gastrointestinal system Flashcards
(41 cards)
Dyspepsia signs n symptoms
Nausea
abdominal pain
bloating
acid reflux
vomiting
loss of appetite
heartburn regurgitation
serious dyspepsia symptoms
ALARM
Anaemia
loss of weight
anorexia
recent onset of progressive symptoms
melena, dysphagia, hematemesis
may require referral for upper GI endoscopy.
mucosal protectant
example moa counselling point
Drug: Misoprostol
Mechanism: Inhibits gastric acid secretion by stimulating prostaglandin E1 receptors on parietal cells, reducing acid production.
Counselling: Can cause uterine contractions, commonly used for pregnancy termination.
H2 receptor antagonists
example, moa, counselling
Drug: H2RAs (e.g., Ranitidine, Famotidine)
Mechanism: Block histamine H2 receptors on parietal cells, inhibiting the secretion of stomach acid.
Counselling: Take as directed.
May cause dizziness or drowsiness. Use cautiously in patients with liver or kidney disease.
PPIs
example, moa, counselling
Drug: e.g., Omeprazole, Lansoprazole
Mechanism: Inhibit the proton pump (H+/K+ ATPase) in the stomach lining, effectively reducing the production of gastric acid for long-term relief.
Counselling: Take 30 minutes before meals. Long-term use may increase the risk of fractures, vitamin B12 deficiency, and hypomagnesaemia.
Alginates
example
Gaviscon
Mechanism: Form a gel-like barrier on top of stomach contents, preventing acid reflux into the oesophagus, providing relief from heartburn.
counselling: take after meals
avoid lying down after taking
bloating, flatulence
Non-pharmacological advice for GI tract conditions (UC, GORD, chrons, IBS)
- wight loss
- avoid datty foods
- eat smaller meals regularly
- extra pillow hen sleeping
- avoid choco, mint, alch, coffee
- avoid spicy food
GORD
reflux of gastric acid contents into oesophagus causing heart burn and acid regurgitation
cause: weakened gullet
GORD complications
- oesophagitis
- ulcers
- haemorrhage
- stricture formation
- anaemia
- aspiration pneumonia
- Barret’s oesophagus- erosion of oesophagus, and causes metaplasia.
sings and symptoms of Barret’s oesophagus
- frequent heart burn
- dysphagia
- vomiting blood
- stomach pain
- weight loss as eating is painful.
2 types of hiatus hernia
1) sliding
2) rolling
h pylori diagnosis test
carbon-13 urea breath test
upper endoscopy
Pharmalogical treatment of peptic ulcer disease (h pylori)
first line: triple therapy of
PPI + amoxicillin + clarithromycin/metronidazole
for 1 week
NSAID induced peptic ulcer treatment
stop nsaid
PPI at highest dose (8weeks) then reduce after review
or if nsaid treatment continue:
treat with ppi as normal
treat with ppi and on healing witch to misoprostol
treat with PPI and swtich NSAID to COX-2 inhibitor (celecoxib, etoricoxib)
examples of antiflautulents
simethicone
pepper mint oil
examples of antispasmodics
Anticholinergic drugs (atropine-like) e.g. hyoscine butylbromide, dicloverine
* Direct-acting smooth muscle relaxants e.g. Mebeverine, alverine and peppermint oil
constipation causes
laack of excercise
low fibre diet, dehydration
drug induced: antacids, antihistamines, opioids etc
Laxatives 5 types
1) bulking: ispaghula husk
- moa: stimulate mucosal receptors, causing peristalsis.
- counselling: increase fluid intake
2) osmotic: lactulose
- moa: retains fluid in the bowel, changing water distribution in the faeces, producing a softer stool
counselling: not used in HF patients, can cause imbalance of electrolytes.
3) stimulant: senna
- moa: stimulates colonic nerves causing increased intestinal motility and movement of stool.
counselling: bedtime dose preferred. can cause abdominal cramps.
4) softeners: docusate
moa: reduces surface tension of stool, intestinal fluid can then penetrate stool easier.
counselling: usually used as a combo with stimulant laxative.
5) selective serotonin 5HT4- receptor agonist: Prucalopride
counselling:
cautious in patients with history of arrthymias, or ischaemic heart disease.
- dizziness and fatigue may
initially affect a patient’s ability to drive or operate
machinery
serious diarrhoea symptoms
constipation alternating with diarrhoea
blood in stool
high fever, abdominal pain, vomit
weight loss
dehydration (moderate-severe)
faecal incontinence
3 grades of dehydration
mild: body weight reduced by less than 4%, thirst, reduced urine output, dry mucus membranes, mild tachycardia
moderate: body weight reduced by 4-6%. sunken eyes, abnormal respiratory pattern, reduced skin turgor
severe: reduced body weight by 7% or more, no ability to drink, lack of consciousness.
general diarrhoea treatment
generally, staying hydrated and oral rehydration salts, loperamide (anti-motility), emptying bowels when appropriate.
antibiotic choice for treating diarrhoea based on infection
campylobacter enteritis: erythromycin
acute giardiasis and amoebiasis: metronidazole
clostridium difficile: 1st line: vancomycin (in addition to metronidazole if severe)
2nd line: fidaxomicin
toxic megacolon: metronid/vanco
salmonella: amoxicillin, chloramphenicol
shigellosis: norfloxacin, amoxicillin
cholera: doxycycline, amoxicillin
what laxative is used in IBS
linaclotide
used first and second line treatment for constipation no work
its is a black triangle drug
for IBS-C
what is first line treatment IBS
antispasmodics: meberverine hydrochloride, pepper mint oil.
loperamide
laxatives
second line: TCAs: amitriptyline, nortriptyline
