What are the referral symptoms for nausea and vomiting?
- Severe abdominal pain
- Weight loss (RED FLAG)
- Blood in vomit (RED FLAG)
- Vomiting in < 1 month old
- Projectile in < 3 months
- 24hrs vomiting in < 1 year old
- Suspected pregnancy and intractable vomiting
What treatment is available OTC for nausea and vomiting?
- Oral rehydration therapy (first line)
Anti-emetics (limited indications)
- Prochlorperazine (migraine related)
- Anti-histamines, Anticholinergics (travel sickness related)
- Acupresure
What are the referral symptoms for diarrhoea?
- Change in bowel habits in over 50s
- Recent foreign travel
- Treatment failure
- Unable to drink fluid/dehydration
- Blood/mucus in stools
- Accompanied by bouts of constipation (IBS)
- Sever abdominal pain
- Weight loss
- Symptoms lasting longer than 2-3 days in children and elderly
- Symptoms lasting longer than 24 hours in diabetics
What treatment is available OTC for diarrhoea?
- Oral Rehydration Therapy (first line)
- Anti motility drugs (loperamide, piperamide, bismuth, kaolin)
What practical advice do you give with ORT?
- Drink normally
- Replace lost fluids using ORT
What doses of ORT do you recommend to different age groups?
Adults - 1-2 sachets in 200-400ml of water after every loose movement
Children - 1 sachet in 200ml water
Infants (3months-2years) - 1 to 1 and a 1/2 times the normal 24 hour feed volume (under medical supervision)
What anti-motility drugs are available OTC?
- Loperamide, Piperamide
- Bismuth
- Kaolin
How does Loperamide work?
It acts on the mu-opiate receptors to increase the tone of both the small and large bowel, hence increasing intestinal transit time and re-absorption.
What advice would you give to a patient with diarrhoea?
- Drink plenty of clear fluids
- Avoid very sugary drinks
- Avoid milk and milky drinks
- Eat depending on appetite, consider avoiding food if it makes diarrhoea worse
- Stay off work
- Careful hygiene
What are the symptoms of a duodenal ulcer?
Pain, especially at night, 2-3 hours after food.
What are the symptoms of a stomach ulcer?
Sharp pain in the stomach area. 30 minutes after food
What are the referral symptoms for dyspepsia?
- GI bleeding
- Difficulty swallowing
- Unintentional weight loss
- Abdominal swelling
- Persistent vomiting
What treatment is available OTC for dyspepsia?
- Antacids
- Alginates
- Prokinetics (e.g domperidone aka motilium)
- H2 Antagonists (e.g ranatidine and famotidine)
- PPIs (e.g omeprazole and pantoprazole)
What is dimethicone?
It can be added to alginates to reduce the surface tension of the gastric contents
What is the downside of aluminium salts?
They can cause constipation
What is the downside of magnesium salts?
They can cause diarrhoea
How do antacids work?
They raise the pH of the stomach
How do alginates work?
They swell in water to form a raft that sits ontop of the stomach contents
How do prokinetics work?
They increase gastric emptying and raise lower oesophageal sphincter
How do H2 antagonists work?
They suppress acid secretion
limited since only the histamine component of secretion is inhibited at the parietal cell
How do PPIs work?
They suppress acid secretion at the proton pump in the parietal cells
What lifestyle advice should you give to a patient with dyspepsia?
- Dietary modifications
- Smoking
- Weight loss
- Alcohol and caffeine intake
- Posture
What are the referral symptoms for constipation?
- Blood/tar/mucous in stools
- Greater than 14 days duration (with no cause)
- Middle aged with sudden change in bowel habit (no cause)
- Suspected depression
- Weight loss
What can you give OTC for constipation?
- Lifestyle advice (first line)
- Laxatives
