CCC - GI - Dyspepsia, GORD, Colic, Constip.

Question 1

What are the symptoms of dyspepsia?

Answer 1

Upper abdominal discomfort/pain
heartburn
reflux
nausea
vomiting related to eating

Question 2

List 5 ALARM symptoms for dyspepsia?

Answer 2

GI bleeding
Dysphagia
Progressive unintentional weightloss
Persistent vomiting

Question 3

What is the most common differential diagnosis which should be considered?

Answer 3

Cardiac pain - angina

Sweating/clammy/ pale pallor/ breathing problems.

Question 4

Which medicines should be ruled out as they increased risk of dyspepsia/GI bleed?

Answer 4

Bisphosphonates
NSAIDs
Iron
Corticosteroids

Question 5

When are antacids best taken for dyspepsia?

Answer 5

After meals + bedtime

Question 6

What side effects can be common with antacid ingredients?

Answer 6

Magnesium - diarrhoea

Aluminium - constipation

Question 7

Can other meds be taken alongside antacids?

Answer 7

No - will impair absorption

Question 8

What is the max licensed dose of ranitidine for OTC sale?

Answer 8

75mg

Question 9

What are 3 practical tips for reducing dyspepsia?

Answer 9

Weightloss if overweight
Smoking cessation if a smoker
Avoid trigger foods

Question 10

Who can orlistat be sold to?

Answer 10

Overweight adults >18 and with BMI >28kg/m2

Question 11

What are the main symptoms of GORD?

Answer 11

Burning feeling behind breastbone

sour/bitter taste in throat

Question 12

What would you see on an endoscope of someone with frequent GORD and what can this progress to?

Answer 12

Oesophagitis - inflammation of oesophageal lining.

Barretts oesophagus or oesophageal stricture.

Question 13

List 6 trigger factors for GORD?

Answer 13

Foods - fatty, citrus, onions, coffee. 
Drugs which relax LOS - CCBs, theophylline, nitrates. 
Smoking
Alcohol
Obesity 
Genetic factors.

Question 14

List 4 ALARM symptoms for GORD?

Answer 14

GI bleeding
Dysphagia
Progressive unintentional weightloss
Persistent vomiting

Question 15

What differential diagnosis should be considered and how should it be ruled out?

Answer 15

Cardian pain

• will not be relieved by antacid
• brought on by exercise/exertion
• relieved by GTN

Question 16

MoA PPIs?

Answer 16

Inhibit H/K-ATPase - proton pump - of the gastric parietal cell to reduce H+ ion secretion and reduce acid production.

Question 17

Can PPIs be used as symptomatic relief PRN or must they be taken regularly?

Answer 17

NICE (2014) evidence says they can be used PRN.

Question 18

Do PPIs have any efficacy in healing ulcers?

Answer 18

Yes their effectiveness is related to healing ulcers rather than improving GORD.

Question 19

What are 3 most common S/E with PPIs?

Answer 19

diarrhoea
headaches
dizziness

Question 20

What 3 characteristics would make someone unsuitable for a PPI?

Answer 20

Electrolyte problems - hypoMg
Osteoporosis
Elderly - increased risk of fractures

Question 21

What are conditions on omeprazole sale OTC?

Answer 21

10mg tabs
>18y
max 4 weeks treatment

Question 22

What are conditions on eomeprazole sale OTC?

Answer 22

> 18y

max Tx 14 days

Question 23

3 practical tips for GORD?

Answer 23

• smaller meals
• raising head of bed
• lying flat when sleeping.

Question 24

Can Gaviscon sachets be used in pre-term infants?

Answer 24

Not recommended due to high sodium content.

Question 25

Important question to ask if anyone is buying PPIs OTC?

Answer 25

Do they have a referral for endoscopy? PPI will mask symptoms - avoid for 2 weeks before.

Question 26

What is typical age of colic?

Answer 26

few weeks - 4/5 months.

Question 27

What are the symptoms of colic?

Answer 27

excessive crying for >3 hours a day for 3 days per weeks for 3 weeks.

Question 28

What is the rule of 3 for colic?

Answer 28

>3hours/day >3 days/week >3 weeks.

Question 29

List 5 signs a baby might have colic?

Answer 29

- crying at same time each day. - draw legs up when they cry - flace flushes - clench hands - crying often relaxes when baby exhausted or passes stool.

Question 30

What are 2 danger symptoms of colic?

Answer 30

- failure to thrive in baby | - post-natal depression in mum

Question 31

List some points of advice to give parents?

Answer 31

- hold baby upright to allow wind to pass. - if breastfeeding avoid products in diet which may upset baby - caffeine, alcohol, spicy foods, chocolate, dairy. - bottle feeding - ensure teat hole is correct size - too large - gulp air. - relax baby - relaxed parents, baby massage.

Question 32

What treatments are available for colic?

Answer 32

Simeticone - dentinox, infacol Gripe water

Question 33

what treatment for colic can be given on pharmacy service?

Answer 33

Infacol - simeticone - helps coalesce gas bubbles - easier to pass.

Question 34

What are some symptoms of post-natal depression?

Answer 34

- low mood/enjoyment - anxiety - disturbed sleep/eating - poor concentration - low energy/self-esteem

Question 35

Symptoms of constipation?

Answer 35

- reduced frequency of defaecation - straining and passing small hard stools - abdominal discomfort, cramps or feeling incomplete emptying.

Question 36

Is constipation more common in women or men?

Answer 36

women

Question 37

Is constipation a problem during pregnancy?

Answer 37

Yes - changes in hormones.

Question 38

What are the 3 main contributing factors to constipation?

Answer 38

- dietary lack of fibre - dehydration - sedentary lifestyle.

Question 39

What are some danger symptoms for constipation?

Answer 39

- new/worsening constipation - blood in stool - weightloss - nausea/vomiting

Question 40

When does the BNF recommend laxatives are used?

Answer 40

- when straining should be avoided - angina | - when rectal bleeding needs to be avoided - haemorrhoids.

Question 41

What are 1st line treatments for constipation?

Answer 41

- increase fluid intake - increase exercise - increase fibre in diet.

Question 42

What are the 4 main types of laxatives?

Answer 42

Osmotic Stimulant Stool softener Bulk-forming

Question 43

Give 2 examples of bulk-forming laxatives and how long they take to work?

Answer 43

- ispaghula husk, stericula | - few days.

Question 44

How do bulk-forming laxatives work?

Answer 44

Increase faecal mass and draw water into the stool - stimulates persitalsis.

Question 45

Give 2 examples of osmotic laxatives and how long they take to work?

Answer 45

- lactulose, macrogol | - 8-12 hours.

Question 46

How to osmotic laxatives work?

Answer 46

Draw water into the large bowel - lubricate and help move things along.

Question 47

Give 2 examples of stimulant laxatives and how long they take to work?

Answer 47

- senna, bisacodyl, sodium picosulfate | - 8-12 hours - take nocte.

Question 48

How do stimulant laxatives work?

Answer 48

Stimulate colonic nerves to increase intestinal motility and reduce transit time.

Question 49

Give an example of a stool softener laxative and how does it work?

Answer 49

docusate sodium Reduce surface tension and increase fluid in faeces - also has stimulant properties.

Question 50

What is the best advice for constipation on children?

Answer 50

Ensure fibre in diet, hydration and physical activity. Avoid toilet phobias and use encouragement at all times. Apple, pear or prune juice is good for relieving constipation - natural laxative.

Question 51

What symptoms of constipation in a child should be referred to GP?

Answer 51

- weak, dizzy. - marked anal pain - blood in the stool - constipation becomes regular.

Question 52

What are the best laxatives for use in pregnancy?

Answer 52

Bulk-forming and osmotic - not absorbed by the body.

Question 53

Can senna be used in pregnancy?

Answer 53

Not ideal Can induce contractions in 3rd trimester Can enter breastmilk - cause colic/diarrhoea in infant.

Question 54

Which electrolyte disturbance is common in laxative abuse?

Answer 54

hypokalaemia

Question 55

List some common drugs which can cause constipation?

Answer 55

- antimuscarinics - iron - antispasmodics - opioids - verapamil - antipsychotics/antiepileptics - aluminium/calcium salts.