| Show Learning Points most relevant to Phase 1: |
Chronic upper abdominal symptoms
| Clinical Discipline(s)/Organ System(s) Digestive System, General Practice, Gastroenterology & Hepatology, Infectious Diseases, General Surgery | Progress Test Topic(s) Digestive |
Description
A 33 year old NZ European woman presents to her GP with fatigue, dyspepsia and acid reflux. Her symptoms have been slowly developing over the past couple of months. You take a history and examine her. After presenting your findings to the GP they ask you how you would like to manage her symptoms.
Progress Test-Type Questions: Question 1 | Question 2Applied Science for Medicine
- Anatomy of the gastrointestinal tract
- Physiology of acid production in the stomach, function of the lower oesophageal sphincter and gallbladder
- Iron, vitamin B12 and folate absorption
- Pathophysiology of gallbladder disease, hiatus hernia
- Genetic predisposition to gastric cancer
- Progression of malignancy from pre-cancerous to cancerous to metastatic disease
- Histopathology of oesophagitis, peptic ulcers and gastric cancer
- Microbiological characteristics of Helicobacter pylori; diagnosis and treatment
- Pharmacology of non-steroidal anti-inflammatory drugs, antacids, proton pump inhibitors, H2 antagonists, metoclopramide, oral bisphosphonates
- Anatomy of the gastrointestinal tract
- Physiology of acid production in the stomach, function of the lower oesophageal sphincter and gallbladder
- Iron, vitamin B12 and folate absorption
- Pathophysiology of gallbladder disease, hiatus hernia
- Genetic predisposition to gastric cancer
- Progression of malignancy from pre-cancerous to cancerous to metastatic disease
- Histopathology of oesophagitis, peptic ulcers and gastric cancer
- Microbiological characteristics of Helicobacter pylori; diagnosis and treatment
- Pharmacology of non-steroidal anti-inflammatory drugs, antacids, proton pump inhibitors, H2 antagonists, metoclopramide, oral bisphosphonates
Clinical and Communication Skills
- Outline the dietary control advice in gastro-oesophageal reflux disease
- History from the patient with fatigue (including possible psychological component, stress); recognise red flag symptoms
- History from a patient with reflux, dyspepsia; recognise red flag symptoms
- Perform an examination of the abdomen
- Differential diagnosis of chronic upper abdominal symptoms
- Indications for endoscopy, biopsy, abdominal ultrasound; complications of endoscopy
- Interpret FBC, vitamin B12/ (B12 NZF link)levels, folate levels , autoantibodies, Schillings test, urea breath testing, liver function tests
- Recognise the morphological types of anaemia: microcytic, macrocytic, and normocytic
- Management of H. pylori infection, peptic ulcer disease, dyspepsia, chronic abdominal pain, coeliac disease, pernicious anaemia
- Risk factors for peptic ulcer disease, including alcohol history
- Role of psychosocial assessment
- Appropriate communication for discussing lifestyle including alcohol and weight loss
- Structuring, framing and timing of consultation
- Outline the dietary control advice in gastro-oesophageal reflux disease
- History from the patient with fatigue (including possible psychological component, stress); recognise red flag symptoms
- History from a patient with reflux, dyspepsia; recognise red flag symptoms
- Perform an examination of the abdomen
- Differential diagnosis of chronic upper abdominal symptoms
- Indications for endoscopy, biopsy, abdominal ultrasound; complications of endoscopy
- Interpret FBC, vitamin B12/ (B12 NZF link)levels, folate levels , autoantibodies, Schillings test, urea breath testing, liver function tests
- Recognise the morphological types of anaemia: microcytic, macrocytic, and normocytic
- Management of H. pylori infection, peptic ulcer disease, dyspepsia, chronic abdominal pain, coeliac disease, pernicious anaemia
- Risk factors for peptic ulcer disease, including alcohol history
- Role of psychosocial assessment
- Appropriate communication for discussing lifestyle including alcohol and weight loss
- Structuring, framing and timing of consultation
Personal and Professional Skills
- Demonstrate an empathic approach to a patient with chronic symptoms
- Time-management: taking a complex history in a primary care setting
- Awareness of own relationship with alcohol
- Demonstrate an empathic approach to a patient with chronic symptoms
- Time-management: taking a complex history in a primary care setting
- Awareness of own relationship with alcohol
Hauora Māori
- Appropriate engagement and consultation with whānau
- Cater for differential health literacy needs of Māori patients and whānau
- Consideration of patient and whānau needs with regards to 'breaking bad news'
- Consideration of access to cultural/spiritual support for patient and whānau
- Appropriate engagement and consultation with whānau
- Cater for differential health literacy needs of Māori patients and whānau
- Consideration of patient and whānau needs with regards to 'breaking bad news'
- Consideration of access to cultural/spiritual support for patient and whānau
Population Health
- Economic and social impacts of fatigue
- Epidemiology of H. pylori: prevalence, associations, treatment
- Epidemiology of dyspepsia, pernicious anaemia, gastric cancer, gastro-oesophageal reflux disease
- Economic and social impacts of fatigue
- Epidemiology of H. pylori: prevalence, associations, treatment
- Epidemiology of dyspepsia, pernicious anaemia, gastric cancer, gastro-oesophageal reflux disease
Conditions to be considered relating to this scenario
Common
peptic ulcer disease, gastro-oesophageal reflux disease, H. pylori infection, non-steroidal anti-inflammatory drug use, gastritis, coeliac disease, irritable bowel syndrome, gallstones, pregnancy, pernicious anaemia
peptic ulcer disease, gastro-oesophageal reflux disease, H. pylori infection, non-steroidal anti-inflammatory drug use, gastritis, coeliac disease, irritable bowel syndrome, gallstones, pregnancy, pernicious anaemia
Less common but 'important not to miss'
ovarian carcinoma, gastric cancer, gastrointestinal lymphoma, pancreatitis
ovarian carcinoma, gastric cancer, gastrointestinal lymphoma, pancreatitis
Uncommon
Zollinger-Ellison syndrome
Zollinger-Ellison syndrome
