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GI disease (Liver (Hepatitis, Cirrhosis), Inflamatory Bowel Disease…
GI disease
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Peptic Ulcer Disease
Can be gastric or duodenal: duodenal more common than gastric
Most ulcers are caused by H.Pylori or NSAID use Also remember smoking and alcohol, stress and steroids, and Zollinger-Ellison syndrome (gastrinomas secreting gastrin = high H+ production)
If < 55, rx with over-the-counter antacids. No improvement, do C breath test (most sensitive and specific non invasive test). If -ve, Rx with PPi. If +ve, eradicate H Pylori (triple therapy - PPI + clarythromycin + amox or metronidazole
GORD
2 episodes of heart burn per week +/- complications( oesophagitis, stricture, Barrets oesophagus, vomitting, dysphagia)
Rx with antacids, if oesophagitis PPI, or surgery if drugs not working
Los Angeles Classification has 4 grades, from minor mucosal breaks to whole oesophageal circumference
Endoscopy if worrying symptoms or persists for > 4 wks, or unresponsive to Rx,
Risk of progression to adenocarcinoma higher if baretts present; low grade dysplasia 90% will get adenocarcinoma within 6 yrs, and high grade dysplasia 50% already have adenocarcinoma
UGI Ca
2 week wait referral
- New onset dysphagia
-Dyspepsia + weight loss/anaemia/vomiting
- Dyspepsia + hx (baretts, previous peptic ulcer surgery/pernicious anaemia/atrophic gastritis)
- Jaundice
- New dyspepsia post 55 yo
Upper abdominal mass
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