Dyspepsia

Question 1

What is dyspepsia

Answer 1

umbrella term for group of upper abdominal symptoms

Question 2

Dyspepsia symptoms

Answer 2

• vague abdominal pain above belly button
• bloating, belching, flatulence
• early satiety
• fullness
• nausea/vomiting
• heartburn

Question 3

Dyspepsia referral (ALARM)

Answer 3

• A naemia
• L oss of weight
• A norexia
• R ecently changed or new dyspepsia unresponsive to treatment
• M alaena, vomiting, dysphagia

Question 4

Ruling out Gastric ulcers (the symptoms)

Answer 4

Persistant gnawing, boring pain from one point in abdomen

Question 5

Two types of peptic ulcers

Answer 5

• Gastric Ulcer
  (pain aggravated by food)
• Duodenal Ulcers
  (pain when stomach is empty)

Question 6

Ruling out Cardiovascular problems

Answer 6

• Pain radiating to jaw, back and arms
  (confused with heart burn, can be heart attack)
• Pain started by exercise not relieved by antacids
  (angina)

Question 7

OTC treatment (Antacids)

Answer 7

neutralise stomach acid
(Gaviscon, Tums, Rennies)

• immediate
• liquids more effective

Question 8

OTC treatment (Alginates)

Answer 8

puts raft ontop of stomach contents
(Gaviscon)

• suitable in pregnancy
• first line of GORD
• take after each main meal and at bed, or PRN

Question 9

Which medication interact with Antacids to impair absorption of other drugs

Answer 9

• Tetracyclines
• Quinolones
• Bisphosphonates

(leave 2 hours gap when taking)

Question 10

Which conditions should antacids be avoided

Answer 10

• hypertension
• heart/kidney/liver failure
• sodium restricted diets

Question 11

Why should antacids not be taken with these conditions

Answer 11

because it is high in sodium and can cause fluid retention

Question 12

What do antacids do to the stomach

Answer 12

damages enteric coating of stomach by increasing pH

Question 13

OTC treatment (H2 receptor antagonists)

Answer 13

acid suppressor

Ranitidine (Zantac 75)

• onset 1 hour lasting 9
• 16 years pus
• Max use 14 days

Question 14

How to take Ranitidine

Answer 14

ONE 75mg tablet when symptoms occur

• if symptoms stay for another hour take another tablet
• max FOUR tablets in 24 hours

Question 15

Side effects of Ranitidine

Answer 15

• headaches
• rashes
• dizziness
• diarrhoea
• masks symptoms of gastric cancer
• not recommended in pregnancy or breastfeeding

Question 16

OTC treatment (proton pump inhibitors)

Answer 16

acid suppressor
(1 to 3 day onset, lasts 24 hours)

• Omeprazole
• Esomeprazole (Nexium)
• Pantoprazole

Not recommended for pregnant or breastfeeding

18+
max supply 14 days

Question 17

How to take OTC proton pump inhibitors

Answer 17

ONCE daily, swallow whole

• do not take with another acid suppressor (H2 antagonists)

Question 18

Side effects of proton pump inhibitors

Answer 18

• abdominal pain
• nausea
• diarrhoea
• vomiting
• masks symptoms of gastric cancer

Question 19

What drug interacts with PPIs to increase anticoagulant effect

Answer 19

Warfarin

Question 20

What drug interacts with PPIs to increase risk of toxicity (narrow therapeutic range)

Answer 20

Phenytoin

Question 21

What drug interacts with PPIs to reduce anti platelet effect

Answer 21

Clopidogrel

Question 22

Advice for dyspepsia

Answer 22

• smoking cessation
• avoid excess alcohol, caffeine and chocolate
• avoid bending over, lying down or slumping
• evening meal 3 hours before bed
• small frequent meals
• avoid fatty or spicy food
• reduce weight
• avoid tight clothing