GI problems

Describe the GI tract

• 9m

• Mouth → oesophagus → stomach → small I → large I → rectum

• Peristalsis happens - contraction to mix, move food with enzymes

• Small I - duodenum, jejunum and ileum

• Larg I - caecum, colon and rectum

What is dyspepsia (indigestion) and its symptoms?

• Too much acid in the stomach

  • Irritation of the stomach lining from food, alcohol, nic and meds

  • Overeating stretching the stomach

• Bloated feeling

• Churning stomach

• Stomach cramps

• Pain (though usually less severe than heartburn)

• Excess acid (leaving a nasty taste)

• Dull stomach ache

• Wind

What is gastric reflux (heartburn) and its symptoms?

• Acid reflux when it goes back into the O due to a weak sphincter because of dyspepsia

  • Causes reflux oesophagitis over time, inflamed irritated

• Severe pain in the upper chest

• Burning in the back of the throat

• Taste of acid in the mouth

• Burning pain rising up the throat

• Stabbing pain

• Excess acid

What worsens heartburn?

• After eating food, when lifting or bending from the waist, or when the body is horizontal

• Chemicals in/released by, fatty foods, chocolate, alcohol, coffee and smoking

• Growing baby pushing internal organs upwards

What are the red flags for heartburn?

• Pain radiating down the arm or pain on exertion (may indicate heart problems)

• Pain waking the customer at night (may indicate peptic ulceration)

• Any person 55 years or over with new or worsening symptoms (higher risk of cancer)

• Any of the following:

  • Bleeding

  • Unexplained or sudden weight loss

  • Anaemia (fatigue, pale skin)

  • Persistent vomiting

  • Pain or difficulty on swallowing

  • Breathlessness

  • Symptoms occurring more than twice a week

What are the causes of cramp-like chest pain?

Angina- obstruction of blood flow to heart

• Goes from chest to jaw or arm

Myocardial infarction - heart attack

Describe duodenal ulcers, gastric (peptic) ulcers and gastric cancer

DU

• Random wakeups, blood in vomit/stools, hunger pain, relief but happens again

GU

• No appetite, nausea, salivation, bloating, worse after food, weight loss, localised pain

GC

• No appetite, anaemia, blood in vomit/stools, weight loss

What lifestyle changes can people make to prevent heartburn and indigestion?

• Raising the bed - blocks underneath helps with night-time symptoms

• Stop smoking and reduce alcohol and caffeine intake reduces the frequency and severity of symptoms

• Cutting out certain foods from the diet will also help.

• Spicy and oily foods should be avoided by indigestion sufferers

  • People react to foods differently and your patient may know their triggers

What antacids are used for indigestion?

Mg salts (OH → trisilicate) - long lasting but causes diarrhoea

Al salts (OH) - line the stomach but causes constipation (mix with Mg)

Ca salts - fast and short acting but causes constipation and rebound acid

Na salts - fast but short acting, CO₂ released relieves bloating due to wind

• High content not for: pregnant and kidney, heart and bp issues

What form of antacid should be used?

• Liquids and powders are faster acting than tablets although

• Tablets are more convenient for the patient so out - purchase both

• Tablets should not be swallowed but chewed or sucked

Take after a meal for the longest action

Can affect other meds so 2 hour gap minimum

How do alginates (rafting agents) prevent oesophagitis?

• When in contact with acid, a thick substance floats to the surface

• Holds down the contents even if reflux occurs so there’s no damage