramps Abdominal pain +/- nausea and vomiting

Answer 37

Age: very young and old most susceptible to dehydration Duration: in infants > 1 day of symptoms would be worrying, in adults a few days (unless anything else concerning) 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

Answer 38

Oral re-hydration therapy, e.g. Dioralyte first-line therapy even when referring Quantities (general rule of thumb) age 1> 50ml 1-5 years 100ml 6-12 years 200ml Adult 400ml [200ml is one glass]

Answer 39

Loperamide, e.g. Imodium over 12s only Kaolin +/- morphine Antimotility drugs should not be used in patients with a high fever or blood and/or mucus present in their stool (dysentery), or in confirmed E. coli (VTEC) or Shigellosis infections

Answer 40

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 treatment

Answer 41

- Thought to affect 13-36% of the population - clusters of vascular tissue, smooth muscle and connective tissue arranged in three columns along the anal canal

Answer 42

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

Answer 43

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

Answer 44

Blood should be fresh and red. GP referral to exclude other diagnoses should be made if the blood has a different appearance, such as darker red, brown or black, or is mixed with the stool. These signs suggest a more proximal blood source and may be a ‘red flag’ cancer symptoms.

Answer 45

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)

Answer 46

- persistant change in bowel habit - faecal incontinence - over 40 years - extreme pain on defecation - weight loss - patient feel a mass