Heartburn History and Management

Question 1

You are the GP

A 45-year-old lady comes to the surgery complaining of heartburn

Give three initial differential diagnoses (2 common diagnoses and 1 serious)

Answer 1

GORD
Ulcer
Hiatus Hernia
Oesophagitis
Cancer

Question 2

You are the GP

A 38-year-old man comes to the surgery complaining of heartburn

Take a focused HxPC using a mnemonic as a guide (TOP EARS)

Answer 2

Timing
Onset
Progression

Exacerbating / Relieving

• meals
• lying flat
• exercise?

ASSOCIATED SYMPTOMS

• vomiting (Gastroenteritis)
• fever (Gastroenteritis)
• choking (Cancer)
• haematemesis (Cancer)
• acid reflux (GORD)
• pain swallowing (GORD / sore throat)
• unintentional weight loss (Cancer)

Rule Out by System C
- Chest Pain (Angina)
-

Question 3

You are the GP

A 58-year-old man comes to the surgery complaining of heartburn

Take a focused PMHx

Answer 3

Hernia

Past episodes of reflux

Question 4

You are the GP

A 63-year-old lady comes to the surgery complaining of heartburn

Take a focused DHx

Answer 4

Over the counter medications?
NSAIDs
Ibuprofen
Neurofen
Naproxen
Steroids

Question 5

You are the GP

A 63-year-old man comes to the surgery complaining of heartburn

Take a focused SHx

Answer 5

Smoking?

Alcohol?

Question 6

You are the GP

A 36-year-old woman comes to the surgery complaining of heartburn

You have taken a focused history and carried out an Abdo examination

Describe the relevant igx you would like to perform. Use UBEX as a guide

Answer 6

• FBC - anaemia
• Barium Swallow - narrowing
• Endoscopy - ulcer, barretts
• Urease -H.pylori ulcer

Question 7

You are the GP

A 47-year-old man comes to the surgery complaining of heartburn and pain swallowing

You have taken a focused history and carried out an Abdo examination, described the relevant investigations and are now talking about management.

How should you structure the management?

Answer 7

Initial symptoms treatment

• acid reflux discomfort - antacids
• lying flat trigger - use pillow

preventing further episodes

• stop NSAIDs
• acid reflux discomfort - PPI
• reduce smoking
• reduce alcohol

Question 8

You are the GP

A 63-year-old lady comes to the surgery complaining of heartburn

Take a focused FHx

Answer 8

Any gi problems run through the family

Question 9

You are the GP

A 47-year-old man comes to the surgery complaining of heartburn and pain swallowing

You have taken a focused history and carried out an Abdo examination, described the relevant investigations and discussed management.

Conclude the consultation properly

Answer 9

Summary

Initial symptom + associated positives
relevant red flag negatives
+ examination findings

reassurance not serious

Igx to be carried out
+ mgx symptoms

Do you have any questions?
Have I addressed your concerns and met your expectations?

SAFETY NET if symptoms don’t improve or get worse COME BACK

Question 10

You are the GP

A 45-year-old lady comes to the surgery complaining of heartburn

Give three initial differential diagnoses (2 common diagnoses and 1 serious)

Answer 10

GORD
Ulcer
Hiatus Hernia
Oesophagitis
Cancer

Question 11

You are the GP

A 47-year-old man comes to the surgery complaining of heartburn and pain swallowing

Ask a question to distinguish between GORD and hiatus hernia

Answer 11

Burning sensation when bending?

if yes more likely hernia