Diagnosis and management

Question 1

Important questions to ask: Nausea/vomiting

Answer 1

• Blood in vomit?
• Weight loss?
• Have you travelled recently?
• Can you keep fluids down?

Question 2

Refer if (nausea/vomiting):

Answer 2

• Severe abdominal pain
• Dehydration
• Vomiting in <1 months
• Projectile vomiting in <3 months
• 24hr vomiting in <1 year
• Pregnant and uncontrollable vomiting
• Blood in vomit
• Weight loss

Question 3

Nausea/vomiting treatments: Re-hydration

Answer 3

Only if fluids tolerated

Replaces lost fluids

Offer range of flavours

Question 4

Nausea/vomiting treatments: Anti-emetics

Answer 4

-Migraine associated: prochlorperazine buccal tabs for 18+

>1-2 tabs daily for 2 days only

Question 5

Nausea/vomiting treatments: Anticholinergics

Answer 5

-Travel sickness (anticholinergics)

>Hyoscine: 300mcg tab 20mins before travel repeat every 6 hours if needed (max of 3 tabs/24 hours)

Question 6

Dyspepsia

Answer 6

Upper abdominal symptoms caused by:

• Indigestion
• Heartburn
• Increased gastric content
• Gastritis
• Duodenal/gastric ulcers

Question 7

Dyspepsia symptoms

Answer 7

• Belching
• Nausea/vomiting
• Early satiety
• Upper ab/lower discomfort
• Bloating
• Flatulence
• Heartburn
• Duodenal ulcer (2-3hrs after food, especially at night)
• Gastric ulcer (sharp pain in stomach, 30mins after food)

Question 8

Important questions (Dyspepsia)

Answer 8

• Describe pain (sharp, gnawing, stabbing)
• Point to where the pain is
• Does the pain radiate anywhere?
• Does food make it better or worse?
• Any other lifestyle factors that make it worse?

Question 9

Referral symptoms (Dyspepsia):

Answer 9

• Anaemia (pale, tired, SoB) (!)
• Loss of weight (!)
• Anorexia (!)
• Recent onset of symptoms (!)
• Melaena (dark fecal matter,blood in stool) (!)
• long standing change in bowel habit
• Debilitating pain
• Referred pain (possible cardiac problem)
• Treatment failure
• Indigestion with medicines

Question 10

Dyspepsia: Lifestyle advice

Answer 10

1st ID the cause

Then: modify diet, cease smoking, alcohol, caffeine, reduce weight, correct posture

Question 11

Treatment: mild dyspepsia

Answer 11

Antacids
Al salts cause constipation, Mg salts cause diarrhea
eg.Renee
Also alginates can be used in combo

Question 12

H2 antagonists

Answer 12

eg. Zantac
Barely better than antacid/alginate
16+ only

Question 13

PPI’s

Answer 13

Highest efficacy
eg. Zanprol (Omerazole 10mg) BD until symptoms improve then 1xdaily
Max 4 weeks treatment

Question 14

Mouth ulcer questions

Answer 14

How many?
where?
Shape and size?
Painful?
Any new/increased meds?
Do you know of any possible cause?

Question 15

Mouth ulcer referral

Answer 15

<10yrs old
Larger than 1cm
in groups larger than 5-10+
>14days
Painless ulcers 
Involvement of eye

Question 16

Mouth ulcer treatment

Answer 16

Chlorhexidine mouthwash (antibacterial)- reduces pain/symptoms

Choline salicylate (analgesic)- 16+ only
Lido/bencocaine available for <16yrs

Hydrocortisone buccal tabs- reduces inflammation, pain and healing

Question 17

Anti-emetics

Antihistamines

Answer 17

-Travel sickness (antihistamines)
>Cinnarizine: 2 tabs 2 hours before journey and 1 every 8 hours of journey (adult)
>Promethazine: 25mg on night before journey then every 6-8 hours as required (adult)