Heartburn History and Management Flashcards Preview

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Flashcards in Heartburn History and Management Deck (11):
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)

GORD
Ulcer
Hiatus Hernia
Oesophagitis
Cancer

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)

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)
-

3

You are the GP

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

Take a focused PMHx

Hernia
Past episodes of reflux

4

You are the GP

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

Take a focused DHx

Over the counter medications?
NSAIDs
Ibuprofen
Neurofen
Naproxen
Steroids

5

You are the GP

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

Take a focused SHx

Smoking?
Alcohol?

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

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

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?

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

8

You are the GP

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

Take a focused FHx

Any gi problems run through the family

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

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

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)

GORD
Ulcer
Hiatus Hernia
Oesophagitis
Cancer

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

Burning sensation when bending?

if yes more likely hernia