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Clinical > Dyspepsia and GERD > Flashcards

Dyspepsia and GERD Flashcards

(60 cards)

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1
Q

what is dyspepsia

A

group of symptoms!! pain/discomfort in or around upper abdomen

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2
Q

rome 3 criteria defines dyspepsia as at least one of the following

A

posprandial fullness
early satiation (unable to finish normal meal)
epigastric pain/burning

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3
Q

symptoms of dyspepsia

A

bloating
nausea
anorexia
burping

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4
Q

functional dyspepsia

A

idiopathic- pahtophysiology not understood
normal endoscopy
majority of cases

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5
Q

organic dyspepsia

A

actual pathological or drug source

minority of cases

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6
Q

what causes gerd

A

retrograde movement of stomach contents in esophagus

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7
Q

what is gerd

A

chronic digestive disease

symptoms and esophageal damage from reflux

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8
Q

montreal classifications defines gerd as condtion from reflux of stomach contents causing troublesome symtoms, what is considered troublesome

A

mild symptoms two or more days a week

moderate/severe symptoms occur more than one day a week

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9
Q

what ph daamages esophagus

A

lower than 4

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10
Q

describe a defective LES

A

pressure gradient between LES and stomach is less than normal or absent
(normally resting tone of LES > intragastric pressure)

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11
Q

pathogenisis of GERD

A 
hiatal hernia 
impaired esophageal peristalisis 
delayed gastric emptying 
excessive gastric acid production 
bile reflux
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12
Q

complication of gerd (11)

A 
esophagitis 
stricture
barretts esophagitis 
esophageal cancer
worseing asthma or pneumonia 
ulcer
hemorrhage
anemia 
tooth decay 
gingivitis 
halitosis
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13
Q

factors that contribute to gerd and dyspepsia

A 
food and beverage
pregnancy 
lifestyle- obesity, smoking
advancing age
meds
disease states (hernia. sjogren, asthma)
posture 
stress and anxiety
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14
Q

how can food exacerbate symptoms

A 
decrease LES tone 
direct mucosal irritation 
irritation of preexisting ulcer
direct stimulation of mucosal sensory receptors 
gastric over distention 
delayed gastric emptying 
gas production
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15
Q

foods that reduce LES tone

A 
alcohol 
carbonated
caffeinated
high sugar/fat content 
garlic onion 
peppermint
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16
Q

foods with direct irritant effect

A

citrus
coffee
spicy
tomato

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17
Q

meds that have direct irritant effect

A

antibiotics
NSAIDS
iron
biphosphonates

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18
Q

reflux like symptoms

A

heartburn and acid regurgitation

belching and burping

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19
Q

ulcer like symptoms

A

epigastric pain/discomfort
pain relieved by food
pain wakens person from sleep

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20
Q

dismotility symptoms

A 
early satiety or postprandial fullness
N/V or retching 
bloating with no visible distention 
feeling of abnormal digestion 
worsened by food
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21
Q

main symptoms of gerd

A 
heartburn and regurgitation most common
hypersalivation 
noncardiac chest pain 
burp/belching
worsens when bendign over/ lying down 
occurs 1-2 hours after eating
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22
Q

frequent symptoms

A

2 or more days per week

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23
Q

episodic symptoms

A

mild and sporadic unpredictable

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24
Q

persistent/chronic symptoms

A

3 months or greater

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25
red flags
``` larynigitis pharyngitis choking/globus sensation hiccups water brash dental erosion chronic cough cardiac chest pain odynophagia dysphagia pain unrelated to meals sever symptoms nighttime symptoms wake them up radiating pain anemia jaundice hematemesis melena N/V diarrhea unexplained weight loss resp symptoms pediatrics ```
26
differential diagnoses
``` IBS peptic ulcer gastric/ pancreatic cancer angina myocardial infraction gallstones asthma ```
27
goals of therapy
``` relieve symptoms prevent recurrence heal esophageal muscosa improve quality of life prevent complications ```
28
bismuth subsalicylate mechanism of action
suppresses h.pylori
29
indication of bismuth
treatment of overindulgence of food and alcohol, diarrhea
30
use of bismuth
adults and children over 12 | 2 tab or 30ml QID with meals and bedtime
31
side effects of bismuth
darkening of tongue grayish black stool toxicity tinnitus
32
precautions of bismuth
``` young children bleeding disorders salicylate sensitivity meds that interact with salicylates not during pregnancy or breastfeeding ```
33
omeprazole mechanism of action
inhibit hydrogen potassium ATPase, irreversibly blocking the final step in gastric acid secretion
34
onset of omeprazole
2-3 hours but complete relief may take 1-4 days
35
omeprazole indication
frequent heartburn in patients who have symptoms 2 or more days per week, not acute episodes
36
dosage of omprazole
20 mg by mouth 30-60 min before eating for 14 days | may be repeated 4 months after if symptoms recur
37
omeprazole drug interactions
CYP 2c19 | decrease absorption of ph dependent drugs
38
side effects of omeprazole
diarrhea, constipation, headache | long term may increase risk of osteoporosis, bone fracture, c.diff infection, hypomagnesamia and vitamin b12 deficiency
39
types of antacids
``` caco3 aloh mg salts mg/al complexes na bircarbonate na citrate ```
40
chemical names of h2bs
rantidine | famotidine
41
proton pump inhibitors
omeprazole
42
some combo products
famotidine with caco3 and mgoh antacid/simethicone antacid/alginate
43
chemical names of foaming agents
alginic acid alginates gaviscon
44
chemical name of antiflatulents
simethicone
45
which agents prevent and relieve symptoms of dyspepsia/GERD
h2b | combo products
46
which agents relieve symptoms of dyspepsia/GERD
antacids h2b combo products foaming agents
47
which agents relieve symptoms of bloating and gas
antiflatulents
48
antacids mechanism of action
neutralize existin acid doesnt affect amount or rate of gastric acid secretion increase both gastric and duodenal ph
49
h2b mechanism of action
competitively and reverely binds to h2 receptors in gastric parietal cells dose dependent inhibition of gastric acid secretion
50
foaming agents mechanism of action
alginates precipitate in acid medium of stomach to form sponge like matrix of alginic acid bicarbonate reacts with gastric acid to form co2 which is trapped in matrix and helps it float like a raft which acts as a barrier between contents of stomach and esophagus
51
antiflatuents machanism of action
decrease surface tension of gas bubbles in stomach and intestine so they are broken and eliminated more easily
52
what is ANC and what is it influences by
amoutn of acid buffered/dose over a specified period | influenced by ingredients, formulation, and manufacturer
53
common dose of antacids
10-20ml or 2-4 tablets after meals and at bedtime
54
duration of antacid action
as long as antacid is in the stomach | lasts 1 hour if given without food and 1-3 hours if given after food
55
side effects of antacids
too many hell no
56
which antacid do you use in renal failure, pregnancy, or breast feeding
calcium
57
who shouldnt use mg and al antacids
renal dysfunction elderly not studied extensive in pregnancy
58
who should you avoid sodium in
people with restricted sodium intake such as renal dysfunction, edema, cirrhosis, heart failure, HTN pregnant or breast feeding
59
how do antacids interfere with drugs
increase gastric ph interferes with absorption increases urine ph interferes with elimination bind to drug to form complexes alteration of GI transit time
60
drug interactions with antacids
enteric coated and buffered products antibiotics iron and digoxin do not take oral meds within 2 hours of antacids

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