GI Tract

Question 1

Symptoms of constipation (5)

Answer 1

Hard stools difficult to pass
Less frequent than usual 
Abdominal discomfort 
Bloating 
Nausea 

WHATS NORMAL FOR PATIENT

Question 2

Referral criteria constipation(5)

Answer 2

Pain on defacation 
Bloody tarry stools
Above 40 days with sudden change and no obv cause
More than 14 days
Associated prolonged tiredness (anaemia)

Question 3

Non pharmalogical treatment constipation (4)

Answer 3

Increase in dietary fibre - fruit veg everything whole eg whole grain wheat meal

Adequate fluids

Avoid sedentary lifestyle

Reduce caffeine intake as leads to dehydration

Question 4

Pharmacological treatment constipation

Answer 4

Laxatives -
Stimulant laxatives eg Senna or bisacodyl 6-8H - 2 tablets at night

Bulk laxatives eg ispaghula - fybogel - 6-12H - sachets mixed with water (150-200ml)

Osmotic laxatives- lactulose - 1-2 days - 15ml twice a day

Glycerin suppositories - 1H - immediate relief - insert high into rectum

Question 5

Symptoms of diarrhoea and triggers

Answer 5

Normally acute and self limiting 
Lasts a few days
Abdominal cramps 
Flatulance
Weakness 

Recent trip abroad??
Local outbreaks of gastroenteritis

Question 6

Referral diarrhoea

Answer 6

Blood and mucus in stool
Severe vomiting
Pregnancy

1 day in children under 1
2 days in children under 3
3 days in 3+ and adults

Question 7

Treatment for diarrhoea

Answer 7

Oral rehydration - drink plenty of fluids and 1 sachet of diaorylyte with 200 ml water after every loose movement

Loperamide - 12+ - 2X2mg capsules initially followed by 1 capsule after each movement - maximum 6 a day

If longer than 3 days see GP

Question 8

Haemorrhoids symptoms

Answer 8

Bleeding 
Perinatal itching 
Mucous discharge 
Pain 
Bright red blood 
Contributory factor = constipation

Question 9

Referral for haemorrhoids

Answer 9

Persistent change in bowel habit 40+ years 
Unexplained rectal bleeding 
Sever pain when pooing
Blood mixed IN with poo 
Fever

Question 10

Treatment for haemorrhoids

Answer 10

Anaesthetics eg lidocaine
Astringents - bismuth / zinc
anti inflammatory - hydrocortisone

Question 11

Symptoms of mouth ulcers

Answer 11

Occur in crops of 1-5 up to 5mm in diameter
White yellow centre inflamed outer edge
Inside lips cheek Young’s
Last for 5-14 days

If major then 30mm and crops of up to 10

Question 12

Referral criteria for ulcers

Answer 12

Longer than 3 weeks
Weight loss
Rash
Diarrhoea

Question 13

Treatment for ulcers

Answer 13

Chlorhexidine mouthwash - do not swallow- twice a day 10 ml rise for approx 1 min use for 2 days after healing

Bonjela - apply every 3h

Local anaesthetic - anbesol- lidocaine - apply to affected area every 3h

Question 14

Cold sore symptoms

Answer 14

Prodromal symtoms of itching burning or tingling - occurs a few hours / days before lesion
lesion then occurs as a red blister and crusts over within 24 hours and resolves in 7-10 days

Can be triggered by stress
Ill health
Sunlight
Viral infection

Question 15

When to refer a cold sore

Answer 15

14 days + 
INSIDE the mouth 
Severe and wide spread lesions 
Immunocompromised
Spread from lips to face

Question 16

Treatment for cold sore

Answer 16

Antiviral - acyclovir (zovirax) apply a thin layer of cream to infected areas 5 times a day for 4 days

Blistex - ammonia and phenol - use on early stages to be effective - 5 times a day

Question 17

Symptoms of heartburn

Answer 17

Burning discomfort in the upper stomach

Worse when lying down / bending after a large meal m

Question 18

When to refer for heart burn

Answer 18

Alarm symptoms 
Anemia 
Loss of weight 
Anorexia 
Recent onset of progressive symptoms 
Melania dysphagia haematemsis 
Severe pain
Vomiting 
Pain in arm neck jaw 
Failure to antacid after a week

Question 19

Treatment for heartburn

Answer 19

Antacids - peptobismol gaviscon

Alginates - gaviscon - one / two 5ml spoonfuls after bed and at night for 7 days

H2 antagonists - Zantac - one tablet- max 2 tabs in 24h

PPI