Upper GI

Question 1

Dyspepsia: Causes

Answer 1

• 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

Question 2

Dyspepsia: Signs and Symptoms

Answer 2

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

Question 3

Dyspepsia: Alarm Symptoms

Answer 3

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

Question 4

Dyspepsia: Treatment

Answer 4

• 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)

Question 5

Antacids:

Answer 5

• 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

Question 6

Pregancy Risk B

Answer 6

• 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

Question 7

Heartburn vs. GERD

Answer 7

• 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

Question 8

Heartburn: Non-pharm Treatment

Answer 8

• 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

Question 9

Histamine H₂ Antagonists

Answer 9

• 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

Question 10

PPI

Answer 10

• 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

Question 11

Gastritis: Etiology

Answer 11

• 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

Question 12

Gastritis: Symptoms

Answer 12

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

Question 13

Alarm Symptoms for UGI

Answer 13

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

Question 14

Gastritis: Treatment

Answer 14

• Discontinue causitive agent
• H2 blocker, antacid, PPI

Question 15

Nausea/Vomiting: Etiology

Answer 15

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

Question 16

Complications of Vomiting

Answer 16

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

Question 17

Nausea: Nondrug

Answer 17

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

Question 18

Nausea: Referral

Answer 18

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

Question 19

Nausea: Pharmacological

Answer 19

• 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

Question 20

Morning Sickness: Treatments

Answer 20

• Pyroxidine-Vitamin B6
• Doxylamine-Unisome
• Ginger