WHAT PART OF QUIET DIDN'T YOU UNDERSTAND

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WHAT PART OF QUIET DIDN'T YOU UNDERSTAND??
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The GP and Digestive Problems
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Key messages

• Digestive problems are common in general
  practice.
• The general practitioner has a central role in
  the diagnosis and management of digestive
  problems in primary care.
• Dyspepsia and gastro-oesophageal reflux disease
  (GORD) are common conditions, affecting around
  28 of the population.
• Prevention and early treatment of colorectal
  cancer are priorities of the Departments of
  Health.

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Primary Care managementCompetences

• Manage primary contact with patients who have a
  digestive problem.
• Demonstrate a consistent, evidence-based approach
  to prescribing for dyspepsia.
• Explain the indications for urgent referral to
  specialist services, especially for patients with
  suspected gastrointestinal cancer.

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COULDN'T HELP IT MA, THAT FIRST STEP IS A KILLER..
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knowledge base- Symptoms

• Dyspeptic symptoms (epigastric pain, heartburn,
  regurgitation, nausea, bloating)
• Abdominal pain
• Nausea, vomiting, anorexia, weight loss
• Haematemesis and melaena
• Rectal bleeding, tenesmus
• Jaundice
• Diarrhoea and constipation
• Dysphagia

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Common and/or important conditions

• GORD
• Non-ulcer dyspepsia, gastritis, peptic ulceration
• Gallstones
• Irritable bowel syndrome
• Gastroenteritis
• Constipation
• Coeliac disease
• GI cancers (oesophageal, gastric, hepatic,
  pancreatic, colonic)
• Inflammatory bowel disease
• Diverticulosis
• Acute abdominal conditions, e.g. appendicitis,
  cholecystitis, pancreatitis
• Perianal disease (e.g. haemorrhoids, perianal
  haematoma, pilonidal sinus).

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IT'S IN THERE SOMEWHERE, I JUST KNOW IT!!
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GORD

• Diagnostic test 97 sens/spec History
• PPIs work both for ERD NERD
• Persistent fluctuant symptoms

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Non-ulcer dyspepsia, gastritis, peptic ulceration

• H.pylori eradication, stop NSAIDs
• NUD ulcer like pain not improved by therapy (cf
  IBS)
• Look for dietary triggers

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Gallstones

• U/S
• Commonly asymptomatic, post cholecystectomy pain
• Lap cholecystectomy

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Irritable bowel syndrome

• Make a positive Diagnosis (coeliac, anaemia,
  inflamatory markers, age)
• Encourage self therapy (cf rest of population)
• Antispasmodics and antidiarrhoreals

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Gastroenteritis

• Stool cultures
• Ciporfloxacin
• Home management

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Constipation

• Multi-factorial
• Idiopathic
• Fibre and non stimulant laxatives

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Coeliac disease

• 1 in 200 (IBS)
• Transglutaminase
• Gluten free diet

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GI cancers

• Colonic, oesophageal, gastric, pancreatic,
  hepatic,
• Age
• Alarm symptoms
• screening

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Inflammatory bowel disease

• Colonic
• Bloody diarrhoea
• Shared care
• Prompt steriods

• Small Bowel
• Obstruction
• (IBS)
• Aneamia / malabsorption

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Diverticulosis

• Normal over 65
• Stricture and bleeding far less common

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Acute abdominal conditions,

• appendicitis, cholecystitis, pancreatitis
• Sick Patient
• Admit

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Perianal disease

• haemorrhoids,
• perianal haematoma,
• pilonidal sinus.
• Fissure

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NOW WHAT DO I DO???
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Symptoms