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PMP 103 Practice of Pharmacy > Responding to symptoms Gastrointestinal > Flashcards

Responding to symptoms Gastrointestinal Flashcards

1
Q

Gastro conditions

A
  • Mouth ulcers
  • Dyspepsia
  • Nausea and vomiting (motion sickness covered in ENT)
  • Constipation
  • Diarrhoea
  • Haemorrhoids
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2
Q

Mouth ulcers

A
  • Usually a single, irregularly-shaped ulcer
  • Burning sharp pain biting
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3
Q

Aphthous minor mouth ulcer

A
  • Often in groups of up to five
  • Small ulcers (<1cm)
  • Feels uncomfortable
  • Heal within 10-14 days
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4
Q

Signs of mouith cancers

A
  • Under tounge could be cancer also multiple mouth ulcers that are reoccouring
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5
Q

Causes for mouth ulcers

A
  • Iron deficiency anaemia
  • Hypertensivity - preservatives food sodium laryl sulphate
  • Psycological stress
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6
Q

Aphous major

A
  • 1-3 larger than 1cm may be painful eating
  • Takes weeks to heal
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7
Q

Herpetiform

A
  • Groups of 10-50 small ulcers
  • Very painful
  • Heal within 10-14 days
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8
Q

Treatment for mouth ulcers

A
  • Saline and garggle with salt water
  • Antiseptic - Rinse twince a day
  • Can cause temporary yellow staining of teeth
  • Can be used OTC from age 12
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9
Q

Treatment for more painful mouth ulcer

Anti-inflammatory

A
  • Use every 1.5-3 hours over the age of 6
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10
Q

Treatment for mouth ulcer

Steroid hydrocortisone

A

One tablet dissolved on ulcer four times a day
Can be used OTC from age12

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11
Q

When to refer mouth ulcer

A
  • Lasts longer than 3 weeks
  • Keeps coming back
  • Painless and persistant
  • Grows back bigger than usual
  • At back of throat
  • Bleeds or gets red and painful
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12
Q

Dyspepsia

A

Complex of upper gastrointestinal tract symptom

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13
Q

Symptoms

Dyspepsia

A
  • Severe varies from patient to patient
  • Upper abdomen pain and discomfort
  • Burning sensation starting in stomach, passing upwards to behind the breastbone
  • Gastric acid reflux
  • Nausea or vomiting
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14
Q

Dyspepsia

A
  • Gastro-oesophageal reflux disease (GORD)
  • Peptic ulcer disease
  • Barrett’s oesophagus
  • A premalignant condition
  • Upper GI malignancy
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15
Q

Gastric-oesophageal reflux disease

A
  • Transient relaxation of lower oesophageal sphincter
  • Increased intra-gastric pressure
  • Delayed gastric emptying
  • Impaired oesophageal clearance of acid
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16
Q

Things that trigger GORD

A
  • Smoking
  • Alcohol
  • Coffee
  • Chocolate
  • Fatty foods
  • Being overweight
  • Stress
  • Medicines (calcium channel blockers, nitrates, NSAIDs)
  • Tight clothing
  • Pregnancy
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17
Q

Peptic Ulcer Disease

A
  • Ulcers may be present in stomach or duodenum
  • Vomit from lower down darker in coulor higher up more red
  • Confirm ulcers with endoscopy
18
Q

Causes for peptic ulcers

A
  • Helicobacter pylori infection
  • Medication mainly NSAID’S
  • Zollinger-Ellison syndrome
19
Q

Dyspepsia management

A
  • Most patients have mild non-pharmacological means and OTC treatments
  • Non-pharmacological
  • Antacids
  • Alginates
  • H2 receptor antagonists
  • Proton pump inhibitors
20
Q

Non-pharmacutical Dyspersia

A
  • Loss of weight
  • Eating small frequent meals
  • Eat several hours before bedtime
  • Cut down on tea/coffee/cola/alcohol
  • Avoid triggers, e.g. rich/spicy/fatty foods
  • If symptoms worse when lying down, raise head of bed (do not prop up head with pillows)
  • Avoid tight waistbands and belts, or tight clothing
    Stop smoking
21
Q

Antacids

A
  • Compounds that neutralise stomach acid
  • Sodium bicarbonate and calcium carbonate
22
Q

Alginate

A
  • Form a ‘raft’ on top of stomach contents, creating a physical barrier to prevent reflux
  • Some combine both together
23
Q

H2 receptor antagonist

A
  • Ranitidine and famotidine
  • Longer duration of action and longer onset of action than antacids
  • Block H2 receptors in stomach to prevent acid production
24
Q

Proton pump inhibitor

A
  • PPIs block proton pumps in stomach wall to prevent gastric acid production
  • Takes 1-4 days to work fully, so may need to cover with antacids until it kicks in
  • Omeprazole
25
Q

When do refer for Dyspepsia

A
  • Beware of patients frequently attending for dyspepsia remedies
  • Dyspepsia remedies may mask signs of gastric cancer
26
Q

Red flag symptoms of Dyspepsia

A
  • 55 years or over, especially with new onset
  • Dyspepsia hasn’t responded to treatment
  • Features including bleeding, dysphagia, recurrent vomiting or unintentional weight loss
27
Q

Causes

Nausea and vomiting

A
  • Very young and old most at risk of dehydration
    Pregnancy consider in women of childbearing potential
    Duration adults >2 days cause for concern, young children (<2 years) any duration
28
Q

Associated symptoms of nausea and vomiting

A

Diarrhoea – may be gastroenteritis, question about food intake, could be rotavirus in children
Blood in vomit – differentiate fresh blood from that of gastric/duodenal origin
Faecal smell – GI tract obstruction
Medication: opioids, NSAIDs/aspirin, antibiotics, oestrogens, steroids, digoxin, lithium

29
Q

Management Nausea and vomiting

A

Most established vomiting will require referral
Motion sickness covered in ENT lecture

30
Q

Constipation

A
  • Bowel movement less than three times a week
  • Difficult to pass stools
  • Hard, dehydrated stools
  • Women and older people (esp. >70 yrs) more frequently affected
31
Q

Symptoms of constipation

A
  • Abdominal discomfort
  • Cramping
  • Bloating
  • Nausea
  • Straining
32
Q

Red flag symptoms for constipation

A
  • unexplained weight loss
  • rectal bleeding
  • family history of colon cancer or inflammatory bowel disease
  • signs of obstruction
  • co-existing diarrhoea
  • long-term laxative use
  • failed OTC > 1 week
33
Q

Medication that can cause constipation

A
  • Opioid analgesics
  • Antacids – aluminium
  • Antimuscarinics (anticholinergics)
  • Anti-epileptics
  • Anti-depressants
  • Anti-histamines
  • Anti-psychotics
  • Parkinson’s medication
  • Calcium-channel blockers
  • Calcium supplements
  • Diuretics
  • Iron
  • Laxatives
34
Q

Non-pharmacological treatment for constipation

A
  • Increase fibre intake
  • Increase fluid intake
  • Increase exercise
35
Q

Pharmalogical treatment for constipation

A
  • Bulk-forming, e.g. ispaghula husk, methylcellulose - fibre
  • Osmotic, e.g. lactulose, macrogols
  • Stimulant, e.g. senna, bisacodyl, sodium picosulfate, glycerin
  • Faecal softener
36
Q

Diarrhoea

A
  • Most cases are short-lived, self-limiting and benign
  • Acute: symptoms less than 14 days
  • Persistent: symptoms more than 14 days
  • Chronic: symptoms more than 4 weeks
37
Q

Symptoms of Diarrhoea

A
  • Three or more lose, watery stools in 24 hours
  • Faecal urgency
  • Abdominal cramps
  • Abdominal pain
  • +/- nausea and vomiting
38
Q

Question for caution

A
  • Young age and for a long time
  • Severity: “explosive”, blood, pus
  • Systemic symptoms: fever, nausea and vomiting
  • Food intake and fluid intake, esp.in young
  • Anyone else in household affected
  • Foreign travel
  • Any medicines already tried
39
Q

Treatments for Diarrhoea

A
  • Oral re-hydration therapy, e.g. Dioralyte
  • Loperamide, e.g. Imodium
  • Kaolin +/- morphine - can be abused due to morphine
40
Q

When do you refer

A
  • Pregnancy
  • Severe vomiting
  • Fever
  • Blood or mucous in stools
  • Suspected reaction to prescribed medicine
  • Suspected outbreak of “food poisoning”
  • Recent foreign travel
  • Persistent diarrhoea following antibiotic treatment
  • 1 day in < 1year old
  • 2 days in < 3 year old or in older adults
  • 3 days in older children and adults
41
Q

Haemorrhoids

A
  • Haemorrhoids are clusters of vascular tissue, smooth muscle and connective tissue arranged in three columns along the anal canal
  • Are actually normal structures that help maintain continence in healthy people
  • piles which are haemorrhoids in an abnormally swollen and symptomatic state
42
Q

Risk factors for Haemorrhoids

A
  • Constipation and poor diet
  • Increased incidence between ages 45-65yrs
  • Pregnancy
  • Heavy lifting
  • Chronic cough
  • Certain toilet behaviours, such as straining or spending more time on a seated toilet than on a squat toilet

PMP 103 Practice of Pharmacy (41 decks)

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