Treatment Of Upper GI Disease Flashcards
(27 cards)
What are the causes
Smoking Stress Drinking Diet H.pylori Medications = NSAIDS, corticosteroids, biphosphates
How many types of dyspepsia are there, for clinical assessment?
Acute, chronic, uninvestigated and investigated dyspesia
What happens when there is investigated dyspepsia?
An endoscope goes down the GI tract
When should GI diseases be investigated?
Chronic GI bleeding Unintentional weight loss Persistent vomiting Iron deficiency anaemia Epigatsric mass 55+ years old
If investigated dyspepsia Isn’t treated for any underlying conditions, what should you do?
Treat and test for H.pylori
Offer PPI or H2RA for 4 weeks
If the symptoms recur, re start the PPI or H2RA at the lowest possible dose
What should be done for uninvestigated dyspepsia?
Offer H. Pylori test and treat
Offer full dose PPI therapy for 4 weeks
If symptoms return, step down PPI to lowest dose
Offer histamine 2 receptor antagonist (H2RA) if there is an inadequate response to PPI
What is an eradication regimen?
High dose PPI and 2 low dose antibiotics for 7 days
What happens when there is long term PPI use?
Rebound hypersecreyion
Oseteoporotic fractures = calcium cannot be absorbed
Hypomagnesaemis = low levels magnesium
Community and hospital acquired pneumonia
What are the symptoms of GORD.
Heartburn, pyrosis, regurgitation, belching, hiccups, nausea and vomiting
GORD management
Lifestyle advice = lose weight, avoid tight clothing, stop smoking, avoid medications that relax the LOS, avoid eating within 3 hours of bedtime, stop drinking alcohol
What are the causes of nausea and emesis
Drugs = SSRIs, opioids, drugs that work on dopamine receptors Anxiety Pregnancy Infection Motion sickness Diabetes GI obstruction
What are the consequences of nausea and emesis
Dehydration = treatment of oral rehydration therapy Electrolyte imbalances Malnutrition Aspirational pneumonia Oesophageal tear
When are medications prescribed for emesis
Anti emetics are prescribed when the cause of the emesis if known
Which system does motion sickness affect
Vestibular system
What can be used to treat motion sickness
Hyosicne, antihistamines and chewable tablets
What are the side effect of hyoscine (anti-cholinergic)
Drowsiness Blurred visions Dry mouth Constipation Urinary retention
What can high doses of metoclopramide result in?
Akathisia = constant uncontrolled movement
Tremors
Dystopia = involtuary muscle spasms
Tar dive dyskineasia = involuntary jaw movements
What are drugs for chemotherapy induced nausea and vomiting (CINV)
Ondanestron, palonosetron
Aprepitant
Dexamethasone
Metoclopramide
What can be used for treatment of morning sickness and Hyperemesis Gravidarum (extreme morning sickness)
Cyclizine
What are the causes for palliative care nausea and emesis
Chemical
Gastric stasis
Bowel obstruction praised intracranial pressure
Psychological factors
Describe the physiology of nausea
Triggers - NTS (medulla) - CTZ (chemoreceptor trigger zone) - vomiting centre
Which receptors are of high concentration in the vomiting centre
M1
H1
Neurokinin 1 receptors (NK1)
5-HT3 receptors
Which pharmacological treatment are used for nausea and emesis
D2 antagonists 5HT3 antagonists Anti histamines Anti cholinergic Pro motility
What are antihistamines
H1 receptors antagonists
End in “zine”
CNS depression and sedation
