RTS - gastrointestinal conditions Flashcards by Samantha Hughes

list referral points for adults in relation to nausea/vomiting?

vomiting for >48hours
can't keep fluids down 
vomit is green
severe dehydration 
loss of weight
regular occurrence

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list referral points for children in nausea/vomiting

vomiting >24hours
can't keep fluids down for the last 48hours
dehydration
limp, irritable, not usual
refusing food
severe pain 
headache/stiff neck

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what are the signs of dehydration in adults?

lack of energy
loss of appetite 
nausea
lightheaded
dry mouth 
muscle cramps 
rapid heartbeat

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what are the signs of dehydration in children?

irritable
drowsy 
pale skin
cold hands and feet
look unwell

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what is dyspepsia?

indigestion- stomach acid irritates the digestive tract - leads to irritation, inflammation, pain and bloating

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what is the difference between indigestion and heartburn?

indigestion - discomfort after eating, stomach

Heartburn - discomfort before or after eating, burning behind sternum (watch out for heart attack as similar burning)

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symptoms of dyspepsia?

pain in upper abdomen 
belching
bloating
nausea/vomiting
full feeling 
uncomfortable
reflux

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what is the ALARM acronym for dyspepsia that is for referral signs?

A = age >55 and first time 
L = loss of weight 
A= anaemia 
R= recurrent vomiting / swallowing difficulty 
M= malaena - blood (GI)

Also refer in - pain in arms, back, radiation of pain
Child, pregnant/BF
Treatment fail

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What are the 4 types of treatment for dyspepsia?

antacids
alginates
proton pump inhibitors
H2 antagonists

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what are antacids for dyspepsia?

contain ingredients - aluminium, magnesium, calcium carbonate, sodium bicarbonate
Neutralise the stomach acid pH back to 5/6/7 - easier to digest
Best taken 1 hour after a meal
BRANDS= Rennie &gaviscon
available as liquids and tablets but liquids faster as already in solution

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what are alginates for dyspepsia?

Contains antacid. - neutralises stomach acid
forms a raft/thick layer above the stomach contents to stop it coming up the oesophagus.
BRAND= gaviscon liquid, also coats the oesophagus which cools it

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what are H2 antagonists for dyspepsia?

Ranitidine - ZANTAC. 75mg tablets.
lower the acidity in the stomach, work up to 12 hours
16+ only
BUT- may mask symptoms of other issue and stop from healing so caution

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What are proton pump inhibitors for dyspepsia? .

omeprazole 10mg tablets - work up to 24hours.
Restrict acid production - should ideally be initiated by the GP.
MANY interactions
18+ only
can mask symptoms of other conditions too

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Lifestyle advice for dyspepsia?

diet and lifestyle e.g if overweight - lose weight as obesity causes dyspepsia. 
Stop smoking 
eat small, regular meals, chew fully
avoid eating prior to bedtime 
stress management 
MURS
extra pillow in bed to stop acid rising

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why is a thorough drug history check so important when considering antacids for dyspepsia?

antacids can stop some medications from working so must do a thorough check -
antibiotics, antivirals, statins, thyroid hormone replacements,
theophylline - narrow therapeutic window
enteric coatings - it is resistant to low pH but reacts in higher pH - the antacid raises the pH in stomach and the drug with EC will dissolve in the stomach rather than its intended destination which affects the mechanism of action

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what is GORD?

acid leaks out of stomach and irritates the oesophagus, issues with the lower oesophagul sphincter. Predisposing factors - fatty foods, alcohol, hiatus hernia, weight, medicines such as NSAIDS, steroids
Affects babies too

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symptoms of GORD?

heart burn
acid reflux 
laryngitis - throat infection due to acid 
tooth decay - acid in mouth 
taste disturbances and bad breath

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symptoms of GORD in babies?

regurgitation
crying
bad breath 
arch back and roll - raising to move the acid away from their oesophagus
refusal to feet

referral In GORD?

always refer in suspected GORD because cannot be treated by only OTC medication, only symptomatic relief e.g antacids, alginates, PPIs, h2 antagonists

what types of medicines can cause constipation? (5)

antacids
anti-depressants
opioids e.g codeine
duiretics 
iron

what are the red flag symptoms in constipation?

unexplained change in bowel habit
mass in lower right abdomen 
rectal bleeding - persistent
family history of colon cancer
irritable bowel disease
unexplained weight loss 
fever
anaemia 
treatment fail

what are the 4 classes of laxatives?

bulk forming
osmotic
stimulant
faecal softeners

describe bulk forming laxatives

ispaghula husk - fybogel
1 sachet stirred into water morning and night after meals - not for under 6 years.
increases mass of stools - retain water and soften
DRINK PLENTY OF FLUID WHEN TAKING

what generic and brand is bulk forming laxatives?

ispaghula husk - fybogel

dosages of osmotic laxatives?

adults - 15ml 1-2 times a day under 1 - 2.5ml once a day 1-5 - 2.5 to 10ml twice a day 5-10 - 10ml twice a day

what is the onset of action for osmotic laxatives?

48-72 hours

What are osmotic laxatives?

Lactulose. it is a synthetic sugar to soften stool by fluids. - DO NOT TAKE if lactose intolerant or diabetic drink plenty of fluids

what are stimulant laxatives?

take 1-2 tabs at NIGHT - the onset of action is fast 6-12 hours. stimulates the nerve endings in the bowel to promote movement of faeces SHORT TERM use only and Is prone to abuse due to fast action NOT for use in children, or pregnancy

generic and brands of stimulant laxatives?

Senna - senokot | bisacodyl - dulcolax

what are faecal softeners?

1 capsule up to 5 times a day and onset of action is 24-48 hours. acts like a detergent - break down the stool, increases amount of fluid in it to help it pass only for 12+ Dulcoease (docusate sodium)

generic and brand of faecal softeners?

docusate sodium - dulcoease

what are the general cautions of laxatives?

- can cause abdominal cramps - some take a while to work - can cause bloating, flatulence, diarrhoea - overdose issues especially with faster acting ones (abuse) or ones that are too slow

What is chronic diarrhoea?

persistent lasts >14 days caused by - bacterial infection, viral, laxative OD, poor diet, or a long term medical condition e.g IBS, chrons, allergy to lactose, gluten, wheat

what is acute diarrhoea?

short term, sudden onset lasts 5-10 days usually caused by a viral infection (norovirus) or bacterial infection (E.coli) or travelling

symptoms of diarrhoea?

``` increase in bowl movement watery and loose stools associated with - cramps, nausea, vomiting loss of apetite headache (signs of dehydration) ```

what medicines can cause diarrhoea? (6)

``` antibiotics antacids chemotherapy NSAIDS 534statins laxatives ```

what other factors can cause diarrhoea?

``` virus, bacteria, parasites anxiety excessive alcohol or coffee food allergy appendicitis ```

what are the red flag symptoms for diarrhoea?

``` blood in stools , black stools vomiting persistently loss of weight fever recent course of antibiotics recent discharge from hospital ``` CHILDREN 0-1 years = refer after 1 day CHILDREN 1+ and ELDERLY = refer after 2 days ADULTS = refer after 3 days

what are the 3 types of treatments for diarrhoea?

Diarrhoea usually clears up within 2-3 days on its own but can help it go by doing: fluids oral rehydration salts anti-diarrhoea medication

fluid treatment for diarrhoea?

Increase fluid intake to avoid dehydration - small frequent sips (SFS). liquids containing water, salt, sugar e.g water and juice avoid fruit juices and fizzy drinks - make it worse

oral rehydration salts for diarrhoea?

prevent and treat dehydration - dissolve sachets in water - they replace the lost electrolytes (salts) - K, Na, glucose, minerals. Children - 1 sachet (>2 years) Adults - 1 or 2 sachets DIORALYTE can be formulated with rice starch to bulk up the stools - this is called dioralyte relief

anti diarrhoea medication

slows down the muscle movement - allows water reabsorption, stools are firmer, reduces diarrhoea. - formulated with simethicone which reduces flatulence. LOPERAMIDE (immodium) Adults and children >12 years - 2 capsules to start, then 1 after each loose bowel movement NOT for use in young children or pregnancy/BF

brand and generic of anti diarrhoea medication?

Loperamide (brand = immodium)

lifestyle advice for diarrhoea?

small frequent sips of fluids eat easily digestible foods avoid foods with - high dairy, fat, fibre, sugar wash hands thoroughly, sanitise seat and area - hygiene Don't share towels (contagious), wash linen at highest temperature avoid work or school