Case Study 1
Learning Objectives
After completing the case study you should be able to:
• Discuss the signs and symptoms of dyspepsia.
• Explain the test and treatment for H.pylori.
• Understand how a pregnancy testing kit works and advise on how to use effectively.
• Identify opportunities to promote health in pregnancy and ensure that advice
provided is consistent with current national guidelines.
• Identify common problems in pregnancy, provide appropriate advice for their
management and understand when to refer.
• Have a basic understanding of antenatal care and medicines used in labour.
• Understand about the use of medicines in pregnancy and breast feeding, know
where to look for further information and where to refer.
• Identify differences in pharmacokinetics in paediatrics and how this impacts on
medicine use in children.
• Identify some common illnesses in children, and understand which signs and
symptoms suggest serious illness.
• Use the BNF and SPC to advise on appropriate doses and how to administer to
paediatric patients.
• on appropriate doses and how to administer to paediatric patients.
,Signs and symptoms of dyspepsia (Indigestion)
• A burning feeling in his chest after eating (Heartburn)
• Feeling bloating and nauseated at times
• More ‘windy’ than usual
• Bringing up food or bitter-tasting fluids into your mouth
• Feeling sick
• Exacerbated by smoking, alcohol and stress
• **Stomach ache and back pain are usually not symptoms of dyspepsia, if having
those might be constipated.
Cause of dyspepsia
• Acid in stomach irritate the stomach lining
• Medicines
• Smoking
• Alcohol
• H. pylori
Red flag symptoms
• Vomiting, especially blood stained
• Unintentional weight loss
• Swallowing problems
Advice on dyspepsia
Do
• Cut down on tea, coffee, cola or alcohol
• Prop your head and shoulders up in bed – this can stop stomach acid coming up
while you sleep
• Lose weight if you’re overweight
Don’t
• Smoke
• Eat 3-4 hours before going to bed
• Have rich, spicy or fatty foods
• Take ibuprofen or aspirin – this can make indigestion worse
Treatment of dyspepsia
• Antacids
• PPI
** If selling OTC, check whether is it P med.
, Tests for H.pylori
1. 13 Carbon Urea breath
• Detect H.pylori infection
• No complications, risks/ side effects documented
• Not expected to perform during pregnancy & lactation
• Preparation of test:
- Have nothing to eat/drink for 6 hours prior to test
- Take any med for heart, breathing problems /hormone replacement therapy
as usual
- Stop taking any antibiotics 28 days before the test
- Stop taking any PPI 14 days before the test
- Stop taking Ranitidine (Zantac), Cimetidine (Tagamet), Nizatidine (Axid),
Famotidine (Pepcid), Domperidone (Motilium)/ Metoclopramide (Maxolon) 3
days before the test
- Stop taking Gaviscon, Gaviscon Advance, Rennies, Maolox, Algicon,
Gastrocote, Mg Trisilicate/ Settlers 24 hours before the test
- No smoking on the day of the test
• Test process ~40min
- Breathe down a straw into 2 tubes
- Drink 200ml of water containing citric, tartatic and malic acid
- Drink 50ml of water containing urea
- Wait 30 min
- Breathe down a straw into 2 or more tubes
- Result within a week
• The testes exploits the hydrolysis of orally administered urea by the enzyme urease,
which H.pylori produces in large quantities.
2. Stool antigen test
• Tested for antigens associated with H.pylori infection in stool
• Antibiotics, PPI and bismuth subsalicylate can interfere with the test accuracy
• Wait at least four weeks after completing antibiotic treatment
• Wait at least one or two weeks after stop taking PPI
3. Blood test
• Tested for antibodies to H.pylori
4. Scope test (Upper endoscopy exam)
• Endoscope down throat and eosophagus and into stomach and duodenum to view
any irregularities and remove tissue samples (analyzed for H.pylori)
Learning Objectives
After completing the case study you should be able to:
• Discuss the signs and symptoms of dyspepsia.
• Explain the test and treatment for H.pylori.
• Understand how a pregnancy testing kit works and advise on how to use effectively.
• Identify opportunities to promote health in pregnancy and ensure that advice
provided is consistent with current national guidelines.
• Identify common problems in pregnancy, provide appropriate advice for their
management and understand when to refer.
• Have a basic understanding of antenatal care and medicines used in labour.
• Understand about the use of medicines in pregnancy and breast feeding, know
where to look for further information and where to refer.
• Identify differences in pharmacokinetics in paediatrics and how this impacts on
medicine use in children.
• Identify some common illnesses in children, and understand which signs and
symptoms suggest serious illness.
• Use the BNF and SPC to advise on appropriate doses and how to administer to
paediatric patients.
• on appropriate doses and how to administer to paediatric patients.
,Signs and symptoms of dyspepsia (Indigestion)
• A burning feeling in his chest after eating (Heartburn)
• Feeling bloating and nauseated at times
• More ‘windy’ than usual
• Bringing up food or bitter-tasting fluids into your mouth
• Feeling sick
• Exacerbated by smoking, alcohol and stress
• **Stomach ache and back pain are usually not symptoms of dyspepsia, if having
those might be constipated.
Cause of dyspepsia
• Acid in stomach irritate the stomach lining
• Medicines
• Smoking
• Alcohol
• H. pylori
Red flag symptoms
• Vomiting, especially blood stained
• Unintentional weight loss
• Swallowing problems
Advice on dyspepsia
Do
• Cut down on tea, coffee, cola or alcohol
• Prop your head and shoulders up in bed – this can stop stomach acid coming up
while you sleep
• Lose weight if you’re overweight
Don’t
• Smoke
• Eat 3-4 hours before going to bed
• Have rich, spicy or fatty foods
• Take ibuprofen or aspirin – this can make indigestion worse
Treatment of dyspepsia
• Antacids
• PPI
** If selling OTC, check whether is it P med.
, Tests for H.pylori
1. 13 Carbon Urea breath
• Detect H.pylori infection
• No complications, risks/ side effects documented
• Not expected to perform during pregnancy & lactation
• Preparation of test:
- Have nothing to eat/drink for 6 hours prior to test
- Take any med for heart, breathing problems /hormone replacement therapy
as usual
- Stop taking any antibiotics 28 days before the test
- Stop taking any PPI 14 days before the test
- Stop taking Ranitidine (Zantac), Cimetidine (Tagamet), Nizatidine (Axid),
Famotidine (Pepcid), Domperidone (Motilium)/ Metoclopramide (Maxolon) 3
days before the test
- Stop taking Gaviscon, Gaviscon Advance, Rennies, Maolox, Algicon,
Gastrocote, Mg Trisilicate/ Settlers 24 hours before the test
- No smoking on the day of the test
• Test process ~40min
- Breathe down a straw into 2 tubes
- Drink 200ml of water containing citric, tartatic and malic acid
- Drink 50ml of water containing urea
- Wait 30 min
- Breathe down a straw into 2 or more tubes
- Result within a week
• The testes exploits the hydrolysis of orally administered urea by the enzyme urease,
which H.pylori produces in large quantities.
2. Stool antigen test
• Tested for antigens associated with H.pylori infection in stool
• Antibiotics, PPI and bismuth subsalicylate can interfere with the test accuracy
• Wait at least four weeks after completing antibiotic treatment
• Wait at least one or two weeks after stop taking PPI
3. Blood test
• Tested for antibodies to H.pylori
4. Scope test (Upper endoscopy exam)
• Endoscope down throat and eosophagus and into stomach and duodenum to view
any irregularities and remove tissue samples (analyzed for H.pylori)
