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gastroenterology in general practice.ppt

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gastroenterology in general practice.ppt

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

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