Flashcards in RTS - gastrointestinal conditions Deck (44)
list referral points for adults in relation to nausea/vomiting?
vomiting for >48hours
can't keep fluids down
vomit is green
loss of weight
list referral points for children in nausea/vomiting
can't keep fluids down for the last 48hours
limp, irritable, not usual
what are the signs of dehydration in adults?
lack of energy
loss of appetite
what are the signs of dehydration in children?
cold hands and feet
what is dyspepsia?
indigestion- stomach acid irritates the digestive tract - leads to irritation, inflammation, pain and bloating
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)
symptoms of dyspepsia?
pain in upper abdomen
what is the ALARM acronym for dyspepsia that is for referral signs?
A = age >55 and first time
L = loss of weight
R= recurrent vomiting / swallowing difficulty
M= malaena - blood (GI)
Also refer in - pain in arms, back, radiation of pain
What are the 4 types of treatment for dyspepsia?
3. proton pump inhibitors
4. H2 antagonists
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
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
what are H2 antagonists for dyspepsia?
Ranitidine - ZANTAC. 75mg tablets.
lower the acidity in the stomach, work up to 12 hours
BUT- may mask symptoms of other issue and stop from healing so caution
What are proton pump inhibitors for dyspepsia? .
omeprazole 10mg tablets - work up to 24hours.
Restrict acid production - should ideally be initiated by the GP.
can mask symptoms of other conditions too
Lifestyle advice for dyspepsia?
diet and lifestyle e.g if overweight - lose weight as obesity causes dyspepsia.
eat small, regular meals, chew fully
avoid eating prior to bedtime
extra pillow in bed to stop acid rising
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
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
symptoms of GORD?
laryngitis - throat infection due to acid
tooth decay - acid in mouth
taste disturbances and bad breath
symptoms of GORD in babies?
arch back and roll - raising to move the acid away from their oesophagus
refusal to feet
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
what types of medicines can cause constipation? (5)
opioids e.g codeine
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
what are the 4 classes of laxatives?
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
what generic and brand is bulk forming laxatives?
ispaghula husk - fybogel
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
what is the onset of action for osmotic laxatives?
What are osmotic laxatives?
it is a synthetic sugar to soften stool by fluids.
- DO NOT TAKE if lactose intolerant or diabetic
drink plenty of fluids
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
generic and brands of stimulant laxatives?
Senna - senokot
bisacodyl - dulcolax