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Yr 4 General Practice > GP Student Handbook GI Common Presentations > Flashcards

GP Student Handbook GI Common Presentations Flashcards

1
Q

Define dyspepsia and its presentation

A

Upper abdominal pain/discomfort

Described as: Burning sensation, heaviness, ache often related to eating.
Associated with nausea, abdominal fullness and belching

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2
Q

What is GORD?

A

Gastro-oesophageal reflex disease

Endoscopically determined oesophagitis or endoscopy-negative reflux disease

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3
Q

What is peptic ulcer disease

A

Occurrence of ulceration of either the mucosa of the stomach (gastric ulcer) or of the duodenum (duodenal ulcer)

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4
Q

3 most common causes of dyspepsia?

A

GORD
Peptic ulcer disease
Non-ulcer dyspepsia (dyspepsia with normal endoscopy)

Other: Hiatus herna, barrett’s oesophagus, gastric/oesophageal cancer, drugs, smoking, alcohol

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5
Q

Red flags associated with dyspepsia?

A 
Haematemesis 
Weight loss 
Dysphagia 
Persistent vomiting 
Malaena
On examination: Epigastric mass, low ferritin
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6
Q

Investigations prompted by presentation with dyspepsia

A
  • Blood tests – FBC, Ferritin (Red flag: iron deficiency anaemia)
  • Helicobacter Pylori – In Lothian this is a stool antigen test, other health boards use breath tests and/or serology
  • Endoscopy (see below for indications)
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7
Q

What is an alginate?

A

Alginic acid derivatives, or alginates, treat GORD by creating a mechanical barrier that displaces the postprandial acid pocket. In the presence of gastric acid, they precipitate into a gel and form a raft that localizes to the acid pocket in the proximal stomach.
e.g. Peptac and Gaviscon

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8
Q

Management of dyspepsia with no red flags?

A
  • Stop NSAIDs, consider other medications that may be contributing/causing symptoms
  • Reduce alcohol/smoking
  • Trial of medication if above measures not indicated/not working
  1. Alginates e.g. Peptac/Gaviscon
  2. Histamine 2 Receptor Antagonist (H2RA) e.g. Ranitidine
  3. Proton Pump Inhibitor (PPI) e.g. Lansoprazole
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9
Q

Indication for endoscopy in dypepsia presentation

A
  • Red Flags present – urgent endoscopy
  • If H. pylori negative and no response to medication, consider endoscopy/alternative diagnoses
  • If >55 with persistent or recurrent dyspepsia with NO red flags, consider routine referral for endoscopy
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10
Q

H pylori test consideration

A

It is important to bear in mind that H Pylori testing is inaccurate if a patient has been taking a PPI, so this must be stopped at least 3 weeks prior to undergoing the test.

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11
Q

What are the limits of normal frequency of bowel movement?

A

3 movements per day-week

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12
Q

Clinical definition of diarrhoea

A

3+ loose stools per day

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13
Q

What is acute diarrhoea?

A

The abrupt onset of 3+ loose stools per day for less than 14 days

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14
Q

What are the infective causes of acute diarrhoea?

A

Often accompanied by fever, vomiting and abdo pain. Usually lasts about a week

  1. Rotavirus
  2. Norovirus (winter vomitng bug)
  3. Clostridium difficile
  4. Food poisoning
  5. Traveller’s diarrhoea
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15
Q

Presentation of acute diarrhoea due to rotavirus

A

Rotavirus is the commonest cause of diarrhoea in young children.

It presents with severe watery diarrhoea, vomiting, fever and abdominal pain, and typically lasts for about a week.

Routine vaccination gives partial protection.

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16
Q

Presentation of acute diarrhoea due to norovirus

A

Norovirus affects all ages and causes outbreaks in the winter months.

It presents with watery diarrhoea, vomiting, fever and abdominal pain.

It is very contagious and spreads quickly in residential settings such as hospitals and care homes.

17
Q

Presentation of acute diarrhoea due to c. diff

A

Clostridium difficile is uncommon in general practice – it generally affects hospital patients, especially those taking antibiotics.

18
Q

Presentation of acute diarrhoea due to food-poisoning

A

It can be caused by toxins produced by bacteria (such as Bacillus cereus which is associated with rice) or by the ingestion of viruses (norovirus) or bacteria (E coli, salmonella, campylobacter). The symptoms of toxin-mediated food poisoning occur within hours of ingesting contaminated food, whereas viral and bacterial food-poisoning take longer to present.

19
Q

Presentation of acute diarrhoea due to travellers diarrhoea

A

Diarrhoea is common in patients returning from abroad and is mainly caused by ingestion of food or water contaminated by bacteria (E coli, salmonella, shigella); by viruses such as rotavirus; or by protozoa (giardia lamblia, entamoeba histolytica, cryptosporidium).

20
Q

Non-infective causes of acute diarrhoea

A

Drugs e.g. antibiotics, metformin, ferrous sulphate and laxatives
Start of chronic diarrhoea

21
Q

Acute diarrhoea management

A
  • Decide whether the patient is at risk of dehydration. If the patient is well and not at risk, advise them to DRINK plenty and REST.
  • If the patient is at risk of DEHYDRATION, they should be admitted to HOSPITAL.
  • If a stool sample result shows pathogenic BACTERIA, treat with ANTIBIOTICS if recommended by microbiology.
  • It may be appropriate to contact the local HEALTH PROTECTION UNIT if (i) there is a suspicion of a public health hazard (for example diarrhoea in food handlers or residents of a care home) or (ii) isolating the organism may help pinpoint the source of a community outbreak.
22
Q

With chronic diarrhoea what other symptoms should be assessed for?

A 
Pain
Fatigue
Unintended weight loss
Blood in stoll
FH of bowel condition

Exam:

  • Abdo for Hepatomegaly and masses
  • Rectal for masses and impacted faeces (overflow)
23
Q

7 conditions in which chronic diarrhoea can occur?

A 
Coeliac disease
Inflammatory (Crohns or UC)
Diverticulitis 
Chronic infection
Anxiety
Overflow diarrhoea 
Colonic carcinoma
24
Q

Define impaction

A

I.e. faecal loading
Retention of faeces to the extent that spontaneous evacuation is unlikely
Usually palpable on abdo exam and maybe on rectal exam

25
Q

Epidemiology of IBS

A

10-20% of population
20-30yrs most commonly
2F:1M

26
Q

Characteristics for IBS

A

Constipation / diarrhoea
Abdo pain relieved by defecation
Bloating

With: Lethargy, nausea, back pain, headache, bladder symptoms, dyspareunia (painful sex)

27
Q

For people who meet IBS diagnostic criteria, what tests exclude other diagnoses?

A

ESR (inflammation in UC and chrohns)
FBC (anaemia)
Coeliac disease serology

28
Q

What is the management plan for IBS

A

PSYCHOLOGICAL FACTORS
Reduce stress
Increase relaxation time

DIET
Adjust fibre intake accordingly
Eating regularly
Slow down eating

FLUIDS
Min 8 cups/day
Restrict tea/coffee to 3 cups/day

PHYSICAL ACTIVITY
Increase

DRUGS
Mebeverine for anti-spasmodic
Bulk forming laxative for constipation
Anti-motility drug (loperamide i.e. Imodium) for diarrhoea

29
Q

What is gastroenteritis?

Causative agent of viral form?

Treatment?

A

Diarrheal disease with N/V, headache, abdo cramping, myalgia, fever

Causative agents: Rotavirus*, norovirus, enteric adenovirus and astrovirus

Treatment?
Supportive with oral and iV hydration

Yr 4 General Practice (9 decks)

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