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PMP-201 > GORD, Peptic Ulcers & H. pylori infection > Flashcards

GORD, Peptic Ulcers & H. pylori infection Flashcards

(47 cards)

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1
Q

GORD:

A

Gastro-oesophageal reflux disease

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2
Q

What is GORD caused by?

A

Usually caused by weakening/relaxation in lower oesophageal sphincter

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3
Q

Symptoms of GORD: acid from stomach leaks up into oesophagus

A

Heartburn
Acid reflux
Bad breath
Bloating / belching
Nausea / vomiting

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4
Q

Risk factors of GORD:

A

Smoking
Alcohol
Coffee
Chocolate
Fatty Foods
Being Overweight
Stress
Medicines (calcium channel blockers, nitrates, NSAIDs etc)
Tight clothing
Pregnancy

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5
Q

How to diagnose GORD?

A
  • made on symptoms
  • full drug history; calc antogonists, nitrates, anti-inflam drugs, corticosteroids

test like;
urea breath trest fro H. pylori infecion
Endoscopy for gastric cancers

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6
Q

GORD lifestyle advice

A

Lose weight if overweight

Eating small, frequent meals rather than large meals

Eat several hours before bedtime

Cut down on tea/coffee/cola/alcohol

Avoid triggers, e.g. rich/spicy/fatty foods

If symptoms worse when lying down, raise head of bed (do not prop up head with pillows)

Avoid tight waistbands and belts, or tight clothing

Stop smoking

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7
Q

GORD OTC Management

A

Antacid: Pepto-Bismol®, Rennie®

Alignate: Gaviscon Advance®

Dual Product: Gaviscon Dual Action®, Peptac®

PPI or H2 receptor antagonists

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8
Q

GORD: why take PPi or H2 instead of other OTC?

A

Longer acting, but take longer to work than antacids

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9
Q

PPI or H2 receptor antagonists - council for GORD

A

Do not take both at same time, one or the other
Quite strict criteria of who you can supply PPI to (recent POM to P switch)
Max 2-4 weeks treatment, then refer to GP

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10
Q

GORD red flags/ when to refer??

A

Patients over 55 years with new onset symptoms

Patients over 55 years with unexplained dyspepsia that hasn’t responded to 2 weeks of treatment

Patients who have continuously taken remedies for 4 weeks (risk of rebound indigestion)

Pregnant or breastfeeding

Not responded to OTC treatment

Red flag symptoms

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11
Q

What are the red flag symptoms for GORD?

A

Unintentional weight loss
Epigastric mass
Stomach pain, pain/difficulty when swallowing
Persistent vomiting
Jaundice
Signs suggestive of GI bleed

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12
Q

GORD POM Management?

A

if CONFIDENT patient has GORD

offer full dose PPI for 4-8 weeks

PPI = Proton Pump Inhibitor

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13
Q

What if patient does not respond to PPI POM meds for GORD?

A

give H2 receptor antagonist

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14
Q

PPI doses GORD dose: lanzoprazole (proton pump inh)

A

30mg OD - full standard dose

15mg OD - low dose

30mg^2 BD - double dose

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15
Q

PPi doses GORD dose: Omeprazole (proton pump inh.)

A

20mg OD - full standard dose

10mg^2 OD - low dose

40mg OD - double dose

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16
Q

PPIs - issues?

A

Subacute Cutaneous Lupus Erythematosus - low risk

risk:
fractures, GI infections, making gastric cancer, interactions (some interact w clopidogrel), s.e > abdo pain, nausea, vomit, constipation

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17
Q

H2 Receptor Antagonists
(GORD) exaples of drug

A

Examples: ranitidine, famotidine, cimetidine
BD dosing

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18
Q

H2 Receptor Antagonists
- aware of….

A

risk of masking gastric cancer

s.e > constripation, diarrhoea, fatigue, headache

interactions

supply chain - manufac. issues

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19
Q

What are peptic ulcers?

Study These Flashcards
A

Sores that develop in lining of stomach and intestines
Gastric ulcer = in stomach
Duodenal ulcer = in duodenum (small intestine)

20
Q

signs and symptoms of peptic ulcers:

Study These Flashcards
A

Burning or gnawing pain in centre of abdomen

Indigestion

Heartburn

Nausea and vomiting

Pain can last minutes to hours, and can come and go for several days, weeks or months

21
Q

Risk factors & Causes
of peptic ulcers?

Study These Flashcards
A

common over 60 and in males
cause: when protective lining of stomach is damaged

22
Q

What is poeptic ulcers a RESULT of?

Study These Flashcards
A
  1. Helicobacter pylori (H. pylori) infection
  2. Taking non-steroidal anti-inflammatories (NSAIDs)
  3. Sometimes caused by ‘stress’ (e.g. in intensive care) or some foods (patchy evidence)
23
Q

Why is taking on-steroidal anti-inflammatories (NSAIDs) a risk for peptic ulcers?

Study These Flashcards
A

NSAIDs (e.g. aspirin, ibuprofen, naproxen) block COX-1 enzymes
Enzyme plays role in GI mucosal protection – if blocked, protective lining becomes vulnerable to stomach acid, causing an ulcer

24
Q

Helicobacter pylori (H. pylori) infection role in causation of peptic ulcers?

Study These Flashcards
A

Bacteria damages mucous coating of stomach and duodenum lining
Once lining is damaged, hydrochloric acid of stomach can reach the lining
The acid and the bacteria irritate the lining, causing an ulcer

25
Explain the pathophysiology of peptic ulcers?
in the injury - damaguing factors incl; H. pylori infection NSAID Tobacco Alcohol Gastric hyperacidity Duodenal-gastric reflux which causes an increased damage or impared denenses (causes ischema/shock) ULCER is formed: 1) necrotic debris 2) nonspecific acute inflammation 3) granulation tiussue 4) fibrosis
26
What damaging factors are at risk to a normal human before injury that can cause peptic ulcers?
gastric acidity and peptic enzymes
27
Pathophysiology of peptic ulcers; protective factors in a normal human:
1) surface mucus secretion 2) bicarbonate secretion into mucus 3) mucosal blood flow 4) epithelial barrier function 5) epithelial regenerative capacity 6) elaboration of prostaglandins
28
Complications of peptic ulcers - uncommon but lie threatening
Bleeding at site of ulcer Slow bleed – anaemia Rapid and severe – vomit blood, melaena = risk of death Stomach perforation GI bacteria can infect lining of abdomen – peritonitis GI bacteria may go into bloodstream - sepsis Gastric obstruction Scarred or inflamed stomach can stop passage of food to gut Will repeatedly vomit, won’t take on nutrients
29
Diagnosis
1) full history 2) physical abdo exam (feel mass/ listen to bowel sounds/ tap abdomen - tender, pain??) 3) urea breath test = identify H.pylori infection REFER for endoscopy?
30
Peptic ulcer POM Management
due to NSAIDs? stop if poss Full dose PPI or H2RA therapy for 8 weeks to help ulcer heal if due H.pylori offer h.pylori eradication course if due NSAIDs !AND! H/pylori Full dose PPI or H2RA therapy for 8 weeks to help ulcer heal first THEN offer H. pylori eradication course not due to NSAIDs or H. pylori Full dose PPI or H2RA for 4-8 weeks
31
Monitoring and follow-up???
- ensure only take PPi as a course (avoid long term) - manage pain w/o NSAID p[aracetamol or low-dose ibuprofen IF want NSAID, try low dose short course of PRN basis can consder COX-2
32
What if symptoms of peptic ulcers persist?
Exclude non-adherence, inadvertent NSAID use or drugs causing ulcers Exclude other cause, e.g. malignancy, Crohn’s, Zollinger-Ellison syndrome
33
Symptoms of peptic ulcers reoccur????
Trial low-dose PPI, on a PRN basis Might get rebound dyspepsia on stopping PPI, so PRN use of antacids during this time may help
34
What is H.pylori?
gram -ive bacteria found in STOMACH
35
What are the Risk factors of H.pylori?
Living in crowded conditions Living without a reliable source of clean water Living with someone who has H. pylori infection More common in developing countries
36
How is H.Pylori transferred?
saliva, voimit, stool of infected person
37
Complications of infection
Peptic ulcers Gastritis Inflammation of stomach lining Stomach cancer Important to identify cases and treat properly
38
Diagnosis of H.pylori
- Carbon-13 urea breath test - Other options are stool test or blood test
39
What is the first line management for H.pylori for no pen allergy
amoxicillin 1g PO BD clarythromycin 500mg PO BD or metronidazole 400mg PO BD any PPI e.g. omeprazole 20mg PO BD duration = 7 days
40
What is the first line management for H.pylori for pen allergy
clarythromycin 500mg PO BD Metronidazole 400mg PO BD any ppi e.g. omeprazole 20mg PO BD for 7 days
41
What is the 2nd line management for H.pylori for no pen allergy
Amoxicillin 1g PO BD 1g PO BD Clarythromycin 500mg PO BD PPi e.g. omeprazole 20mg PO BD 7 days
42
What is the 2nd line management for H.pylori for pen allergy
levoflaxacin 250mg PO BD Metronidazole 400mg PO BD any PPI e.g. omeprazole 20mg PO BD 7 days
43
Management – 3rd Line H.pylori
10 days of treatment No penicillin allergy: PPI + Bismuth Subsalicylate + Any 2 Abx listed not previously used Other Abx options: Rifabutin or Furazolidone Penicillin allergy: PPI + Bismuth Subsalicylate + Rifabutin / Furazolidone
44
points to consider - H.Pylori
strain may be resistant diarrhoea adherence
45
Bismuth ?
Active ingredient in Pepto-Bismol Link to salicylic acid Do not give to people with aspirin allergy Do not give to children under 16 – Reye’s syndrome can cause tongue and faeces to turn black
46
potential issue for treatment failure - H.pylori
- poor compitence with meds - resistant H.pylori strains - prior use of regimen antibiotics - inadequate suppression of stomach acid during treatment
47
Monitoring and follow up - H.pylori
Re-testing is recommended if: Patient was poorly compliant High local resistance rates Severe persistent or recurrent symptoms Re-test at least 4 weeks (ideally 8 weeks) after treatment Only use urea breath test to re-test

PMP-201 (34 decks)

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