GEM - Curriculum Statement 15.2 Digestive Problems
Knowledge Base for the nMRCGP
Curriculum Statement 15.2 Digestive Problems
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Symptoms:
- Dyspeptic symptoms (epigastric pain, heartburn, regurgitation,nausea, bloating)
- Abdominal pain
- Nausea, vomiting, anorexia, weight loss
- Haematemesisandmelaena
- Rectal bleeding, tenesmus
- Jaundice
- Diarrhoea and constipation
- Dysphagia
Common and/or important conditions:
- GORD
- Non-ulcer dyspepsia,
- gastritis
- peptic ulceration
- Gallstones
- Irritable bowel syndrome
- Gastroenteritis
- Constipation
- Coeliac disease
- GI cancers (oesophageal, gastric, hepatic, pancreatic, colonic)
- Inflammatory bowel disease
- Diverticulosis
- Acute abdominal conditions, e.g. appendicitis, cholecystitis, pancreatitis
- Perianal disease (e.g. haemorrhoids, perianal haematoma, pilonidal sinus)
Investigations:
- Liver function tests
- Amylase
- H. pylori testing- serology, breath test, stool antigen testing
- Coeliac antibody screening
- Stool testing
- Faecal occult bloods
- Abdominal ultrasound
Knowledge of secondary care investigations including endoscopy (oesophago-gastro-duodenoscopy, sigmoidoscopy, colonoscopy), abdominal imaging techniques (barium swallow, barium enema, computed tomography), liver biopsy, endoscopic retrograde cholangio-pancreatographyand jejunal biopsy.
Treatment:
- Understand principles of treatment for common conditions managed largely in primary care
- Be aware of secondary care management of digestive problems, including surgical options
- Emergency care:
- Recognition of the acute abdomen
- Acute management of haematemesis and melaena
Prevention:
- Dietary advice to include five portions of fruit or vegetables daily
- Smoking cessation and alcohol reduction to prevent GI cancers
Relevant information:
- summary of NICE dyspepsia guidelines
- smoking cessation guidance summary of NICE guidelines relating to nicotine replacement therapy and bupropion
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