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