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PHAM01 > Wk 12: Dyspepsia > Flashcards

Wk 12: Dyspepsia Flashcards

1
Q

What happens in the initial investigation?

A
  • Alarm symptoms
  • Assess: freq. duration + pattern
  • Fx
  • Lifestyle: obesity, trigger food, smoking
  • Assess: stress, anxiety + depression
  • Med
  • Examine: weight loss (serial weight + BMI), anaemia + abdominal mass + tenderness
  • FBC + platelet count: anaemia
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2
Q

When would you refer for endoscopy?

A

Dyspepsia w/ acute GI bleed

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3
Q

Which medications may cause dyspepsia?

A
  • Calcium antagonist
  • Nitrates
  • Theophylline
  • Bisphosphonates
  • Corticosteroids
  • NSAIDs
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4
Q

When referring a patient, which medication must you suspend?

A

NSAIDs

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5
Q

What are the alarm symptoms?

A
  • Abdominal distention
  • Abdominal, pelvic or rectal mass
  • Abdominal/pelvic pain
  • Change in bowel habit
  • Dyspepsia
  • Dysphagia
  • Vom
  • Haematemesis
  • Rectal bleed
  • Weight loss
  • Anaemia
  • Raised platelet count
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6
Q

What needs to be carried out if a patient has reflux with weight loss/ >55?

A
  • Urgent direct access upper GI endoscopy w/in 2 wks
  • Possible: oesophageal or stomach cancer
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7
Q

What needs to be carried out if a patient has reflux with raised platelet count, nausea/vom/ >55?

A
  • Non- urgent Endoscopy

-Possible: esophageal or stomach cancer

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8
Q

What is the initial diagnosis if a patient has not undergone endoscopy?

A

Uninvestigated dyspepsia

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9
Q

What happens after a patient is diagnosed with uninvestigated dyspepsia?

A
  • Prescribe full dose PPI 1 month
  • Test H pylori infection, if positive offer eradication therapy
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10
Q

How do you test for H pylori?

A
  • Carbon 13 urea breath test or stool antigen
  • Make sure patient hasn’t taken PPI in past 2 wks or antibiotics past 4 wks
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11
Q

What are the PPIs offered for first line H pylori eradication in uninvestigated dyspepsia?

A
  • Lansoprazole 30 mg
  • Omeprazole 20–40 mg
  • Esomeprazole 20 mg
  • Pantoprazole 40 mg
  • Rabeprazole 20 mg
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12
Q

What is given to a patient if they test positive for H pylori in uninvestigated dyspepsia?

A

7 day therapy:

  • PPI BD + amoxicillin 1g BD
  • Clarithromycin 500mg BD OR metronidazole 400mg BD
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13
Q

What is given to a patient if they test positive for H pylori but are allergic to penicillin in uninvestigated dyspepsia?

A

7 day therapy:

  • PPI BD
  • Clarithromycin 500mg BD
  • Metronidazole 400mg BD
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14
Q

What is given to a patient if they test positive for H pylori but are allergic to penicillin + has had a previous exposure to clarithromycin in uninvestigated dyspepsia?

A

7-10 day therapy:

  • PPI BD
  • Metronidazole 400mg BD
  • Levofloxacin 250mg BD
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15
Q

When would you consider retesting for H pylori?

A
  • Poor compliance 1st therapy
  • Initial test w/in 2 weeks of PPI or 4wks of antibiotic therapy
  • Aspirin/NSAID indicated
  • FX gastric malignancy
  • Severe/persistent or recurrent symptoms
  • Person request
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16
Q

Following an endoscopy, what are the possible diagnosis?

A
  • Functional dyspepsia
  • Gastroesophageal reflux disorder (GORD)
  • Peptic ulcer disease
  • Malignancy
17
Q

What are the types of functional dyspepsia?

A
  • Epigastric pain syndrome: intermittent/burning pain in epigastrium
  • Postprandial distress syndrome: fullness/early satiety
18
Q

What do you do if a person tests positive for H pylori in functional dyspepsia?

A

Prescribe 1st line eradication therapy

19
Q

What do you prescribe if a person tests negative for H pylori in functional dyspepsia?

A

Low dose PPI OR standard dose histamine receptor antagonist for 1 month

20
Q

What is GORD?

A
  • Chronic condition
  • Reflux of gastric contents into oesophagus
  • Causes: heartburn + acid regurgitation
21
Q

Proven GORD may be due to what?

A
  • Oesophagitis: inflammation + mucosal erosion
  • Endoscopy negative reflux disease: symptoms of GORD but endoscopy normal
22
Q

What are the risk factors for developing GORD?

A
  • Obesity, trigger food, alcohol, smoking, coffee, stress
  • Drugs that dec esophageal sphincter pressure
  • Pregnancy
23
Q

Which drugs dec esophageal sphincter pressure?

A
  • CCB
  • Anticholinergics
  • Theophylline
  • Benzo
  • Nitrates
24
Q

What is the initial management of GORD symptoms?

A
  • Lifestyle advice + sleeping w/ head raised
  • Stop drugs that exacerbate symptoms
  • Full dose PPI 4 wks for proven GORD
  • Full dose PPI 8 wks for proven severe oesophagitis
25
Q

What is given to patients who have recurrent symptoms with confirmed oesophagitis?

A
  • Further 4 wks initial PPI at full dose/double dose

OR

  • Add H2RA at bed
26
Q

What is given to patients who have recurrent symptoms with confirmed severe oesophagitis?

A
  • High dose initial PPI 8 wks

OR

  • Switch to alt full dose
27
Q

In peptic ulcer disease, what is given to a patient who has tested positive for H pylori with proven gastric/duodenal ulcer due to NSAIDS?

A
  • Full dose PPI 2 months
  • 1st line eradication therapy after PPI completion
28
Q

In peptic ulcer disease, what is given to a patient who has tested positive for H pylori with proven gastric/duodenal ulcer not due to NSAIDS?

A

1st line eradication therapy

29
Q

In peptic ulcer disease, what is given to a patient who has tested negative for H pylori with proven gastric/duodenal ulcer?

A

Full dose PPI therapy 4-8 wks

30
Q

What are the adverse effects of PPI?

A
  • Inc fracture risk: esp elderly + smoker
  • Inc GI infection
  • Masks symptoms of gastric cancer
31
Q

What are the monitoring requirements of PPIs?

A

Magnesium before + during

  • Esp if on digoxin or diuretics
  • Causes hypomagnesaemia
32
Q

Outline the interaction of clopidogrel + PPIs

A
  • Clopidogrel converted into metabolites by liver cytochrome p450
  • PPIs also metabolised by cytochrome p450
  • PPIs inhibit isoenzymes, affecting efficacy of clopidogrel
33
Q

Which PPIs can’t be given with clopidogrel?

A

Omeprazole + esomeprazole

34
Q

Which PPIs can be given with clopidogrel?

A

Pantoprazole, rabeprazole + lansoprazole

35
Q

Which skin disease is associated with PPIs?

A

Subacute cutaneous lupus erythematosus (SCLE)

36
Q

What happens if a patient is on a PPI + develops lesions in sun exposed areas, accompanied by arthralgia?

A
  • Avoid skin exposure to sun
  • Stop PPI
  • Symptoms resolve upon w/drawal
  • If symptoms haven’t resolved: topical or systemic steroids

PHAM01 (47 decks)

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