RTS Gastro-Intestinal System Flashcards
Define Dyspepsia
A term used to describe a range of symptoms including: - Pain/discomfort in the abdomen - Regurgitation of food or acid re-flux - Nausea and vomiting relating to eating - sour acid taste - fullness, bloating, wind - heartburn
Triggers to dyspepsia
Smoking, Eating late near bed time, Alcohol,
NSAIDS, Being overweight Pregnancy
Key conditions in dyspepsia
Peptic ulcer disease
GORD, duodenitis, gastritis infection by H.Pylori
Danger symptoms in dyspepsia
GI bleeding unintentional weight loss persistent vomiting black ‘tar’ stools cardiac pain (after mistaken for dyspepsia) pain radiating down arm, not relieved by antacids patients above age 45 with first episode ever recurrent
When do you refer for dyspepsia - what drugs??
Dyspepsia caused by POM NSAIDS, Iron, corticosteroid
Dyspepsia first line treatments
combinations of antacids, to be taken after meals and at bedtime e,g Magnesium and Aluminium Alginate rafts to form a barrier and minimise reflux.
Dyspepsia second line treatments
H2 Antagonists e.g ranitidine and famotidine - Inhibit stomach acid production. Short term use. 12 hour relief
Dyspepsia third line treatments
Proton pump inhibitors - Omeprazole/Pantoprazole to suppress acid.
Who shouldnt we give ranitidine or omeprazole to?
under 16’s (ranitidine) and under 18s (omeprazole) and don’t give it to pregnant/breastfeeding women Or liver/renal impairment
Self care for dyspepsia
weight loss, no smoking, avoid trigger foods e.g caffeine/ alcohol/ rich and spicy foods/ take small or regular meals.
What is Nausea?
queasy feeling a person gets before being sick or throwing up
Define vomiting?
body’s way of getting rid of stomach contents it feels may be causing harm
Internal causes of nausea and vomiting
headaches, viral infections, pregnancy, severe pain, heart attacks
External causes of nausea and vomiting
motion sickness, alcohol poisoning, food poisoning, medicines
Other causes of nausea and vomiting not so common?
Allergy, Stress, cancer, overeating
Nauseas and vomiting - when do you refer?
Pregnant women. Dehydrated following ORT. Food poisoning, e.g E.coli. Infant/Child <6 Not urinated in last 6 hours.
what calls for urgent referral where you might want to give Dr an added note
Blood in vomit (bright red or looks like ‘coffee grounds’) Severe headache or stiff neck Lethargy, confusion or decreased alertness Rapid breathing or pulse
Drug treatments for nausea
Prochlorperazine, buclizine ( for migrane and for Prochlorperazine vomiting) Promethazine, Cinnarizine, Hyoscine (travel sickness) Bismuth subsalicylate (nausea due to dyspepsia)
Treatment for pregnant women with travel sickness or morning sickness in pregnancy
Accupressure bands
Nausea and vomiting self care
Small frequent sips of water, small meals if possible, rest and ginger tea/biscuits
what do you want to do at the end of any consultation?
make recommendations on websites such as nhs choices and patient.co.uk. As patient if they understand, and if they have any questions, where they should go
Define GORD
unpleasant burning feeling felt behind breastbone, accompanied by a sour or bitter taste in the throat caused by reflux or GI contents into the oesophagus
what actually causes heart burn?
The gullet does not have a protective lining, and so it becomes sore and inflamed when acid rises up from the stomach
Common symptoms of GORD
Burping, A sour acid taste in back of throat. Discomfort that gets worse after eating, lying down or bending over. Bloating. Burning feeling in chest! and pain behind breastbone.
GORD in infants what do they present with? why do they get GORD?
children may present with recurrent vomiting. There is a passive transfer of gastric contents to oesophagus
How long does it take for GORD to be resolved in infants? What can you say to a worried mother about GORD?
12-18 months. Half of babies below 3 months bring up food at least once/day!
How to treat a non-ulcer dyspepsia
Can treat with H2 antagonists or PPI
what is PUD?
Two types: Gastric and Duodenal. Erosion of the stomach lining, often due to overproduction of acid.
What is IBS?
Abdominal pain or discomfort accompanied by changes in bowel habits for the past 6 months. Sx may worsen by eating
IBS Treatments
Bulk-forming laxative e.g isphagula for constipation Anti-diarrhoeals, e.g loperamide Antispasmodics e.g mebeverine, or hyoscine (abdominal pain) Peppermint oil - direct relaxant on smooth intestinal muscle Antiflatulents e.g simeticone to relieve wind pain and bloating
IBS Self care
Exercise Diet Fibre, adequate fluid intake, low fat and cut out processed foods. Monitor triggers e.g foods,stress, hormonal Quit smoking
What is constipation?
Infrequent bowel movement with a sensation of pain and incomplete evacuation. Accompanied by straining and passage of hard stools.
Who defines constipation?
The patient. What is normal
Prevalence of constipation
increases with ages, and affects more women than men. Pregnancy (up to 38%)
what causes constipation? (non drug)
poor fibre intake, diet, water, pregnancy?
what drugs cause constipation
OPIOID USE, Diuretics, long term laxative use, IBS, cancer, iron supplements, antacids containing aluminium
when to refer a constipated patient?
new or worsening symptoms, weight loss, blood in stools, nausea and vomiting. major change in bowel habit.
with opioid induced constipation what laxatives do we avoid?
osmotic and stimulant laxatives
Self care constipation
Diet - plenty of fruit and vegetables. Increased fluid consumption Regular exercise Avoid holding the urge
What is Diarrhoea
Frequent bowel movements of a more watery consistency with a sensation of URGENCY
what accompanies diarrhoea frequently?
vomiting and headache
on the physiological level, why does diarrhoea occur?
the lining of the large intestine becomes inflamed preventing fluid absorption from food in the intestine
Acute Diarrhoea
comes on suddenly and lasts 5-10 days due to viral infection e.g norovirus or bacterial infection e.g E.Coli, Salmonella or parasitic. Infected water “traveller’s diarrhoea” Stress or anxiety, Alcohol/Coffee
What medications can cause diarrhoea
broad spectrum abx and antacids containing magnesium
Chronic Diarrhoea. How long does is last and what can cause it
lasts more than 2 weeks and can also be caused by bacterial or viral infections. Poor diet and overuse of laxatives can be a factor.
Long terms conditions associated with Diarrhoea
IBS, lactose intolerance, ulceration colitis
When to refer a patient with diarrhoea?
drowsiness or confusion. passing little urine more than 3 days in adults more than 24 hours in children under 12, and elderly. dehydration and sunken eyes. Fever and Patient has been abroad
Danger symptoms of diarrhoea to signpost
bloody, black, mucus stool
Treatment of Diarrhoea
ORT e.g Dioralyte. Reconstitute with fresh water. Antidiarrhoeals e.g Loperamide. Slow down passage of food.
Diarrhoea and constipation self care
Good food hygiene, wash hands, clean and disinfect toilet
Diarrhoea self care specifics
Drink water regularly, rest. BRAD Diet. Bannas, rice, apples, dry toast. No need to avoid solid food!
What might we also consider for patients who had abx therapy and are having diarrhoea
probiotics!
