Upper GI Flashcards
1
Q
Dyspepsia: Causes
A
- AKA: upset tummy
- Organic Causes
- food intolerance
- meds (NSAID, ASA, erytro)
- GI disorders
- Pancreatobility disorders
- Systemic disorders (DM, renal insuffi)
- Functional Causes
- Most often
- Food, H. pylori
- No identifiable cause
2
Q
Dyspepsia: Signs and Symptoms
A
- Vague complaints of:
- Pain, discomfort (upper abdomen)
- Bloating or distention
- Early satiety
- Belching
- Flatulence
- Nausea
- Anorexia
- Heartburn
3
Q
Dyspepsia: Alarm Symptoms
A
- Unintentional weight loss
- Bleeding
- Severe or chronic symptoms
- Older age 50 yrs
4
Q
Dyspepsia: Treatment
A
- Refer for symptoms persisting > 2 weeks
- Nondrug therapy
- Reassurance
- Lifestyle modification
- Pharmacotherapy (slightly better than placebo)
- Antisecretory agents (H2 blockers, PPI’s)
- Antacids
- Bismuth Subsalicylate (BSS)
5
Q
Antacids:
A
- For mild, infrequent heartburn
- Immediate relief, lasts 20-30 min
- liquids>tablets, increased surface area
- Side Effects:
- Constipation/diarrhea, rebound, hyperacitidy, alkalosis, electrolyte imbalance
- NOT neutralize stomach acid, acts as buffer, increase pH
- block convesion of pepsinogen to pepsin (takes A LOT of Maalox)
-
Mg salts
- Maalox
- Most potent
- Diarrhea (overides Al)
- Counterindication: renal insufficiency
-
Al salts
- Mylanta
- Constipation
- Not as potent
- Lasts longer
- Binds phosphates
- High doses: renal failure, dementia
-
Ca++
- Tums
- Milk alkali
-
Sodium Bicarb
- Alka Seltzer
6
Q
Pregancy Risk B
A
- Category B are pretty safe
- studies have not shown/proven risk, no controlled studies in pregnant women, or studies in 1st trimester
- Most dangerous time to give a drug
- 1st trimester
- Most safe in 3rd trimester
- Ex: loratidine, diphenhydramine, ampicillin, ibuprofen, fluoxetine, rantidine
7
Q
Heartburn vs. GERD
A
- Heartburn
- burning: substernal to throat
- 2 hrs after eating or lying down
- mild/infrequent, related to food
- GERD
- Severe, frequent, chronic, painful
- Barrett’s esophagus, pre-cancerous
- Need endoscopy
8
Q
Heartburn: Non-pharm Treatment
A
- Elevate head of bed (6 inches)
- Blocks, not pillows
- Smaller meals
- Less dietary fat
- No eating 3 hours before bed
- Dietary changes
- Nicotine, ETOH, caffeine
9
Q
Histamine H2 Antagonists
A
-
Cimetidine (Tagamet)
- Lots of interaction, caution in pregnant/breast-feeding
- warfarin, ketoconazole, clopidogrel, benzo’s, caffiene, phenytoin
- Ranitidine (Zantac)
- Famotidine (Pepcid)
- Nizatidine
- 30-45 min onset, 4-10 hour relief
- 2 week self-treatment
- inhibit histamine effect on parietal cell, decrease acid secretion
- SE:
- HA, contispation, diarrhea, dizzy, drowsy
10
Q
PPI
A
- Need to be titrated off
- For GERD, frequent heartburn, severe dyspepsia
- 2-3 hour onset, best results after 4 days
- 30 min before eating
-
Omeprazole (Prilosec)
- more drug interaction
- Lansoprazole (Prevacid)
- ADR:
- pneumonia
- fractures
- rebound
- poor B12 absorption
- inhibits 2C19 -clopidogrel activation
11
Q
Gastritis: Etiology
A
- Inflammation of gastric mucosa
- manifests in hetergenous group of disorders
- Classifications:
- Acute errosive or hemorragic
- Drugs: NSAID, iron, alcohol, aspirin
- stress
- Mechanical trauma (NG tube, endoscopy)
- ischemia
- GERD
- Non-errosive (chronic)
- H. pylori, Chrons
- Destinctive (specific)
- TB, viral (CMV, HSV) fungal, parasitic
- Acute errosive or hemorragic
12
Q
Gastritis: Symptoms
A
- Most are assymptomatic
- Nausea
- Vomitting
- Anorexia
- Epigastric pain
- Upper GI bleed
13
Q
Alarm Symptoms for UGI
A
- GI bleed
- History PUD
- Unintentional weight loss
- Continuous N/V/D
- Chestpain
- Anemia
- Alcoholism
- Oldersters, pregsters
14
Q
Gastritis: Treatment
A
- Discontinue causitive agent
- H2 blocker, antacid, PPI
15
Q
Nausea/Vomiting: Etiology
A
- 3 Common Causes
- motion sickness, morning sickness, viral gastroentertisi
- GI, cardiac, infectious, metabolic, neurologic, or psychological conditions
- “Nauseated” NOT “nauseas”
