D&M Upper GI

Question 1

Symptoms of Dyspepsia - 6

Answer 1

1. Heartburn/reflux/discomfort/pain
2. Vague abdominal discomfort
3. Nausea/vomiting
4. Early satiety
5. Bloating/Flatulence/Belching
6. Pain, ranging from after eating to several hrs after eating

Question 2

Dyspepsia referral symptoms - 13

Answer 2

1. Anaemia (GI bleeding)
2. Loss of weight
3. Anorexia (loss of appetite)
4. Recent onset of progressive & recurrent symptoms (including change of bowel habit)
5. Melena (blood in stools)
6. Abdominal mass
7. Abdominal pain with weight loss
8. Back pain with weight loss
9. Jaundice
10. Referred pain – possibly cardiac symptoms
11. Treatment failure
12. Symptoms with medicines
13. Symptoms outside of your area of competence

Question 3

Dyspepsia lifestyle advice – 7

Answer 3

1. Identification of the cause (including any medicines that might be causing the symptoms)
2. Consider stress, anxiety & depression if appropriate
3. Avoid heavy & late meals
4. Smoking
5. Weight loss
6. Limit Alcohol & caffeine intake
7. Posture

Question 4

Dyspepsia treatment - 3

Answer 4

1. Antacids e.g Rennies
2. Alginates e.g. Gaviscon
3. PPIs e.g. Zanprol

Question 5

Nausea & vomiting referral symptoms – 7

Answer 5

1. Severe abdominal pain
2. Dehydration
3. Blood in vomit
4. Duration/recurrent symptoms
5. Recent foreign travel
6. Pregnancy, especially if hyperemesis is suspected
7. Any symptoms outside of your area of competency

Question 6

Nausea & vomiting treatment – 3

Answer 6

1. Buccal Prochlorperazine
2. Anti-histamines for travel sickness, (e.g. cinnarizine, meclizine)
3. Hyoscine

Question 7

Anti-emetics OTC – 3

Answer 7

1. Very limited choice OTC, cause must be known
2. 1st generation antihistamines e.g. Cinnarizine (Stugeron), Promethazine (Phenergan)
3. Anti-cholinergics: Hyoscine – (Kwells)

Question 8

Mouth Ulcer referral symptoms - 4

Answer 8

1. A single lesion lasting longer than 3 weeks
2. Larger than 1cm, In crops of 5-10 or more
3. Painless ulcers
4. Multiple site involvement – Behcet disease

Question 9

Mouth Ulcer Treatment - 4

Answer 9

1. Antibacterials (e.g. chlorhexidine mouthwash)
2. Analgesic (e.g. choline salicylate) - Over 16’s only.
3. Lidocaine & benzocaine products available for <16’s
4. Local corticosteroid – hydrocortisone buccal tablets - over 12’s only