PUD + Dysphagia + Dyspepsia Flashcards
What is Dysphagia?
difficulty in swallowing, which might involve problems in the oral, pharyngeal, or oesophageal stages of swallowing
Investigations for Dysphagia include what?
2 week-wait criteria:
Oesophageal/gastric cancer - Offer urgent OGD (to be performed within 2 weeks) in people with dysphagia or those aged 55 years and over with weight loss and any of the following: upper abdominal pain, reflux, or dyspepsia.
When would blood tests be offered to someone when investigating Dysphagia?
iron studies in suspected Plummer-Vinson syndrome
56-year-old man presents to his GP with a 2-month history of dysphagia. He often finds that food comes straight back up when he is eating. On examination, you notice halitosis. His weight has remained stable and he has no other symptoms. What is the most likely diagnosis?
Pharyngeal pouch
ALARMS signs for Dyspepsia include?
Anaemia
Loss of weight
Anorexia
Recent onset of symptoms, Melaena/haematemesis
Swallowing difficulties
Management for Dyspepsia
(1) Lifestyle measurements
(2) Medication review
(3) trial of PPI (e.g. omeprazole) for one month, OR test and treat for H.pylori
many commonly prescribed medications can cause or worsen dyspepsia and these should be reviewed with a decision made as to whether they need to continue. Common offenders include: alpha-blockers, anticholinergics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, nonsteroidal anti-inflammatory drugs (NSAIDs), theophyllines, and tricyclic antidepressants
A 69-year-old man presents to the GP with a 3-month history of epigastric pain. The pain is described as a constant dull ache and does not radiate. He has no vomiting, haematemesis or melaena. He reports 3 kg weight loss in the past 3 months. His appetite is unaffected. Examination is unremarkable. He is a smoker but does not drink alcohol. What is the best next step in the management of this patient?
Refer for urgent (2 week) endoscopy
= He is over 55
Triple PPI is taking how often each day
twice
A 39-year-old man is prescribed eradication treatment for H. Pylori as part of a ‘test and treat’ strategy after presenting with dyspepsia. He is allergic to penicillin and is therefore given metronidazole, clarithromycin and omeprazole. Which of the following pieces of advice should the patient receive from the GP? and why?
Do not drink alcohol with this medication and for 48 hours after finishing course
= drugs mixed with alcohol can cause bad side effects
Define Peptic ulcer disease
Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or the first part of the small intestine, known as the duodenum. The frequency of duodenal ulcers is four times higher than that of gastric ulcers
A 68-year-old woman presents to her GP with abdominal discomfort, nausea and belching which started one month ago. She has not noticed any weight loss or change in bowel habits. Routine blood tests are normal. She has no significant past medical history. She reports a family history of oesophageal cancer. She is taking no regular medications. Abdominal examination is normal. Her GP refers her for an upper gastrointestinal endoscopy, which is reported as normal. She does not have H. Pylori. What is the most likely consequence
Functional dyspepsia
A 46-year-old woman presents to the general practitioner with a one-month history of painless, intermittent difficulty swallowing solid food. She denies any recent weight loss, haematemesis, melaena and hoarseness of voice. On examination, angular stomatitis is evident. Routine blood tests show iron deficiency anaemia. A diagnosis of Plummer-Vinson syndrome is suspected. What is the most likely complication of this?
Squamous cell carcinoma of the oesophagus
What is a known drug that causes dyspepsia and ulceration?
Oral prednisolone
A 67-year-old female patient presents with worsening difficulty swallowing. Initially she only had difficulty swallowing solids however over the last 4 weeks she has struggled to swallow liquids. She has also experienced unintentional weight loss and painful swallowing but denies any hoarseness, cough or fever. What is the most likely cause of her symptoms?
Oesophageal cancer
What is recommended after the start of PPI therapy?
repeat endoscopy in 6-8 weeks
