A1. Responding to symptoms

Question 1

give some red flag symptoms examples?

Answer 1

Blood in:
-Sputum
-Vomit
-Urine
-Faeces
-Unexplained weight loss

Question 2

What is (non-ulcer) dyspepsia?

Answer 2

-Indigestion (‘non-specific’ dyspepsia)
-Heartburn (gastro-oesophageal reflux)
-Also known as:
-Reflux oesophagitis
-Gastric reflux
-Reflux

Question 3

Indigestion symptoms?

Answer 3

-Poorly localized, upper abdominal discomfort (pain, bloating, fullness)
May be brought on by:
-Some foods
-Excess food
-Alcohol
-Medication

Question 4

when to refer for indigestion?

Answer 4

-Children
-Over 45s with first time
symptoms
-Persistent or recurrent
symptoms
-Persistent vomiting
-Blood in vomit or stools
-Severe pain
-Consider origin of pain
-Pain worsens on effort
-Treatment failure
-Suspected adverse drug
reaction (ADR)
-Unexplained weight loss

Question 5

Describe heartburn?

Answer 5

-Reflux of acidic stomach contents: Normally prevented by lower oesophageal sphincter (non-return
valve)
-Oesophageal mucosa lacks protection from stomach acid

Question 6

Heartburn symptoms?

Answer 6

-Burning discomfort / pain in the stomach and
upwards (behind the sternum)
-Worse after eating
-Worse on bending or lying down
-Waterbrash - acidic stomach contents regurgitation in back of throat

Question 7

Heartburn: causal / aggravating factors?

Answer 7

-Certain foods and drinks
-Alcohol
-Smoking
-Some drugs e.g. antimuscarinics, β-blockers, NSAIDs
-Obesity
-Pregnancy
-Anatomical abnormality

Question 8

when to refer for heartburn?

Answer 8

-As for indigestion, plus…
-Failure to respond to treatment
-Pain radiating to arms
-Difficulty swallowing (dysphagia)
-Regurgitation
-Increased severity