Week 11: GI OTC Flashcards
What are the red flag symptoms of the chest? (10)
Chest Pain
SOB
Wheezing
Swollen Ankles
Blood in sputum
Palpitations
Persistent Cough
Whooping Cough
Croup
Sputum mucoid, coloured?
What are the red flag symptoms for the gut? (6)
Difficulty swallowing
Blood in vomit
Bloody diarrhoea
Vomiting with constipation
Weight loss
Sustained alteration of bowel habit.
What are the red flag symptoms of the eyes? (3)
Painful red eye
Loss of vision
Double vision
What are the red flags symptoms for the ear? (6)
Pain
Discharge
Deafness
Irritation
Tinnitus
Vertigo
What are the red flags symptoms of the genitourinary? (6)
Difficulty in passing urine.
Blood in urine.
Abdominal/loin/back pain with cystitis.
Urethral discharge
Vaginal discharge
Vaginal bleeding in pregnancy.
What other red flag symptoms do you need to consider? (3)
Neck Stiffness
Rigidity with temp.
Persistent Vomiting
What other factors do you need to consider? (6)
Drug Interactions
Contraindications
Px’s Age
License restrictions
Legal Issues
Confidentiality
What Qs do you need to ask for px’s presenting with abdominal pain? (7)
Where is the pain?
When did it start?
Is it constant/intermittent?
Has it moved +/or spread?
Have you had it before?
Is the area tender?
Have you taken anything which helps?
What symptoms would be considered as a referral in patients presenting with abdominal pain? (8)
Continuous severe pain lasting > 1hr.
Mild/moderate lasting intermittent for 7 days.
Swelling - ass. with hernias.
Over 45yrs v 55yrs and suffering persistent dyspepsia.
Recent unexplained weight loss.
Vomiting/constipation/diarrhoea + persistent abdomen.
Blood in vomit/stools (red/coffee grounds)
Ab. pain + chronic back pain
What symptoms would be considered as a referral in babies presenting with abdominal pain? (3)
Projectile vomiting
Constipation
Diarrhoea
(Gastroenteritis)
What medication(s) can cause gastric pain? (1)
NSAIDs
What medication(s) can cause constipation? (3)
Opioids
TCAs
Iron
What medication(s) can cause oesophageal ulceration? (3)
KCl
Alendronic Acid
Doxycycline
What are the main causes of oral thrush? (6)
Antibiotic therapy
Diabetes
Pregnancy
Immunocompromised
Ill-fitting dentures
ICS
What are the symptoms of oral thrush? (3)
White raised patches
Tendency to bleed
Painful (baby refusing to feed, ass. with nappy rash)
What are the treatment options available for oral thrush? (3)
Antifungals:
- Miconazole 20mg/g (Daktarin Oral Gel)
- Tx from 4 months
- Dose age related
What counselling points should be given to patients taking antifungal treatment for oral thrush? (4)
Maintain good oral hygiene.
Apply after food
Keep in mouth for as long as possible before swallowing.
Continue tx for 7 days after symptoms.
Which patients need referral when they present with oral thrush? (2)
Pregnant
Breastfeeding
Which drugs are contraindicated with Miconazole? (3)
Warfarin
Sulphonylureas
Phenytoin
What are the main causes of mouth ulcers? (6)
Deficiency? Vit. B, Folic Acid
Stress
Physical Illness (CD, IBD)
Nutrition
Trauma
Carcinoma
What are the common symptoms for mouth ulcers? (4)
Shallow yellow/white ulcers on tongue, cheek and lip mucosa.
Painful, can look swollen
Single/in clusters
Can be recurrent
What are the available treatment options for mouth ulcers? (4)
Topical local anaesthetics/analgesics: Anbesol liquid, bonjela, iglu pastilles (limited use, short duration of action, taken after food)
Antiseptic mouth washes: Chlorhexidine (Corsodyl mouthwash) - reduces risk of secondary infection + accelerates healing process.
Topical local anti-inflammatory/analgesics:
Benzydamine HCl (Difflam Oral Rinse) - can numb +/or sting, dilute with equal amount of water if stings. Use every 1.5 to 3hrs prn, max 7 days. Not to be used on children < 13 yrs.
Hydrocortisone 2.5mg Muco-adhesive buccal tablets:
Reduces inflammation and ulcer size, used only in prev. diagnosed ulceration. > 12 yrs only. Keep in mouth and allow to dissolve slowly close to the ulcers QDS.
When would it be appropriate to refer a patient with mouth ulcers? (6)
Recurrent ulcers
Ulcer > 3 weeks old
Pregnant
Breastfeeding
Diabetes
Ulcers due to infection
What are the common symptoms of oral cancer? (3)
White patch +/or red patches on gums, tongue, mouth lining.
Small sore that looks like a common mouth ulcer that fails to heal.
Lump/mass that can be felt on the lip/mouth/throat.
What is dyspepsia also known for? (3)
Indigestion
Heartburn
Trapped Wind
What are the common causes for dyspepsia? (9)
Hurried meals
Overindulgence
Spicy food
Smoking
Overweight
Pregnancy
Medication (NSAIDs, Digoxin, Iron)
HF
H. Pylori
What are the common symptoms of indigestion? (5)
Epigastric discomfort shortly after eating/drinking.
Felling of fullness
Heartburn
Trapped wind
N+V
What are the treatment options for indigestion? (9)
Antacids:
- Mg Salts (Milk of Magnesia) = can cause diarrhoea.
- Al Salts (now only in combo. products) = can cause constipation.
- Bismuth salts (Pepto-Bismol) = supply issues (UK), avoid if aspirin sensitive, avoid if pregnant, unsuitable < 16yrs
- Co-magaldrox (combo. prep.)
Activated Simeticone:
- Antifoaming agent
- Refuces surface tension of gas bubbles (Windsetlers)
Alginates:
- Useful to treat acid reflux
- ‘raft’ effect
- Usually in combo. with antacid(s)
- Gaviscon/Peptac
What drugs can interact with antacids? (8)
Digoxin
Enteric coated tablets
Lithium (serum level reduced by NaHCO3-)
Tetracyclines
Warfarin
Iron
Alendronic Acid
(Avoid concomitant administration 2-4 hrs either side of dose.)
What is the treatment option for indigestion? (4)
PPI:
Omeprazole 20mg OD:
- no improvement after 2 weeks = refer
- Can use for up to 4 weeks at 10mg dose
- use at lowest effective dose
- Available as GSL (esomeprazole)
What counselling should you give to patients presenting with indigestion? (7)
Small regular meals.
Avoid meals late at night.
Avoid highly spiced foods
Avoid bending/stooping.
Don’t wear tight clothing.
Raise the head of the bed.
Take antacid about 1 hr after food.
When would you need to refer a patient presenting with indigestion? (8)
1st time dyspepsia 45+ (GP referral)
Endoscopy Referral:
> 55yrs and with:
- Persistent vomiting
- Appetite Loss
- Difficulty Swallowing
- Feeling lump in throat
- GI bleeding
What are the common causes of IBS? (3)
Emotion/stress
Food intolerance
Disturbance to normal bowel movement.
Which patients are most likely to suffer from IBS? (3)
F>M
Adolescence
Young Adults
What are the colonic symptoms of IBS? (5)
Young adults:
- bloating
- alt. diarrhoea/constipation
- Ab. pain
Rectal fullness
Incomplete Evacuation
What are the non-colonic symptoms of IBS? (3)
Nausea
Back Pain
Urinary Frequency/urgency
What do you need to consider before offering IBS treatment? (1)
Only offer IBS tx OTC if the condition has been previously diagnosed by a Dr.
What are the major symptoms that indicate IBS? (3)
Ab. bloating
Diarrhoea OR Constipation
What are the treatment options for IBS? (10)
Anti-spasmodic:
- Intestinal smooth muscle relaxants.
- C/i in paralytic ileus
- Mebeverine (Colofac IBS)
- Hyoscine Butylbromide (Buscopan IBS)
- Peppermint Oil (Colpermin = contains arachis oil)
Anti-diarrhoeal:
- Loperamide (Imodium)
- Decreases bowel motility
- Reduces stool frequency + urgency.
- Poor penetration of blood/brain barrier.
Bulking agent:
- Improves constipation + diarrhoea.
- Ispaghula husk (Senokot High Fibre)
What counselling points should be given to patient presenting with IBS? (6)
Food diary - identify triggers.
Ask if taking other medicines.
Try not to rush meals.
Eat balanced diet and plenty fluids.
Take regular exercise.
Relaxation.
When would you refer a patient presenting with IBS? (5)
Persistent symptoms > 2 weeks despire tx or if symptoms have changed.
Bloody stools
Not had IBS diagnosed by Dr.
Fever
Unexplained weight loss.
What are the causes of constipation? (11)
Change in lifestyle
Change in eating habits
Reduced fluid intake
Lack of exercise
Medication (e.g. Iron)
Depression
IBS
Anal Fissures
Haemorrhoids
Pregnancy
Refusal to obey urge to pass stool.
What are the symptoms of constipation? (4)
Decreased bowel movement frequency.
Hard stools
Straining
(What is their normal bowel habit?)
What are the treatment options available for constipation? (6)
1st line: Alter diet + lifestyle + increase fluids.
2nd line: Bulk-forming laxatives (Ispaghula Husk)
- Closest to natural process.
- Slow Action (24-72hrs)
- Take with plenty of H2O.
- Not taken at bedtime.
- Not for elderly/bed bound
- Can alter medication absorption.
3rd line: Stimulant Laxatives:
- Stimulates nerve endings in the bowel wall.
- Anthraquinones (Senokit, Ex-lax) = Acts within 8-12 hrs.
- Diphenylmethane derivates (Bisacodyl = Dulcolax tablets + supps, Sodium picosulphate = Dulcolax-pico, Dulcolax perles)
4th line: Osmotic Laxatives:
- Retain fluid in the bowel = stimulating peristalsis and forming a loose stool
- More powerful than the bulk laxatives
- Magnesium salts: magnesium sulphate (EpsomSalts);magnesium hydroxide (Milk of Magnesia)
- effective within 3 hrs
Lactulose/macrogol (polyethyleneglycol’3350’)
- longer action; up to 72hrs of regular dosing
- sweet tasting
- C/I in patients’ lactose/galactose intolerant
- use with caution in diabetes
5th line: Glycerol (Glycerin Supps. 1g, 2g, 4g)
- 1-2 hrs effect
6th Line: Faecal softeners (Docusate sodium = Dioctyl caps)
- Little if straining required.
- Effect within 1-3 days.
What precautions do you need to consider when giving laxatives to a px? (2)
Babies and children < 14yrs can take lactulose if their doctor recommends it.
Don’t give lactulose to a child < 14 yrs unless their doctor has said it’s ok.
What are the restrictions associated with laxatives? (3)
GSL = 18+, P = 12+
Pack sizes = standard strength (pack of 20), max. strength tabs (pack of 10) and syrups (pack size of 100ml)
For short term occasional relief only.
What type of laxative(s) is appropriate/inappropriate for pregnant px suffering from constipation? (3)
Osmotic/bulk-forming = safe
Stimulant = C/I
What type of laxative(s) is appropriate/inappropriate for breastfeeding px suffering from constipation? (1)
Stimulant laxative = c/i
What counselling points should be given to babies who are suffering from constipation? (2)
Breast-fed: may need extra water from bottle.
Bottle-fed: are they making feed with sufficient water.
What counselling points in given to elderly px suffering from constipation? (2)
Increase fluids = dehydration
Bulk laxatives = care in bed bound / inactive px.
What are the symptoms that indicate referral when px is suffering from constipation? (10)
Constipation +:
- Illness + unable to work
- Children/babies who show ill symptoms.
- Blood in stools
- Continuous severe pain
- Weight loss
- Diarrhoea *unless diagnosed with IBS
- Self-medication ineffective after 4-5 days.
- Fever/night sweats
- N+V
What are haemorrhoids? (1)
Varicose vein dilatations in the lower part of the large intestine +/or anus.
What are the causes of haemorrhoids? (7)
Anal infections - STI/Scratching
Sports e.g. cycling (sitting in the same position)
Pregnancy
Constipation
Pelvic area lesions
Laxative abuse
What are the symptoms of haemorrhoids? (4)
Itching in the ‘down there’ region.
Can be painful
Sharp pain on defaecation.
Bright red blood on stool + toilet paper.
What factors can contribute to developing haemorrhoids? (5)
Increased in intra-abdominal pressure.
Elderly
Dehydration
Low fibre intake
Medicines
What are the treatment options for Haemorrhoids? (9)
1st line: Topical Prep (Creams/Ointments/Suppositories)
- Anusol
- Preparation H
- Germoloids
2nd line: Hydrocortisone
- No more than 7 days
- Not used in pregnancy/BF
- Adults > 18yrs only
- Not used if broken skin/infection
What counselling points should you give to patients presenting with haemorrhoids? (6)
Hygiene
Diet
Don’t scratch area
Avoid straining
Increase activity
Laxatives (faecal softeners)
What symptoms would consider a referral for patient presenting with haemorrhoids? (5)
> 3 weeks
Internal anal pain
Rectal bleeding
Suspected drug-induced constipation
Recurrent piles (regular recurrence)
What are the common causes of nausea + vomiting? (7)
Viral/Bacteria/Bacterial toxins
Inner ear disorders
Migraine
Motion sickness
Meningitis
Medications - Digoxin, theophylline, NSAIDs
Pregnancy
What counselling should be given to patient presenting with N + V? (4)
Ensure px doesn’t become dehydrated = offer electrolyte replacement.
Sip water little + often.
Avoid dairy products + greasy foods for 24 hrs.
Re-introduce light diet when hungry.
What treatment options/counselling should be given to pregnancy px presenting with N+V? (3)
Frequent small meals
Ginger
Sea-bands
What px symptoms would indicate referral when presenting with N+V? (8)
Projectile vomiting (babies/adults)
Bloody vomit
Vomiting ass. with weight loss.
Babies < 12 months + symptoms for 24hrs
Children <3 yrs/
Elderly
Symptoms for 48 hrs
Diabetic px (if persistent)
What are the common symptoms of diarrhoea? (2)
Increased frequency
Change in frequency
What are the common causes of diarrhoea? (6)
Bacterial/Viral
Diet changes/overindulgence
Medication
Food allergies
Secondary to medical condition (e.g. diabetes, hyperthyroidism, IBS)
Stress
What are the treatment options for diarrhoea? (16)
1st line: Usually self-limiting
- Maintain fluid intake
- Oral rehydration sachets (Dioralyte)
- Mix with recommended amount of water
- Keep for 1hr or 24 hrs in the fridge
- Sip little + often
2nd line: Anti-diarrhoeals
- Loperamide (Imodium caps)
- Decreased bowel motility
- Adults + children > 12 yrs
3rd line: Morphine-containing products (Kaolin + Morphine; Diocalm)
- Used with adsorbent
- Dependence issue
- Not recommended
4th Line: Bismuth Salicylate (Pepto-Bismol)
- C/i if allergic to aspirin
What counselling points are given to patients presenting with diarrhoea? (3)
Ensure high fluid intake.
If recommending OTC product, emphasise how to take correctly.
If symptoms don’t improve after OTC tx or symptoms worsen - see GP.
What main counselling point is given to babies suffering from diarrhoea? (1)
Ensure bottle is properly sterilised + making feeds properly.
What symptoms would indicate referral when px present with diarrhoea? (12)
Elderly: Persistent symptoms for 48 hrs
Refer if:
- Chronic/Recurrent Diarrhoea
- Fatigue/pain lasting > 2 days
Refer ALL px if:
- Weight loss
- Bloody stool
- Persistent mucous in stool
- Symptom change/worsens
- Alt. diarrhoea/constipation
< 12 months+ symptoms > 24hrs
<3 yrs, elderly and symptoms > 48 hrs
Older adults + children > 72 hrs.
