Gastro-Intestinal Disorders

Question 1

What is the diagnostic for dyspepsia?

Answer 1

Upper abdomen discomfort.

Question 2

What is the treatment for dyspepsia?

Answer 2

Nexium, Rennie’s, ranitidine

etc.

Question 3

What non-pharmacological advice can be given for dyspepsia?

Answer 3

Often triggered by foods so keep a
food diary (dairy is common)
Alcohol, smoking, caffeine, and stress have all got some evidence to suggest that they exacerbate it - check smoking status and if they do, signpost to NRT.

Question 4

When should dyspepsia be referred?

Answer 4

If the patient has been taking an
NSAID without PPI protection -
may be an ulcer (if so symptoms often improve after eating).
Dark and tarry stools.
Persisting vomiting.
Unexplained weight loss.

Question 5

What are the diagnostics for GORD?

Answer 5

Umbrella term consisting of:
‘Heartburn’.
Oesophageal inflammation (making swallowing more difficult).

Question 6

What is the treatment for GORD?

Answer 6

Rennie’s, Gaviscon (antacid

with alginate).

Question 7

When should GORD be referred?

Answer 7

If patient age > 45 with other symptoms (must refer for
an endoscopy to eliminate H.pylori).
If over 45 with significant dyspepsia despite pharmacological intervention with H2 antagonists and/or antacids
Severe pain around the heart may even be angina/heart attack!

Question 8

What is the diagnostic for a peptic ulcer?

Answer 8

Stomach pain common.

Question 9

What is the treatment for a peptic ulcer?

Answer 9

PPI such as esomeprazole

as nexium

Question 10

When should a peptic ulcer be referred?

Answer 10

If PPI does not help.
If suspected H.pylori.
If the patient is taking NSAIDs long-term especially with no protection.

Question 11

What are the diagnostics for IBD?

Answer 11

Diarrhoea, fever, abdominal pain,
malaise, lethargy, unexplained weight loss, feeling bloated, not being able to fully evacuate bowels. Diagnosed by ruling out other diagnoses, e.g. no ulcer present, not H.pylori.

Question 12

When should IBD be referred?

Answer 12

Immediately.

Question 13

What are the diagnostics for constipation?

Answer 13

Inability to evacuate bowels, some discomfort upon trying.
Small, pellet-like stools.
Must be categorised as a
change in the sufferer's usual
routine.

Question 14

What is the treatment for constipation?

Answer 14

Lactulose, senna, macrogol.

Question 15

When should constipation be referred?

Answer 15

Red blood in stool - may be an
anal fissure or external haemorrhoids (potentially even cancer if it has persisted for longer than a week).
Nausea, vomiting, or unexplained weight loss.
Fluctuates with diarrhoea (this would probably be IBS, which we can treat with buscopan, but the patient must be diagnosed with it beforehand to be able to buy it as per the product license).
Bowel obstruction (potentially due to hernias, carcinomas, inflammation).

Question 16

What may cause constipation?

Answer 16

Multiple causes:
Iatrogenic (drug-induced) such as opioids (common with codeine), antacids, diuretics
Lifestyle (not drinking ~1.5-2L of water)
Disease (IBS etc.)
Pregnancy.

Question 17

What is the diagnostic for haemorrhoids?

Answer 17

Blood in stools.

Question 18

What is the treatment for haemorrhoids?

Answer 18

Anusol cream, ointment, suppository
Anusol HC (the only way that
hydrocortisone is licensed
to be used around the
anogenital region).

Question 19

When should haemorrhoids be referred?

Answer 19

If undiagnosed.
If blood is bright (not dark).
If long-term (NHS choices states that surgery may even be required).

Question 20

What are the diagnostics for diarrhoea?

Answer 20

Liquidy stools.

Sometimes also abdominal pain, vomiting, unexplained weight loss.

Question 21

What is the treatment for diarrhoea?

Answer 21

Loperamide, dioralyte.

Question 22

What non-pharmacological advice can be given for diarrhoea?

Answer 22

Suggest a high-fibre diet.
Avoid triggers such as caffeine and
spicy food.
Continue to feed breastfed babies on demand, if bottle-fed then stop for 24 hours and move to ORT (dioralyte).
Adults should drink bland, sugarless drinks.

Question 23

When should diarrhoea be referred?

Answer 23

If chronic.
If the patient is young (<6 months after 24 hours; <2 years after 48 hours if diarrhoea has not passed).
Blood and/or mucus in stools.

Question 24

What may cause diarrhoea?

Answer 24

Caused by over-hydration,

may be drug-induced (NSAIDs, antibiotics, iron-containing compounds, antacids), food poisoning.

Question 25

What are the diagnostics for infant colic?

Answer 25

Inconsolable crying.
Flushed face.
Happens around the same time
every day.
The child appears to be in pain.

Question 26

What is the treatment for infant colic?

Answer 26

Colic drops.
Gripe water.
Simeticone.

Question 27

What may cause infant colic?

Answer 27

May be due to lactose

intolerance (so ask if the child is being breast-fed or bottle-fed).