Dyspepsia Flashcards
(34 cards)
1
Q
What is dyspepsia (7)
A
- Dyspepsia is a broad umbrella term for 5 conditions, covering 90% of cases
- Affects women more slightly then men
- GORD = Gastro-Oesophageal Reflux Disease (next disease state)
- Heartburn = Temporary reflux of acid up the oesophagus causing burning discomfort
- Gastritis = inflammation of the stomach
- Duodenal Ulcers
- Peptic Ulcers
2
Q
What are the oesophageal causes of dyspepsia (3)
A
- GORD
- Hiatus hernia (leading to GORD)
- Dysphagia
3
Q
What are the gastric causes of dyspepsia (2)
A
- Peptic ulcer
- Carcinomas
4
Q
What are the inflammation or disease in other GI organs causes of dyspepsia (4)
A
- Crohn’s
- hepatitis
- pancreatitis
- congestive heart failure
5
Q
What are the lifestyle causes of dyspepsia (5)
A
- Stress
- diet
- pregnancy
- smoking
- excessive caffeine and/or alcohol consumption
6
Q
What are the drug-induced causes of dyspepsia (6)
A
- Aspirin
- NSAIDs
- Iron
- Abx
- SSRIs
- steroids
7
Q
What is the most likely cause of dyspepsia
A
Non-ulcer dyspepsia
8
Q
what are the unlikely causes of dyspepsia (3)
A
- ulcer
- medicine induced
- IBS
9
Q
What are the least likely causes of dyspepsia (2)
A
- cancers
- atypical angina
10
Q
What are the 2 broad categories of dyspepsia
A
- Pre-endoscopy
- Post-endoscopy
11
Q
What are the severe symptoms post-endoscopy dyspepsia (5)
A
- 40% have functional dyspepsia = no ulcer
- 40% have gastro-oesophageal reflux disease (next topic)
- 3% have some form of ulcer (link to Peptic & Duodenal ulcers)
- Gastric and oesophageal cancers occurring in up to 3% of endoscopies
- Cancers are rare, but serious → Red flag symptoms…
12
Q
What are the signs and symptoms of dyspepsia (8)
A
- Generic and hard to distinguish
- Any symptom of the upper gastrointestinal tract (GI), present for 4 weeks or more
- Upper abdominal pain or discomfort, maybe before meals or relieved by food
- Epigastric pain (upper abdomen just below ribs)
- Heartburn
- Acid reflux
- Nausea and/or vomiting
- May be relapsing/remitting
13
Q
What are the red flag symptoms of dyspepsia (10)
A
- unintentional weight loss
- blood in vomit/stool
- GI bleeding
- Persisitant symtptoms 4-6 weeks
- sudden onset (over 55 y/o)
- progressive dysphagia (food ‘sticking’)
- symptoms after 14 days treatment
- epigastric mass/swelling
- Chest pain & feeling faint
- Suspected heart attack
14
Q
What is the relevance of age with dyspepsia (2)
A
- Adults under 50 are likely to have symptoms for no specific pathology
- over 50 a specific pathology becomes more common
15
Q
What is the relevance of the location of pain with dyspepsia (4)
A
- Dyspepsia is felt above the belly button and below the ribs
- Heartburn is felt in ribcage
- If a specific location is pointed to → unlikely to be dyspepsia
- IF IT RADIATES, REFER! Most urgently down left arm suspect heart attack or angina!
16
Q
What is the relevance of the nature of pain with dyspepsia (3)
A
- Aching/discomfort → dyspepsia
- Sharp, stabbing → unlikely to be dyspepsia
- Severe → REFER
17
Q
What is the relevance of other symptoms with dyspepsia (2)
A
- Persistent vomiting, may be ulcer or cancer → REFER
- Black, tarry stools suggest bleeding → REFER
18
Q
What is the relevance of aggravating and relieving factors with dyspepsia (2)
A
- Pain 1-3 hours after eating and then relieved with food or antacids suggests ulcer → REFER
- Dyspepsia often bought on by ingesting certain foods and drinks such as caffeine or spice
19
Q
What is the relevance of social history with dyspepsia (4)
A
- Binge drinking
- binge eating
- eating on the go
- eating too quickly
all associated with dyspepsia
20
Q
What is the first course of action for dyspepsia (7)
A
- f no red flags
- Offer initial and ongoing help
- lifestyle changes
- OTC medication
- Help with Prescribed drugs
- When to see G
- Provide educational material
21
Q
What are diet lifestyle advice for dyspepsia (5)
A
- Reduce alcohol intake- Max 14 units/week spread over 3 days
- Reduce coffee
- Reduce Chocolate
- Reduce fatty foods
- Other healthy diet promotion
22
Q
What are other lifestyle advice for dyspepsia (4)
A
- Reduce/quit smoking
- Lose weight (if overweight) - Aided by diet and exercise
- Raise head of bed at night - lifting whole half ideally
- Avoid large meals close to bedtime
23
Q
What is the second course of action for dyspepsia (10)
A
- Review of potential therapies that could cause symptoms
- Acarbose
- NSAIDs
- Steroids
- Antibiotics
- Antimuscarinics
- Calcium antagonists
- Nitrates
- Theophyllines
- Bisphosphonates
24
Q
What is the third course of action for dyspepsia (5)
A
- If no drug cause and lifestyle changes not working, consider OTC therapy
- Antacids (Rennie®)
- Alginates (Gaviscom)
- Proton Pump Inhibitors (omeprazole)
- H2 receptor antagonists (famotidine)
25
What is the fourth course of action for dyspepsia (4)
1. If none of this works or red flag refer to GP.
Typically a patient gets:
1. 4 weeks full dose PPI (omeprazole)
2. H. Pylori test (after 2 week PPI washout)
3. Endoscopy
26
How are PPIs used for dyspepsia (4)
1. Proton Pump Inhibitors. Inhibit proton (H+) pump in stomach parietal cells → reduced HCl production
2. Most common: Omeprazole
3. Typical dose: 20-40 mg ONCE a day
4. Typical formulation: 20 mg Capsules
27
Oral omeprazole doses: low (OTC), full & double (high)
Low - 20mg OD
Full - 40mg OD
Double - 40mg BD
28
Oral lansoprazole doses: low (OTC), full & double (high)
Low - 15mg OD
Full - 30mg OD
Double - 30mg BD
29
Oral esomeprazole doses: low (OTC), full & double (high)
Low - 20mg OD
Full - 40mg OD
Double - 40mg BD
30
Oral pantoprazole doses: low (OTC), full & double (high)
Low - 20mg OD
Full - 40mg OD
Double - 40mg BD
31
Oral rabeprazole doses: low (OTC), full & double (high)
Low - 10mg OD
Full - 20mg OD
Double - 20mg BD
32
How are H2 receptor antagonists used for dyspepsia (4)
1. Inhibit Histamine 2 receptors on parietal cells, stopping cAMP production, no activation of protein kinase → reduced H+ pump activity
2. The most common: was ranitidine now famotidine
3. Typical dose: 20 - 40 mg at night
4. Typical formulation: 20 mg and 40 mg tablets
33
How are antacids used for dyspepsia (6)
1. Alkaline compounds that neutralise acid producing a salt and water
2. Provide short lived symptomatic relief only
3. Most common: Aluminium, calcium or magnesium compounds
4. Brands: Gaviscon, Rennie's, Tums…
5. Typical dose: Brand specific (see product)
6. Typical formulation: suspension (also powders and chewable tablets)
34
How are alginates used for dyspepsia (8)
1. Often added to antacids- mainly Gaviscon
2. Natural polysaccharide often from seaweed
3. When charged in acidic stomach:
4. ↑ viscosity
5. Forms physical raft
6. Always use after food and drink
7. Shown more effective than antacid alone
8. Do not use simethicone and alginate products together
