Summary GI/Urinary Conditions: Clinical Presentations, Investigations, Management in a GP Setting
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Course
MEDI3101
Institution
University Of Newcastle (UON
)
Structure summary of GI conditions and their management in GP setting
Includes conditions such as:
- GORD
- Gastroenteritis
- IBS
- Peptic ulcers
- Appendicitis
- IBD
- Cholelithiasis
GORD
● regular/frequent heartburn and/or acid regurgitation, commonly due to relaxation of
LES
● Risk factors: NSAIDs, antibiotics, iron/K supplements, obese, chronic respiratory
disease
● Red flags: recurrent vomiting, dysphagia/odynophagia, weight loss, GI blood loss,
symptoms >5yrs or <6 months, epigastric, >50yrs
● Indications for UGI endoscopy: red flags, new symptoms in older person,
changing/severe/frequent/diagnostic clarification of symptoms, inadequate response
to treatment
● Investigations: UGI endoscopy, barium swallow (hiatus hernia), 24hr oesophageal pH
monitoring and manometry (when endoscopy normal)
● Mx:
○ Mild intermittent symptoms: lifestyle modification, weight loss
■ Avoid high fat meals, alcohol, coffee, chocolate, citrus fruit, tomato
products, spicy food, carbonated
■ Smaller meals, fluids between meals rather than with, avoid lying
down and eating, avoid eating/drinking 2-3hrs before bed/vigorous
exercise, elevate head of bed, cease smoking
○ Initial trial of antacid + alginate preparation PRN (gaviscon) or magnesium
hydroxide + aluminium hydroxide preparation PRN (mylanta)
○ If antacids inadequate relief:
■ H2 receptor antagonist → famotidine, nizatidine, ranitidine
■ PPI at standard dose, eg, pantoprazole (somac)
○ Surgery → laparoscopic fundoplication
, ● Broader GP Mx:
○ If initial PPI therapy adequate symptom control → titrated down and
continued at lowest dose/frequency that controls symptoms or
stopped
○ Recall if symptoms persist/inadequately relieved by medication
○ Safety netting → present to ED/GP when experience red flags
GASTROENTERITIS
● Hx: diarrhoea, vomiting, crampy abdominal pain; dehydration, pyrexia,
haematochezia, mucus in stool, affected family/friends, recent antibiotic use
● bacterial toxins - hours between food ingestion and symptoms, viral - days, bacteria -
weeks, parasites - months
● Risk factors: young children, poor food preparation, immunocompromised, poor
personal hygiene
● Investigations: usually self limiting; stool culture if blood/mucus in stool,
immunocompromised, severe/persistent
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