RTS - gastrointestinal conditions

Question 1

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

Answer 1

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

Question 2

list referral points for children in nausea/vomiting

Answer 2

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

Question 3

what are the signs of dehydration in adults?

Answer 3

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

Question 4

what are the signs of dehydration in children?

Answer 4

irritable
drowsy 
pale skin
cold hands and feet
look unwell

Question 5

what is dyspepsia?

Answer 5

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

Question 6

what is the difference between indigestion and heartburn?

Answer 6

indigestion - discomfort after eating, stomach

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

Question 7

symptoms of dyspepsia?

Answer 7

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

Question 8

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

Answer 8

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

Question 9

What are the 4 types of treatment for dyspepsia?

Answer 9

1. antacids
2. alginates
3. proton pump inhibitors
4. H2 antagonists

Question 10

what are antacids for dyspepsia?

Answer 10

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

Question 11

what are alginates for dyspepsia?

Answer 11

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

Question 12

what are H2 antagonists for dyspepsia?

Answer 12

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

Question 13

What are proton pump inhibitors for dyspepsia? .

Answer 13

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

Question 14

Lifestyle advice for dyspepsia?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

what is GORD?

Answer 16

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

Question 17

symptoms of GORD?

Answer 17

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

Question 18

symptoms of GORD in babies?

Answer 18

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

Question 19

referral In GORD?

Answer 19

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

Question 20

what types of medicines can cause constipation? (5)

Answer 20

antacids
anti-depressants
opioids e.g codeine
duiretics 
iron

Question 21

what are the red flag symptoms in constipation?

Answer 21

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

Question 22

what are the 4 classes of laxatives?

Answer 22

bulk forming
osmotic
stimulant
faecal softeners

Question 23

describe bulk forming laxatives

Answer 23

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

Question 24

what generic and brand is bulk forming laxatives?

Answer 24

ispaghula husk - fybogel

Question 25

dosages of osmotic laxatives?

Answer 25

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

Question 26

what is the onset of action for osmotic laxatives?

Answer 26

48-72 hours

Question 27

What are osmotic laxatives?

Answer 27

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

Question 28

what are stimulant laxatives?

Answer 28

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

Question 29

generic and brands of stimulant laxatives?

Answer 29

Senna - senokot

bisacodyl - dulcolax

Question 30

what are faecal softeners?

Answer 30

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)

Question 31

generic and brand of faecal softeners?

Answer 31

docusate sodium - dulcoease

Question 32

what are the general cautions of laxatives?

Answer 32

• 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

Question 33

What is chronic diarrhoea?

Answer 33

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

Question 34

what is acute diarrhoea?

Answer 34

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

Question 35

symptoms of diarrhoea?

Answer 35

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

Question 36

what medicines can cause diarrhoea? (6)

Answer 36

antibiotics
antacids 
chemotherapy
NSAIDS
  534statins
laxatives

Question 37

what other factors can cause diarrhoea?

Answer 37

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

Question 38

what are the red flag symptoms for diarrhoea?

Answer 38

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

Question 39

what are the 3 types of treatments for diarrhoea?

Answer 39

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

Question 40

fluid treatment for diarrhoea?

Answer 40

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

Question 41

oral rehydration salts for diarrhoea?

Answer 41

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

Question 42

anti diarrhoea medication

Answer 42

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

Question 43

brand and generic of anti diarrhoea medication?

Answer 43

Loperamide (brand = immodium)

Question 44

lifestyle advice for diarrhoea?

Answer 44

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