Transcript ORGANIC
ORGANIC • • • • • • Peptic ulcer Reflux Cholelithiasis Pancreatic Malignancy Musculoskeletal Drugs, medication and rarities • ischaemic • metabolic Functional • • • • Sensory motor dysfunction H pylori Gastritis (peptic ulcer Psychosocial factors Idiopathic History Examination Overall assessment –likelihood of disease - needs for reassurance Trial of PPI and reassessment Red flag symptoms: • Dysphagia • Vomiting • Increasing Age • Bleeding • New onset of symptoms • Anaemia • Looks ill • Drs ‘gut’ feeling Disease more common in men versus women Men • Short history • Age over 55 years • Irregular attributes Women • Long history • Young • Nausea ++ • Stressed • Frequent attendees No red flag Age under 55 or Previously investigated with negative results Screen for Helicobacter Empirical treatment (PPIs) Consider other avenues Resist but don’t exclude Endoscopy Guidelines Dyspepsia Clinical evaluation – History physical examination Age over 55 years or red flag symptoms or Patient has strong fear of organic disease Endoscopy HELICOBACTER To test or not to test prior to referral Screening – serology faecal testing breath testing Endoscopy (including cultures) Treatment benefits – symptoms cancer preventative Reasons for not doing Endoscopy in low risk patients: 1. Price 2. Low yield 3. Pressure from PCT Reasons for doing Endoscopy in low risk patients: 1. 2. 3. 4. Reassurance (including medico-legal) Fewer OPD and prescriptions The risk of disease is never zero Barrett’s oesophagus Points: 1. Method of referral: 2. Ultrasound 3. Limit but do not deny Endoscopy in low low risk patient 4. Don’t repeat procedure unless the need 5. Once done modify drug use 6. Concentrate on life style issues Guidelines: 1. Never apply to the individual patient 2. When introduced clearly increases referrals A plan regarding Choose & Book • Price of endoscopy - £485 • Price of consultation £195 + £92.97 = £278