Dyspepsia & Altered Bowel Habit

Question 1

Describe how the symptoms of gastric ulcers and duodenal ulcers differ

Answer 1

GASTRIC
Worse with/shortly after meals
DUODENAL
Relieved with meals, worse 2-3 hours after

Question 2

Describe what the Blatchford score is used to calculate

Answer 2

How urgently a patient with upper GI bleeding needs intervention
Any score higher than 0 is “high risk” for needing a medical intervention of transfusion, endoscopy, or surgery.

Question 3

Describe what the ROCKALL score is used for

Answer 3

Attempts to identify patients at risk of adverse outcomes following acute Upper GI bleed (can be done pre or post endoscopy)

Question 4

What are the alarm symptoms in Dyspepsia and how should these patients be managed?

Answer 4

Anaemia (iron deficinecy)
Loss of Weight
Anoreixa
Recent Onset/Progressive Symptoms
Melena/Haematemesis
Swallowing Difficulties
= URGENT 2 WEEK REFERRAL

Question 5

Why would you not prescribe a PPI in patients awaiting endoscopy?

Answer 5

Need to be off PPI for >2 weeks pre-endocsopy
- PPI may later appearance on endoscopy
Also have to have a 2 week wash out period before testing for H.Pylori if been on PPI

Question 6

When should a patient in primary care be referred for endoscopy?

Answer 6

Presenting for the first time aged >55

ALARM symptoms