Wk 11: OTC GI (abdominal pain, oral thrush, mouth ulcers, dyspepsia) Flashcards
What are the red flags of Gut related diseases?
- Difficulty swallowing
- Bloody di/vomit
- Vomiting w/ constipation
- Weight loss
- Sustained alteration of bowel habit
When do you refer for abdominal pain?
- Continuous severe pain >1hr
- Mild/mod on/off 7 days
- Swelling (hernia)
- > 45ys + dyspepsia
- Unexplained weight loss
- Vom/constipation/di + persistent abdominal pain
- Blood in vom/stools
- Babies: projectile vom, constipation, di
Which medications cause GI symptoms?
- NSAIDs: gastric pain
- Opioids, TCA, iron: constipation
- Potassium chloride, alendronic + doxy: oesophageal ulceration
What is the cause of oral thrush?
Candida infection
What factors can increase the number of organisms for oral thrush?
- Antibiotic therapy
- Diabetes
- Pregnancy
- Immunocompromised
- Ill fitting dentures
- Inhaled corticosteroids
What are the symptoms of oral thrush?
- White raised patches on oral mucosa
- Bleed
- Painful
- Baby: refuse feed
What is the treatment for oral thrush?
- Miconazole 20mg/g (daktarin oral gel)
- From 4 months
- Continue for 7 days after symptoms have gone
- Apply after food
What are the counselling points for people with oral thrush?
- Maintain good oral hygiene
- Inhaler technique
- Dentures
What is contraindicated in miconazole?
- Warfarin
- Sulphonylureas
- Phenytoin
When do you refer for patients with oral thrush?
Pregnant/breastfeeding
What are the causes of mouth ulcers?
- Vit B, folic acid deficiency
- Stress
- Chrohns, IBD
- Nutrition
- Trauma
- Carcinoma
What are the symptoms of mouth ulcers?
- Shallow yellow/white ulcers on tongue, cheek + lip
- Painful
- Single/clusters
- Recurrent
What are the treatment for mouth ulcers - topical anaesthetics?
- Anbesol liquid
- Bonjela
- Short duration
- Not before meals
What are the available treatment for mouth ulcers - mouthwash?
Chlorhexidine (corsodyl mouthwash)
- Red 2ndry infection
- Accelerates healing
What are the available treatments for mouth ulcers - topical anti-inflammatory?
Benzydamine HCl (Difflam Oral Rinse)
- Numb + sting
- dilute w/ equal amount of water if stings
- Every 1.5 to 3 hrs prn, max 7 days
- > 13
What is used for previously diagnosed ulceration?
Hydrocortisone 2.5mg muco-adhesive buccal tabs
- > 12
- Keep in mouth + dissolve QDS
When do you refer patients with mouth ulcers?
- Recurrent
- > 3wks
- Pregnant/breastfeeding
- Diabetic
- Due to infection
What are the symptoms of oral cancer?
- White patch + red on gums, tongue, lining of mouth
- Small sore that fails to heal
- Lump/mass on lip/mouth/throat
What are the causes of dyspepsia?
- Smoking
- Overweight
- Pregnancy
- NSAIDs, digoxin + iron
- HF
- H pylori
What are the symptoms of dyspepsia?
- Epigastric discomfort after eating/drinking
- Fullness
- Heartburn
- Trapped wind
- N+V
Give examples of treatment given for dyspepsia - antacids
- Magnesium salt: cause di
- Aluminum salt: cause constipation
- Pepto-bismol
- Kolanticon gel
- Co-magaldrox
Who can’t be given pepto-bismol?
- Aspirin sensitive
- Pregnant
- <16yrs old
What treatment is best for trapped wind?
Activated semeticone: Windsetlers
- Antifoaming - red surface tension of gas bubbles
What treatment is best for acid reflux?
- Alginates: Gaviscon + peptac
- In combination w/ antacids
Which drugs interact with antacids?
- Digoxin
- Lithium
- Tetracycline
- Warfarin
- Iron
- Alendronic acid
What is used for short term symptomatic relief of excess acid, dyspepsia + heartburn?
H2 receptor antagonists:
- Ranitidine
- > 16
- Interacts w/ cimetidine
- CI: pregnant/breastfeeding
- LT: refer
What is given for recurrent heartburn?
- Omeprazole 20mg/10mg tabs
- 20mg OD
- Refer: no improvements after 2 wks
- Can use upto 4wks at 10mg
What are the counselling points for dyspepsia?
- Avoid meals at night
- Avoid spicy
- Raise head of bed
- Take antacids 1 hr after food
When do you refer someone with dyspepsia?
> 55:
- Persistent vom
- Loss of appetite
- Difficulty swallowing
- Lump in throat
- GI bleed
