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Flashcards in Upper GI Deck (20):
1

Dyspepsia: Causes

  • AKA: upset tummy
  • Organic Causes
    • food intolerance
    • meds (NSAID, ASA, erytro)
    • GI disorders
    • Pancreatobility disorders
    • Systemic disorders (DM, renal insuffi)
  • Functional Causes
    • Most often
    • Food, H. pylori
    • No identifiable cause

2

Dyspepsia: Signs and Symptoms

  • Vague complaints of:
  • Pain, discomfort (upper abdomen)
  • Bloating or distention
  • Early satiety
  • Belching
  • Flatulence
  • Nausea
  • Anorexia
  • Heartburn

3

Dyspepsia: Alarm Symptoms

  • Unintentional weight loss
  • Bleeding
  • Severe or chronic symptoms
  • Older age 50 yrs

4

Dyspepsia: Treatment

  • Refer for symptoms persisting > 2 weeks
  • Nondrug therapy
    • Reassurance
    • Lifestyle modification
  • Pharmacotherapy  (slightly better than placebo)
    • Antisecretory agents (H2 blockers, PPI’s)
    • Antacids
    • Bismuth Subsalicylate (BSS)

5

Antacids:

  • For mild, infrequent heartburn
  • Immediate relief, lasts 20-30 min 
  • liquids>tablets, increased surface area
  • Side Effects:
    • Constipation/diarrhea, rebound, hyperacitidy, alkalosis, electrolyte imbalance
  • NOT neutralize stomach acid, acts as buffer, increase pH
    • block convesion of pepsinogen to pepsin (takes A LOT of Maalox)
  • Mg salts
    • ​Maalox
    • Most potent
    • Diarrhea (overides Al)
    • Counterindication: renal insufficiency
  • Al salts
    • ​Mylanta
    • Constipation
    • Not as potent
    • Lasts longer
    • Binds phosphates 
    • High doses: renal failure, dementia
  • Ca++
    • Tums
    • Milk alkali
  • Sodium Bicarb
    • Alka Seltzer

6

Pregancy Risk B

  •  Category B are pretty safe
  • studies have not shown/proven risk, no controlled studies in pregnant women, or studies in 1st trimester
  • Most dangerous time to give a drug
    • 1st trimester
    • Most safe in 3rd trimester
  • Ex: loratidine, diphenhydramine, ampicillin, ibuprofen, fluoxetine, rantidine

7

Heartburn vs. GERD

  • Heartburn
    • burning: substernal to throat
    • 2 hrs after eating or lying down
    • mild/infrequent, related to food
  • GERD
    • Severe, frequent, chronic, painful
    • Barrett's esophagus, pre-cancerous
    • Need endoscopy

8

Heartburn: Non-pharm Treatment

  • Elevate head of bed (6 inches)
    • Blocks, not pillows
  • Smaller meals
  • Less dietary fat
  • No eating 3 hours before bed
  • Dietary changes
    • Nicotine, ETOH, caffeine
       

9

Histamine H2 Antagonists
 

  • Cimetidine (Tagamet)
    • Lots of interaction, caution in pregnant/breast-feeding
    • warfarin, ketoconazole, clopidogrel, benzo's, caffiene, phenytoin
  • Ranitidine (Zantac)
  • Famotidine (Pepcid)
  • Nizatidine
  • 30-45 min onset, 4-10 hour relief
  • 2 week self-treatment
  • inhibit histamine effect on parietal cell, decrease acid secretion
  • SE:
    • HA, contispation, diarrhea, dizzy, drowsy

10

PPI

  • Need to be titrated off
  • For GERD, frequent heartburn, severe dyspepsia
  • 2-3 hour onset, best results after 4 days
  • 30 min before eating
  • Omeprazole (Prilosec)
    • more drug interaction
  • Lansoprazole (Prevacid)
  • ADR:
    • pneumonia
    • fractures
    • rebound
    • poor B12 absorption
    • inhibits 2C19 -clopidogrel activation

11

Gastritis: Etiology

  • Inflammation of gastric mucosa
  • manifests in hetergenous group of disorders
  • Classifications:
    • Acute errosive or hemorragic
      • Drugs: NSAID, iron, alcohol, aspirin
      • stress
      • Mechanical trauma (NG tube, endoscopy)
      • ischemia
      • GERD
    • Non-errosive (chronic)
      • H. pylori, Chrons
    • Destinctive (specific)
      • TB, viral (CMV, HSV) fungal, parasitic

12

Gastritis: Symptoms

  • Most are assymptomatic
  • Nausea
  • Vomitting
  • Anorexia
  • Epigastric pain
  • Upper GI bleed

13

Alarm Symptoms for UGI 

  • GI bleed
  • History PUD
  • Unintentional weight loss
  • Continuous N/V/D
  • Chestpain
  • Anemia
  • Alcoholism
  • Oldersters, pregsters

14

Gastritis: Treatment

  • Discontinue causitive agent
  • H2 blocker, antacid, PPI

15

Nausea/Vomiting: Etiology

  • 3 Common Causes
    • motion sickness, morning sickness, viral gastroentertisi
  • GI, cardiac, infectious, metabolic, neurologic, or psychological conditions
  • "Nauseated" NOT "nauseas"
     

16

Complications of Vomiting

  • Dehydration
  • Aspiration
  • Malnutrition
  • Elctrolyte/acid-base imbalance
  • Mallory-Weiss Syndrome (esophageal tears)

17

Nausea: Nondrug

  • Dietary modification
  • Stable position (motion sickness)
  • Change of environment
  • Frequent snacks
  • Rehydrate!
    • important in babies and oldsters
      • flat soda, juice, sips

18

Nausea: Referral 

  • Food poising
  • Severe abdominal pain
  • Blood
  • Pregnant
  • Jaundice
  • DM
  • Stiff neck, photosensitivity, headache
  • Chemo
  • NSAID
  • Bulemia

19

Nausea: Pharmacological

  • Pharmacology not very effective with gastroenteritis
    • Slow to use BSS
    • Slow to use Emetrol (antiemetic)
  • Antiemetic/antihistamine/anticholinergic
    • Meclizine (Bonine), Cyclizine (Marezine), Diphenhydramine, Dimenhydrinate (Dramamine)
    • 30-60 min to work
    • Drowsiness, can be abused
  • Scopalamine
  • Transprocloamazine patches best
    • strongest, need rx
  • Careful in oldsters
    • anticholingeric effects
  • Treat heartburn 
  • Phosphorated carbohydrate solution
     

20

Morning Sickness: Treatments

  • Pyroxidine-Vitamin B6
  • Doxylamine-Unisome
  • Ginger