GEM - Curriculum Statement 15.2 Digestive Problems

Knowledge Base for the nMRCGP

Curriculum Statement 15.2 Digestive Problems

Emboldened terms are linked to GPnotebook entries.

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

GPnotebook Educational Modules (GEMs)

• digestive problems part one
• digestive problems part two