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gastroenterology in general practice.ppt
 

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    gastroenterology in general practice.ppt gastroenterology in general practice.ppt Presentation Transcript

    • Gastroenterology in General Practice
    • Gastroenterology
      • Dyspepsia
        • Ulcer disease
        • Non-ulcer dyspepsia
        • Helicobacter pylori
      • Altered Bowel Habit
        • Constipation
        • Diarrhoea
      • Jaundice
    • Gastroenterology
      • GI Cancer
        • Oesophageal
        • Gastric
        • Colorectal
        • Pancreatic
    • Acid Suppressor Therapy
      • Appropriate Use in General Practice
      • H2RAs
      • Proton Pump Inhibitors
    • Life before PPIs
      • The history of dyspepsia
        • Surgery and diet
          • Vagotomy/Pyloroplasty
          • Steamed fish and milk puddings
        • H2-receptor antagonists
          • Tagamet & SKF
          • Zantac & Glaxo
    • Proton Pump Inhibitors
      • Losec (Omeprazole)(Astra)
      • Zoton (Lansoprazole)(Wyeth)
      • Pariet (Rabeprazole)(Janssen)
      • Nexium (Esomeprazole)(Astra)
    • NICE Guidance
      • Issued in 2000
      • Targeted use to make best use of resources
    • Dyspeptic Symptoms
      • Diagnosed or not?
        • Non-ulcer Dyspepsia
          • Lifestyle factors: STRAWS
        • Peptic Ulceration
          • Helicobacter screening techniques
        • GORD
          • Mild/Moderate
          • Severe/Complicated
    • Dyspeptic Symptoms
      • Investigations:
        • Endoscopy
        • C13-Urea Breath Testing
        • Barium Swallow/Meal
    • Peptic Ulceration
      • Helicobacter-related?
        • ERADICATE
      • NSAID-related?
        • Co-Prescribe PPI if cannot stop NSAID
    • Gastro-Oesophageal Reflux
      • Mild
        • alternative Rx: antacid, alginate, H2RA
      • Severe
        • healing dose PPI until symptoms controlled
        • maintenance dose to prevent recurrence
      • Complicated
        • stricture, ulcer, haemorrhage etc
        • full dose maintained
    • Non-ulcer Dyspepsia
      • Use Acid Suppressor
        • H2RA
        • NOT PPI
      • Step-up or Step-down
      • Modify lifestyle factors
        • smoking
        • diet
        • weight
    • Investigation
      • Over 55 ENDOSCOPY
      • Alarm Symptoms ENDOSCOPY
        • dysphagia
        • anaemia
        • progressive weight loss
      • Under 45 NO INVESTIGATION
      • 45-55 DEBATABLE
    • Inflammatory Bowel Disease
      • Crohns Disease
      • Colitis
        • Ulcerative
        • Pseudomembranous
      • Diverticular Disease
    • Altered Bowel Habit
      • Investigations:
        • Faecal Occult Blood
        • CEA/CA19-9
        • Sigmoidoscopy
        • Barium Enema
        • Colonoscopy
    • Jaundice
      • Pre-hepatic
        • haemolysis
      • Intra-hepatic
        • hepatitis, drugs (flucloxacillin, chlorpromazine)
        • cirrhosis, tumour
      • Post-hepatic
        • gallstones
        • pancreatic tumour