gastric acid disorders and ulcerations

Question 1

what is dyspepsia?

Answer 1

-upper abdominal pain, heart burn, gastric reflux, bloating
-nausea and vomiting

Question 2

what are some urgent referrals symptoms for dyspepsia?

Answer 2

gastrointestinal bleeding
aged 55 years+
unexplained weight loss
dysphagia

Question 3

what are the 2 types of dyspepsia?

Answer 3

-uninvestigated
-functional

Question 4

what is uninvestigated dyspepsia?

Answer 4

-PPI for 4 weeks first
-test for H.pylori if PPI didn’t work treat if positive

Question 5

what is the treatment for functional dyspepsia? (investigated but no cause present)

Answer 5

-test for H. Pylori treat positive
not infected: 3 weeks of PPI or H2 receptor antagonist

Question 6

how do you test for H.Pylori?

Answer 6

-diagnosed with a urea (13C) breath test or stool helicobactor antigen test (SAT)
-ppi should have been stopped 2 weeks before test
-antibiotics should have stopped 4 weeks before test

Question 7

how is H pylori treated?

Answer 7

triple therpY: PPI and 2 of the antibiotics

-PPI twice daily
-Amoxicillin 100mg twice daily (use other 2 in penicillin allergy)
-clarithromycin 500mg twice daily for 7 days
-metronidazole 400mg twice daily for 7 days

Question 8

what can increase the chances of gastro-oesophageal reflux disease?

Answer 8

-consuming fatty food
-preganancy
hiatus hernia
-family history
-stress and anxiety
obesity
-drug Side effects
-SMOKING
-ALCoHOL

Question 9

what drug side effects cause GORD?

Answer 9

(a/b-blockers, CCB, anticholinergics, bentos,bisphosphonates, corticosteroids, NSAIDs, nitrates and TCAs) -looses up the sphincter

Question 10

what should be offered first for GORD?

Answer 10

lifestyle advice

Question 11

what lifestyle advice can be given for GORD?

Answer 11

-healthy eating
-weight loss (if obese)
-avoiding any trigger foods
-eating smaller meals
-eating evening meal 3-4hrs before bed
-raising the head of the bed
-smoking cessation
-reducing alcohol consumption

Question 12

what is the treatment for GORD?

Answer 12

Medicine review, some can exacerbate GORD
-UNINVESTIGATED good TREATED THE SAME AS UNINVESTIGATED DYSPEPSIA
-confirmed GORD treatment with 4-8weeks of PPI

Question 13

HOW DO YOU TREAT good IN PREGNANCY?

Answer 13

dietary and lifestyle
antacid or an alginate
omeprazole or ranitidine

Question 14

what are some antacids and their effects?

Answer 14

-magnesium-containing antacids= laxative
-aluminium-containing antacids= constipation
-calcium-containing= indices rebound acid secretion

Question 15

how do simeticone work?

Answer 15

-antifoaminng agent added to antacid leading to relived flatulence

Question 16

what do alginates + antacid do?

Answer 16

increase the viscosity of stomach content. form a viscous Gell (raft) that floats on the surface of the stomach content§

Question 17

what are some antacid interactions?

Answer 17

-increase stomach pH (more alkali) meaning enteric coated capsules are damaged before reaching the intestine
-check sodium content of antacids-not to be taken with lithium/ in hypertension
-not taken with other drugs due to impairing absorption. e.g. bisphosphonates, tetracyclines, ciprofloxacin

Question 18

what is the low sodium antacids ?

Answer 18

-co-magaldrox

Question 19

what are some warnings for PPI?

Answer 19

-low risk subacute lupus erythematosus
-increases risk of fractures/ osteoporosis due to hypomagnesaemia
-increased risk of c.diff
-masks symptoms of gastric cancer

Question 20

what are some interactions with specific drugs for PPI?

Answer 20

-es/omeprazole + clopidogrel (use lansoprazole)
-increases conc of methotrexate, phenytoin, warfarin and digoxin

Question 21

what are H2 receptor antagonists examples?

Answer 21

-ranitadine, cimetidine, famotidine nizatidine

Question 22

what are some cautions for H2 receptor antagonists?

Answer 22

-mask symptoms of gastric cancer=rule out alarm features of cancer before treatment

Question 23

what are some side effects of H2 receptor antagonists?

Answer 23

diarrhoea, headache, dizziness, rash, tiredness

Question 24

what are some interactions to be aware of?

Answer 24

cimedtine is an enzyme inhibitor
-reducted absorption of -azole antifungials