RTS - gastrointestinal conditions Flashcards
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
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
what are the signs of dehydration in adults?
lack of energy loss of appetite nausea lightheaded dry mouth muscle cramps rapid heartbeat
what are the signs of dehydration in children?
irritable drowsy pale skin cold hands and feet look unwell
what is dyspepsia?
indigestion- stomach acid irritates the digestive tract - leads to irritation, inflammation, pain and bloating
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)
symptoms of dyspepsia?
pain in upper abdomen belching bloating nausea/vomiting full feeling uncomfortable reflux
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
What are the 4 types of treatment for dyspepsia?
- antacids
- alginates
- proton pump inhibitors
- H2 antagonists
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
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
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
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
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
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
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
symptoms of GORD?
heart burn acid reflux laryngitis - throat infection due to acid tooth decay - acid in mouth taste disturbances and bad breath
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
