Dyspepsia

Question 1

What is dyspepsia?

Answer 1

A broad term covering indigestion, bloating, fullness, heartburn, and generalised epigastric pain.

Includes symptoms like bloating and retrosternal heartburn.

Question 2

What are worrying/red flag symptoms in dyspepsia?

Answer 2

ALARMS symptoms:
* Anaemia
* Loss of weight
* Anorexia
* Recent onset of symptoms and gradual progression
* Melaena or hematemesis
* Swallowing difficulties

Question 3

When should a patient be referred to secondary care?

Answer 3

With dysphagia.
If aged 55 years and over with weight loss AND upper abdominal pain, reflux, or dyspepsia.

Question 4

What is the immediate management for upper GI bleeding?

Answer 4

Follow the ABCDE approach, take bloods, insert 2 wide bore cannulas, transfuse if unstable, arrange urgent endoscopy, and stop anticoagulants and NSAIDs.

Endoscopy should be arranged within 24 hours.

Question 5

List differentials for GI bleeds.

Answer 5

1. Peptic ulcer disease
2. Oesophageal varices
3. Mallory Weiss tear
4. Gastritis, oesophagitis, duodenitis
5. Drug induced or malignancy

Question 6

What is the primary investigation for GI bleeds?

Answer 6

Endoscopy

Timing depends on hemodynamic stability: 24 hours if stable, 2-4 hours if unstable.

Question 7

What should be done if endoscopy shows active bleeding?

Answer 7

Endoscopic haemostasis (clip, cautery, adrenaline), start IV PPI, and obtain H.pylori culture.

Omeprazole is typically used for 72 hours.

Question 8

What risk assessment tools are used for GI bleeding?

Answer 8

1. Glasgow Blatchford for initial assessment
2. Rockall for post-endoscopy assessment

Glasgow Blatchford predicts outcomes at presentation, while Rockall assesses risks of adverse outcomes.

Question 9

What to do if a patient re-bleeds after endoscopy?

Answer 9

Refer for surgical repair with TIPS for uncontrolled varices.

TIPS stands for transjugular intrahepatic portosystemic shunt.

Question 10

What is the management of a non-variceal bleed?

Answer 10

1. Blood, platelets, PCC if on warfarin
2. Endoscopy (clips/cautery + adrenaline)
3. Post-endoscopy IV PPI
4. H. pylori treatment
5. Withdrawal of NSAIDs

Surgical intervention may be needed if bleeding recurs.

Question 11

What is the management of a variceal bleed?

Answer 11

1. Blood, platelets, PCC if on warfarin
2. Terlipressin
3. Prophylactic antibiotics
4. Band ligation or TIPS for oesophageal varices
5. Endoscopic injection of N-butyl-2-cyanoacrylate for gastric varices

Management varies depending on the type of variceal bleed.