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Flashcards in RTS - gastrointestinal conditions Deck (44)
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1

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

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

2

list referral points for children in nausea/vomiting

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

3

what are the signs of dehydration in adults?

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

4

what are the signs of dehydration in children?

irritable
drowsy
pale skin
cold hands and feet
look unwell

5

what is dyspepsia?

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

6

what is the difference between indigestion and heartburn?

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

7

symptoms of dyspepsia?

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

8

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

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

9

What are the 4 types of treatment for dyspepsia?

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

10

what are antacids for dyspepsia?

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

11

what are alginates for dyspepsia?

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

12

what are H2 antagonists for dyspepsia?

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

13

What are proton pump inhibitors for dyspepsia? .

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

14

Lifestyle advice for dyspepsia?

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

15

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

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

16

what is GORD?

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

17

symptoms of GORD?

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

18

symptoms of GORD in babies?

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

19

referral In GORD?

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

20

what types of medicines can cause constipation? (5)

antacids
anti-depressants
opioids e.g codeine
duiretics
iron

21

what are the red flag symptoms in constipation?

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

22

what are the 4 classes of laxatives?

bulk forming
osmotic
stimulant
faecal softeners

23

describe bulk forming laxatives

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

24

what generic and brand is bulk forming laxatives?

ispaghula husk - fybogel

25

dosages of osmotic laxatives?

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

26

what is the onset of action for osmotic laxatives?

48-72 hours

27

What are osmotic laxatives?

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

28

what are stimulant laxatives?

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

29

generic and brands of stimulant laxatives?

Senna - senokot
bisacodyl - dulcolax

30

what are faecal softeners?

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)