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Flashcards in RTS- GI Deck (64):
1

what is the difference between nausea and vomiting? (2)

1) nausea- feeling of sickness with an inclination to vomit
2) vomiting- ejecting matter from the stomach through the mouth

2

what are the most common causes of vomiting in adults?

gastroenteritis- infection of the gut ( this can cause/lead to: diarrhoea.

3

list some other causes of nausea and vomiting. you should include examples and presenting features. (6)

1) gastrointestinal disorders: e.g. gastroenteritis - coincide with feeling unwell
2) food allergy:e.g. seafood- within 48 hours of eating suspect food
3) neurological:e.g. migraine- headache/ visual disturbances
4) hormonal: e.g. pregnancy- "morning" sickness ( give ginger)
5) medication: e.g. painkillers (opiates) - initiation if new meds/ increase in dose
6) alcohol: e.g. Jager- bombs/ snakebite- binge drinking

4

outline the referral criteria for nausea and vomiting in children (7)

1) Vomiting for more than 24 hours
2) Unable to keep fluids down for 8 hours
3) Signs of dehydration
4) They are: limp, irritable, not usual self
5) Refuse food
6) Severe stomach or “tummy” pain
7) Headache / stiff neck

5

outline the referral criteria for nausea and vomiting in adults (6)

1) Vomiting for more than 48 hours
2) Unable to keep any fluids down
3) Vomit is green in colour ( emptied stomach , bringing up bile)
4) Signs of severe dehydration ( little/no urine)
5) Loss of weight
6) It is a regular occurrence

6

what are the symptom of dehydration in children? (6)

1) irritability or drowsiness
2) passing urine frequently
3) pale skin
4) cold hands
5) cold feet
6) they look unwell

7

what are the symptom of dehydration in adults? (9)

1) Tiredness/ lack of energy
2) loss of appetite
3) nausea
4) feeling light-headed
5) dizziness
6) dry mouth/tongue
7) sunken eyes
8) muscle cramps
9) rapid heartbeat

8

what is dyspepsia?

Gastro Discomfort- Stomach acid irritates the digestive tract

9

what can dyspepsia lead to? (4)

1) Irritation
2) Inflammation
3) Pain
4) bloating

10

describe the difference between Indigestion and Heartburn (2)

1) indigestion ( dyspepsia):
- discomfort after eating
- mainly localised to the stomach
2) heartburn:
- discomfort before or after eating
- discomfort behind the sternum

11

what are the signs and symptoms of indigestion and heartburn (8)

1) pain in upper abdomen
2) discomfort in upper abdomen
3) uncomfortable or "full" feeling
4) belching
5) bloating
6) bringing food up (reflex)
7) nausea
8) vomiting

12

what are the causes of dyspepsia? (8)

1) normally caused by eating
2) smoking
3) alcohol
4) caffeinated drinks
5) stress
6) pregnancy
7) medications ( NSAIDs/ Asprin/ Nitrates)
8) obesity

13

outline the referral criteria for dyspepsia (5)

1) Treatment failure
2) Child
3) Pregnant / breastfeeding
4) People over 55 years of age – 1st presentation!
5) Persistent or unexplained recent-onset dyspepsia

14

outline the Red-Flag Symptoms for dyspepsia (7)

Dyspepsia with one or more of the following:
1) Gastrointestinal bleeding
2) Unintentional weight loss
3) Difficulty swallowing
4) Persistent vomiting
5) Pain in the arm(s)
6) Pain in the back ( cardiac issue)
7) Radiation of any pain

15

what does the acronym ALARM stand for with regards to dyspepsia

A- age >55
L- loss of weight
A- anaemia
R- recurring vomiting/difficulty swallowing
M- Melaena ( blood in stools)

16

what could be the Differential Diagnosis of dyspepsia (6)

1) Indigestion?
2) Heartburn? – aka reflux
3) Peptic ulcer?
4) Gastric cancer?
5) Oesophageal cancer?
6) Cardiovascular event?

17

explain the treatment options for dyspepsia (2)

1) Antacids - Combination of: Aluminium, Magnesium, Calcium carbonate, Sodium bicarbonate work to neutralise the stomach acid from pH 1 to pH 5
- Liquids ‘vs’ Tablets - must chew fully
- best taken 1 hour after a meal
e.g. Rennie/Gaviscon peppermint tablets
2) Alginates-contain antacids : able to neutralise the acid in the stomach
- forms a raft which stops the acid coming up
e.g. Gaviscon liquid oral suspension

18

list the medications affected by gaviscon (6)

- antacids can prevent other medications from working - always ensure you carry out a through medical history
1) antibiotics
2) antivirals
3) Statins
4) Theophylline
5) thyroid hormone replacement
6) Enteric coatings on any medicines

19

what is the alternative treatment for heartburn? (2)

1) H2 antagonists
2) PPIs- proton pump inhibitors

20

what are H2 Antagonists? (3)

e.g. Ranitidine ( zantac) 75mg tablets
1) these medicines work by reducing the amount of acid produced by cells in the lining of the stomach.
2) work up to 12 hours
3) H2 antagonists can hide problems ( mask symptoms)

21

what are the cautions and side effects of H2 antagonists? (2)

1) cautions: 16+ only
2) side effects include:
- headaches
- diarrhoea
- blurred vision
- aches and pains
- itching

22

What are PPIs? (4)

e.g. Omeprazole 10mg tablets
1) PPIS restrict the acid production
2) Should be initiated by the GP
3) works up to 24 hours
4) lots of interactions (e.g. warfarin)

23

what are the side effects and cautions associated with taking PPIs? (2)

1) cautions: 18+ only
- PPIs can hide problems
2) side effects include:
- headaches
- diarrhoea
- constipation
- feeling sick ( nausea)
- vomiting
( nexium PPIs will be GSL)

24

what is GORD? (3)

1) Gastro-Oesophageal Reflux Disease
2) The Oesophagus connects the mouth to the stomach, acid leaks out of the stomach and irritates the oesophagus
3) problem with LOS - lower oesophagus sphincter

25

what are the risk factors for weakened LOS? (7)

1) weight
2) fatty foods- longer to digest
3) consuming tobacco, alcohol, coffee or chocolate
4) pregnancy
5) hiatus hernia
6) stress
7) medications e.g. calcium channel blockers and nitrates

26

who gets GORD? (3)

1) adults
2) children
3) babies/infants :
- common in babies and infants
- their oesophagus is shorter and narrower

27

outline the signs and symptoms of GORD (8)

1) heartburn
2) acid reflux
3) Dysphagia
4) feeling sick
5) cough worse at night
6) tooth decay
7) laryngitis ( inflammation on larynx husky voice)
8) taste disturbance/ halitosis (bad breath)

28

explain the non-pharmacological treatment for options for people suffering with dyspepsia (6)

1) diet and lifestyle changes: weight, smoking, foods, drinks
2) avoid eating prior to bedtime
3) stress/ anxiety management
4) medication review
5) eat small regular meals , chew food
6) if worse at night use extra pillow - elevation

29

outline the signs and symptoms of GORD in younger children. (7)

1) regurgitation
2) frequent crying
3) irritability
4) halitosis
5) difficulty sleeping
6) aching back
7) refusing to feed

30

can pharmacists diagnose GORD? (5)

1) Might / May be diagnosed by a pharmacist
2) Should NOT be treated solely by OTC medication
3) Investigation MUST be initiated by GP
4) Treatment MUST be initiated by GP
5) patient: MUST BE REFERRED

31

what are the two treatment options for GORD? (2)

1) OTC: provide symptomatic relief
- antacids: Rennie
- Alginates: Gaviscon
- H2 Antagonists: Rantidine
- PPI: Omeprazole

2) GP referral : Treat underlying condition
- as OTC treatment but confirmed diagnosis
- confirmed diagnosis
- endoscopy
- condition managed by GP!

the above are supported by self care techniques

32

what are the red flag symptoms for GORD? (7)

1) GI bleeding
2) unintentional weight loss
3) difficulty swallowing
4) persistent vomiting
5) pain in arms
6) pain in the back
7) radiation of any pain

33

what is Constipation?

Infrequent bowel evacuations and the passage of hard stools

34

what are the causes of constipation? (4)

1) Infrequent stools
2) Difficulty stool passage
3) Incomplete defecation
4) Stools are often:
- Dry, Hard, Abnormally large or abnormally small

35

who is affected by constipation? (5)

1) elderly
2) adults
3) women during pregnancy
4) children
5) babies
- not moving around causes constipation

36

what questions would you ask a patient suffering from constipation? (8)

1) What does the patient believe to be normal bowel movements?
2) What is the normal pattern for defecation?
3) When did constipation first become a problem?
4) What is the frequency?
5) Are they hard?Are they large?
6) Is there discomfort?
7) Straining
8) Bleeding

37

what are the signs and symptoms of constipation in adults? (7)

1) reduction in frequency
2) strain
3) stools appear: dry, hard, lumpy
4) stomach aches and cramps
5) feeling bloated
6) feeling sick
7) loss of appetite

38

what are the signs and symptoms of constipation in children? (6)

- same as adults but also
1) appetite
2) energy
3) irritable, angry, unhappy
4) smelly wind
5) soiling clothes
6) feeling unwell

39

list the causes of constipation. (10)

1) poor fibre intake
2) poor fluid intake
3) change in routine/ lifestyle
4) privacy in the loo
5) ignoring the urge
6) immobility/lack of exercise
7) fever
8) medical conditions : anxiety, depression
9) psychiatric issues: abuse, violence, trauma
10) medicines: antacids, antidepressants, opiate painkillers, diuretics, iron

40

what are the complications associated with constipation (4)

1) Pain
2) Rectal bleeding
- Anal fissure
- haemorrhoid
3) Faecal impaction
- Bowel incontinence
- Rectal prolapse
4) Cardiovascular events

41

what are the red flag symptoms for constipation? (10)

1) Unexplained change in bowel habit
2) Mass in the lower right abdomen
3) Persistent rectal bleeding
4) Family history of colon cancer
5) Inflammatory bowel disease
6) Unexplained weight loss
7) Anaemia (tiredness, nails, eye lids)
8) Fever
9) Nocturnal symptoms
10) Unresponsive to treatment

42

what are the signs and symptoms of Colorectal Cancer? (5)

1) men of any age- unexplained anaemia
2) women ( not menstruating)- unexplained anaemia
3) any aged patient- right abdominal mass
4) 40 years and above- Rectal bleeding with change in bowel habit – looser stools/increased stool frequency
Time: 6 weeks or more
5) 60 years & above- Rectal bleeding for 6 weeks or more without a change in bowel habit
-Change of bowel habit to looser stools/increased stool frequency . Time: 6 weeks or more without rectal bleeding

43

what are the two treatment options for constipation? (2)

1) Lifestyle and diet modifications
2) OTC - Treatment

44

Define: laxative and list the 4 OCT classes of treatment for constipation. (4)

laxatives- Type of medicine which helps you pass stools
1) Bulk-forming laxatives
2) Osmotic laxatives
3) Stimulant laxatives
4) Faecal softeners

45

how are Bulk-forming laxatives used to treat constipation?
E.g. – Fybogel (7)

1) Dose: 1 sachet in the morning
2) Onset of action: 24-48 hours
3) Contain natural fibre
4) Increase the mass of the stools
5) Encourage gut motility
6) Help stools retain fluid
7) Make stools softer
-Cautions: Drink plenty of water,Can cause pain! Drink straight away!

46

how are Osmotic laxatives used to treat constipation?
e.g. Lactulose solution (5)

1) Dose: 15ml once or twice a day
2) Onset of action: 48-72 hours e.g. – Lactulose solution
3) Increase the amount of fluid in the bowel
4) A synthetic sugar, not absorbed by body
5) Soften stool
- Cautions: Drink plenty of water! Bloating / flatulence
Lactose intolerance! Diabetics
- children aged 1-5: 2.5 -10ml 2 times a day

47

how are Stimulant laxatives used to treat constipation?
E.g. – Senokot, Dulcolax (6)

1) Dose: 1-2 tablets at night
2) Onset of action: 6-12 hours
E.g. – Senokot, Dulcolax
4) Stimulate nerve endings in the bowel
5) Promote movement of faeces
6) Dosing should be at night
- Cautions: Cause abdominal cramps, Short term use only Prone to abuse, Do not use in children, Do not use in pregnancy!

48

how are Faecal softeners used to treat constipation? (5)

1) Dose: 1 tablet 5 times a day
2) Onset of action: 24-48 hours
E.g. – Dulcoease
3) Adults and children 12+
4) Acts like a “detergent”
5) Increases the amount of water in the stools
Cautions: Causes abdominal cramps, Time to treat

49

what side effects could you experience while taking laxatives? (5)

1) Laxatives can cause diarrhoea!
2) Bloating!
3) Cramping!
4) Flatulence!
5) Overdose issues (“I’ll have a little bit more” mentality!)

50

outline the lifestyle advice given to patients suffering from constipation? (5)

Diet + Lifestyle changes:
1) Fibre
2) Fluid,
3) Toilet habits: Timing/urge, Positioning
4) Exercise
5) Medication

51

define: Diarrhoea and list what it is normally accompanied with (2)

1) An increase in bowel movement that results in loose or 2) accompanied watery stools
Abdominal with:
- pain
- Nausea
- Vomiting
(It affects most people from time to time,Usually nothing to worry about. It can be distressing and unpleasant until it passes)

52

what is Acute diarrhoea and what is it caused by? (3)

1) short term , sudden onset
2) lasts 5-10 days
3) usually caused by:
- viral infection- norovirus
- bacterial infection ( Ecoli)
- travellers too

53

what is chronic diarrhoea and what is it caused by? (3)

1) persistent
2) more than 14 days
3) can be caused by:
- bacterial infection
-viral infection
- overuse of laxatives
- poor diet
-long term medical condition
- UC, Crohn's disease, IBS, allergy (lactose)

54

list the causes of diarrhoea (9)

1) virus
2) bacteria
3) parasites
4) anxiety
5) excessive alcohol
6) excessive coffee
7) food allergy
8) appendicitis
9) medicines: antibiotics, antacids, chemotherapy, NSAIDS, statins, laxatives

55

list the signs and symptoms of diarrhoea (3)

1) increase in bowel movements
2) watery/loose stools
3) associated: abdominal cramps, nausea and or vomiting, loss of appetite, headache ( dehydration signs and symptoms)

56

outline the referral criteria for diarrhoea (7)

1) blood in stools
2) black stools
3) vomiting persistently
4) loss of weight
5) high temperature/fever
6) recent course of antibiotics
7) recent discharge from hospital (MRSA)

57

what is the referral time for children, adults and elderly suffering from diarrhoea (4)

1) children 0-1 years = 1 day
2) children 1+ = 2 days
3) elderly = 2 days
4) adults= 3 days

58

what are the 3 treatment options for diarrhoea

- normally clears up without treatment after 2-3 days . to ease symptoms:
1) drink fluids
2) oral rehydration salts (ORS)
3) Antidiarrhoeal medicines

59

outline the treatment of diarrhoea using fluids. (4)

1) Drink plenty of water to avoid dehydration. Small Frequent Sips (SFS!)
2) Liquids containing: Water, Salt ( Water mixed with Juice), Sugar
3) Think about a child/baby! – Frequent sips!
4) Fruit juices and fizzy drinks should be avoided Can make diarrhoea worse!

60

outline the treatment of diarrhoea using ORS (4)

1) ORS prevent + treat dehydration
2) Available as sachets- Dissolved in water and replace:
Salts (Na, K), Glucose,Minerals
3) Can be formulated with rice starch (carbs!) to bulk up stools (Dioralyte Relief ®)
4) E.g. Dioralyte®
- Dose: 0- 2yrs: GP!
- Children: 1 sachet after a loose motion
- Adults: 1 or 2 sachets after a loose motion

61

outline the treatment of diarrhoea using Antidiarrhoeals (6)

1) Slows down muscle movement
2) Allows water reabsorption
3) Stools become firmer
4) Reduces diarrhoea
5) Formulated with Simeticone – reduces flatulence
(Imodium Plus®)
6) E.g. Loperamide
- Dose: Adults and children 12+
- 2 caps to start, then, 1 after each loose bowel movement
- Children/Pregnant/ Breastfeeding?

62

what are the non-pharmacological treatment options for diarrhoea? (8)

1) keep sipping water
2) plenty of rest
3) eat easily digestible food
4) avoid foods high in: fibre, fat , dairy, sugar
5) wash hands thoroughly, sanitise the toilet( handle and seat)
6) avoid sharing towels
7) wash soiled clothing or linen at highest temp
8) avid work or school
9) travellers diarrhoea : use bottled water, check seal, avoid ice. for food : cook it, boil it, peel it or leave it.

63

suggest what could be the cause of pain at the following locations:
1) above umbilicus, central, area of stomach
2) below umbilicus, general lower abdomen
3) behind sternum
4) localised, specific

1) above umbilicus, central, area of stomach :
- simple dyspepsia
2) below umbilicus, general lower abdomen :
- irritable bowel syndrome (IBS)
- diverticulitis ( sections of intestines get stuck together forming pockets - causes constipation and pain)
3) behind sternum :
-heartburn, reflux oesophagitis
4) localised, specific
- may be non-digestive, e.g. renal colic, muscular strain

64

suggest the cause of the following types of pain:
1) aching, general discomfort
2) gnawing, sharp, stabbing, severe:
3) moving from behind breastbone towards face or down left arm
4) moving to the neck, back or left shoulder
5) moving towards right
6) severe pain moving to the back.

1) aching, general discomfort :
- Dyspepsia, indigestion
2) gnawing, sharp, stabbing, severe:
- more serious cause, e.g. gastric ulcer
3) moving from behind breastbone towards face or down left arm :
- possible heart attack
4) moving to the neck, back or left shoulder:
- angina
5) moving towards right :
- Biliary colic, gallstones
6) severe pain moving to the back:
- gastric ulcer