Read week

3

Current Week

Hi Everyone!

Have you been eating well today? I know during my preparation for exams I gained over 5kg in weight from eating whatever I wanted. Chips and chocolates were my go-to foods. While I thought it felt great to lay my usual restrictions aside, I know that these foods were not great for my mood or my brain. If you have no time to cook during these times then seek out a healthy alternative: pay a family member/friend to cook for you, purchase prepared meals from businesses such as Lite n’Easy (not sponsored) or choose frozen meals that are low in salt. You are important! Nourish your body and your brain will flourish.

This article is about Gastroenterology.

My first consultation as a GP registrar was with a real ole country bloke whose opening line was to complain about his “a**hole doctor” (excuse the language). A short period of confusion and directed questioning later revealed that he was talking about his gastroenterologist who had been reviewing him for his severe ulcerative colitis. This started my journey with him through the storms of inflammatory bowel disease, DMARDs and a 100+ day hospital admission following a partial colectomy. And of course, lots of opportunities to learn along the way for me.

One of the most common presentations in the GP setting for gastrointestinal medicine comes in the form of a request for a medical certificate. Patients present during or following a bout of gastroenteritis – quite often with the queasy look on their face or the vomit bag in hand. When dealing with a patient with gastroenteritis, after establishing they aren’t dying,  it is vital to provide education about hydration and transmission. Thorough and regular washing with soapy water, should prevent the condition spreading around the community – the importance of this is not to be discounted – I’ve seen nursing homes and schools put in lock down after an epidemic of viral gastroenteritis. It’s not hard to write a medical certificate to encourage them to stay away from their work place for 24-48hours after resolution of their symptoms to prevent spread.

You’ll soon notice in general practice that nearly everyone you see is taking a proton pump inhibitor for GORD. These are drugs that, like paracetamol, have been dished out like candy over the years. Don’t be afraid to take the step to trial de-prescribing this medication, particularly if the patient has been symptom-free for many years. Coupled with some counselling about avoiding triggers, and some empowerment towards weight loss, it is possible to control this condition without medication. In saying that, don’t be complacent when it comes to new onset of symptoms of dyspepsia in an older person. This is a red flag.

Be kind to yourself, and give your body nourishment in the week ahead!

Dr Andrew Harris
Director of Amadeus Education.


Did you know?

According to BEACH data, 8.2% of all encounters in General Practice were specifically related to the digestive system. Consider this as you are preparing for your exams. (Source: General practice activity in Australia: 2015-16. https://bit.ly/2c4d8Em)

Presenting complaints:

These are the common presenting complaints that should be covered for this topic:


Important conditions:

These are the common conditions that should be reviewed for this topic:

Topics

Important reading

Disorders of the mouth
Stomach/oesophagus abnormalities – including GORD, Peptic ulcer disease/h. Pylori
Bowel disease – including inflammatory bowel disease, coeliac disease, diverticular disease, appendicitis, gastroenteritis
Bowel dysfunction – including constipation, diarrhoea, irritable bowel disease
Bowel dysfunction – including constipation, diarrhoea, irritable bowel disease
Liver disease – including Hepatitis, fatty liver disease
Pancreatitis
  • Chronic pancreatitis: Negotiating the complexities of diagnosis and management. AFP, October 2015. (https://bit.ly/2XcC8w6)
Anorectal disorders – including haemorrhoids, pruritis ani
Cancer of the GIT – including oesophageal, colon, stomach, pancreatic, liver
  • Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Cancer Council. (https://bit.ly/2NdXg0a)
  • Early Detection, Screening and Surveillance for Bowel Cancer. Gastroenterological Society of Australia, 2013. (https://bit.ly/2SawXZz)
  • Diagnosing colorectal polyps and masses: The use of CT colonography. AFP, March 2011. (https://bit.ly/2tqnAeB)
  • Bowel cancer screening: A role for general practice. AFP, April 2009. (https://bit.ly/2GQGHq7)
Intestinal parasitesIntestinal parasites. RCH. (https://bit.ly/2tGiGtK)
Gall bladder disease

Medication doses:

These are the medications and doses that should be learned for the exam:

Condition

Medication

Nausea
  • Metoclopramide 10mg orally TDS PRN
  • Ondansetron 4-8mg orally TDS PRN
GORD
  • Ranitidine 150mg daily orally
  • Esomeprazole 20mg daily orally
H.Pylori infection
  • Triple therapy (ACE) for 7 days:
    • Amoxycillin 1g orally BD
      Clarithryomycin 500mg orally
    • Esomeprazole 20mg orally BD
Diarrhoea
  • Loperamide 2mg, 1-4 times daily PRN
Constipation
  • Movicol 13.12g sachet, use 1-2 daily
  • Docusate+senna 50+8mg 1-2 nocte

CHECKS:

Here are the list of recommended Checks that would be useful in your study for GP exams (accessed via subscription from http://gplearning.racgp.org.au):

  • Gastroenteritis, May 2014
  • Chronic viral hepatitis, March 2013
  • Abdominal pain, December 2012

Focus on clinical skills:

Here is a brief focus on some OSCE preparation materials related to this topic:

  • Gastrointestinal examination playlist by GP Synergy: https://bit.ly/2SWfMMt
  • Interpersonal relationships for patients with irritable bowel syndrome: A qualitative study of GPs’ perceptions. AFP, November 2013. (https://bit.ly/2TT5s8A)

Copyright © 2021 Andrew Harris

Leave a Reply