OSCE Revision - GI Problems

These are for Community Pharmacy and preparation for OSCE exams

?
What are the symptoms of Haemorrhoids?
- Bright red rectal bleeding
-seen as spotting or streaking
-itching and irritation
-intermittent, episodes - lasting few days/weeks
-Internal piles - often painless
-internal piles- painful- pressure causing them to become thrombosed
-Pain -dull ache an
1 of 39
What questions would you ask when diagnosing Haemorrhoids?
- Duration?
-Pain & when does it occur?
-Rectal bleeding?
-Associated symptoms?
-Diet/Lifestyle?
2 of 39
What conditions should you eliminate before diagnosing haemorrhoids?
- Dermatitis related
-Medication
-Conditions with rectal bleeding (anal fissures- pregnancy and 15-40yr olds)
-Ulcerative colitis and Crohns disease (bloody diarrhoea)
- Upper GI bleed (black tarry stool) - NSAID uptake.
- Diverticulitis disease - left
3 of 39
What OTC or treatment would you provide for Haemorrhoids?
-Diet
- Anaesthetics (Germaloid Cream)
- Antistingents
-Protectorants
- Ant-inflammatory drugs
4 of 39
When would refer someone with symptoms of haemorrhoids?
-Persistent marked changes in bowel habits >40ys
-Unexplained bleeding
-Blood mixed in stool
- Fever
- Patients who have reduced piles manually
- severe pain associated with defecation.
5 of 39
What lifestyle advice would you give to a patient with haemorrhoids?
-Do not wipe bottom hard
- Do not ignore urge to poo.
-Avoid painkillers - codeine
- Do not take ibuprofen if piles bleed
-Avoid just sitting on the toilet
- Drink lots of water and eat fibre - 30g/day
- keep good hygiene
-Exercise
6 of 39
What are cold sores caused by?
Herpes Simplex Labialis
7 of 39
What lifestyle advice would you give to a patient with haemorrhoids?
-Do not wipe bottom hard
- Do not ignore urge to poo.
-Avoid painkillers - codeine
- Do not take ibuprofen if piles bleed
-Avoid just sitting on the toilet
- Drink lots of water and eat fibre - 30g/day
- keep good hygiene
-Exercise
8 of 39
What are the symptoms of a cold sore?
-Prodromal symptoms - itching, burning, pain and tingling for 6-48hrs before eruption.
-Lesions appear as blisters/vesicles associated with redness on outer lip.
-Spontaneous resolution 7-10 days
-Recurrence is common and lesions tend to be in the same pl
9 of 39
What conditions would you eliminate before diagnosing a cold sore?
Impetigo- around the mouth and nose - sticky brown crust
Angular Cholitis - common in denture wearers, corners of the mouth become fissured/ macerated .
Aphthous ulcers- tend to be inside rather than outside part of lip.
10 of 39
What questions would you ask in order to diagnose a cold sore?
- Appearance?
-Location?
-Trigger factors?
-Lifestyle?
-Age?
11 of 39
What OTC treatment would you prescribe if you diagnose a cold sore?
-Aciclovir (apply this in the prodromal phase)
e.g. Cymex Ultra, Visorb, Zovirax
5x a day 4hr intervals (okay for pregnant/breastfeeding)

-Hydrating cream (after the prodromal phase)
e.g. Cymex and Blistex
12 of 39
When would you refer a cold sore?
- Duration 14 days (unlikely a cold sore) - GP referral.
-Cold sore is located in the mouth (severe and widespread lesions)
- Lesions that spread away from the lips and on the face
(Impetigo more likely)
13 of 39
What advice would you give for someone with a cold sore?
-Avoid kissing during the first 1-4 days of symptom and touching. Most infective period.
- When applying product- use separate towel and wash hands straightaway.
- Eat soft, cool foods
- Take analgesics to reduce swelling
-Drink plenty of fluids to avoid
14 of 39
What are the symptoms of a mouth ulcer?
MAUs- Major Aphthous Ulcers
- roundish, grey colour and painful
- they are 1cm in diameter
- shallow roundish rim
Pain is key symptom - passes after a few days.
15 of 39
What conditions would you eliminate before diagnosing a mouth ulcer?
-Trauma - irregular borders, patient should be able to recall the event.
- Herpetiform ulcer - large crop, very painful. Located in the posterior part of the mouth.
- Oral thrush
- Herpes Simplex
-Medicine induced ulcer
- Oral carincoma - painless patch
16 of 39
What questions would you ask in order to diagnose a mouth ulcer?
-Number of ulcers?
-Location of ulcers?
-Size and shape?
-Painless ulcers?
-Age?
17 of 39
What OTC treatment would you advice for mouth ulcers?
-Antibacterial agent - Chlorohexadine Mouthwash
-Choline Salicylate (Bonjela and Bonjela cool
-Local anaesthetic - Abensol range, Iglu gluten, medijel
-Lidocaine
-Benzocaine
18 of 39
When would you refer a mouth ulcer?
-Children <10yrs - recurrent
(MUAs rare. Hand, foot and mouth disease?)
- Ulcers >1cm in diameter
-Ulcers in a crop of 5 or more
-Associated eye involvement
-Duration 14 days +
- Painless? - URGENT
19 of 39
What lifestyle advice would you give to a patient with mouth ulcers?
-Use a soft bristled brush
- drink cool drinks through straws
-eat softer food
-get regular dental checks
-eat healthy, balanced diet
- avoid spicy, acidic and salty foods
- Avoid chewing gum
- do not use toothpaste - sodium sulphate.W
20 of 39
What is Dyspepsia?
Upper abdominal pain. It includes- Indegestion, GORD, Gastritis, Duodenal ulcers
21 of 39
What are the common symptoms of Dyspepsia?
- Vague discomfort above the umbilicus, associated belching.
-Bloating
-Flatulence
-Feeling of fullness
- Nausea and vomiting
-Heart burn
22 of 39
What questions to ask a patient in order to diagnose dyspepsia?
Age?
Location?
Nature of pain?
Radiation of pain?
Severity?
Associated symptoms?
Social history?
23 of 39
What conditions should you eliminate before diagnosing dyspepsia?
- peptid ulceration
- medicine induced
-IBS
-Biliary disease
- Gastric Carincoma
-Oesophageal carincoma
- Atypical angina
Coeliac disease
Crohns disease
24 of 39
What OTC treatment would you prescribe for the treatment of dyspepsia?
-Antiacids
(sodium, magnesium and aluminium
only)
-Aliginates (Gaviscon Range)
-Ranitidine (Zantac, Gavilast,Ranicalm)
-Omeprazole (Dexcel heartburn relief)
- Esomeprazole
-Pantoprazole
25 of 39
When would you refer dyspepsia?
-Alarm signs and symptoms (anaemia, loss of weight, tiredness, anorexia, recent onset of progressive symptoms, dysphagia)
-Pain described as severe, debilitating or that awakens patients at night
-Persistent vomiting
-Referred pain - cardiovascular or b
26 of 39
What lifestyle advice would you give to a patient with dyspepsia?
-Cut down on tea, coffee and alcohol.
-Prop your head and shoulders up in bed - stops stomach acid coming up when you're sleeping.
-Eat 3 to 4 hrs before going to bed.
-Avoid taking ibuprofen or aspirin - make indigestion worse.
- Stop smoking.
27 of 39
What are the symptoms of IBS?
-Abdominal pain or discomfort (particularly Lower left abdomen)
-Altered defecation, constipation or diarrhoea with associated bloating.
(one will be predominant)
- May have mucous in the stool.
-Diarrhoea shortly after waking and eating.
- Likely if symp
28 of 39
What questions would you ask when diagnosing IBS?
How long have you had symptoms?
Travel?
Age?
Periodicity?
Presence of abdominal pain?
Location of pain?
Diarrhoea or constipation?
29 of 39
What conditions should you eliminate before diagnosing IBS?
-Constipation and Diarrhoea
30 of 39
What OTC would you prescribe for a patient with IBS?
Hyoscine Butyl Bromide
(Buscopan IBS and Buscopan cramps)
-Mebeverine
-Peppermint oil
31 of 39
When would you refer IBS?
-Blood in stool - inflammatory bowel disease
-fever, nausea and vomiting
-children <16yrs
-People with recent changes in bowel habits
-OTC failure
32 of 39
What lifestyle advice would you give for IBS?
`NOT A CURE, USUALLY LIFE LONG PROBLEM.
-Cook with fresh ingredients
-keep a food diary - highlights triggers
-Get plenty of exercise
-Take probiotics
-Do not skip or delay meals
- Limit intake of high fibre
- limit amount of fresh fruit.
-Avoid alco
33 of 39
What are the symptoms of Constipation?
-Inability to defecate
-Abdominal blasting
-Children may be more irritable
-Specks of blood from straining
34 of 39
What questions would you ask in order to diagnose constipation?
-Change in routine?
-Pain on defecation?
-Presence of blood?
-Lifestyle changes?
-Duration?
35 of 39
What conditions should you eliminate before diagnosing constipation?
-Medicine induced
-IBS
-Pregnancy
-Depression - low mood, loss of interest
- Cancer
-Hypothyroidism - subtle and insidious in onset
(weight gain, legarthy, cold )
36 of 39
When would you refer constipation?
-Patients >40yrs marked change in bowel habit with no obvious reason (same day referral)
-Longer than 14 day duration - no identifiable cause (ASAP)
-Tiredness - anaemia - thyroid dysfunction
-Pain of defectaion - may cause them to suppress the reflex
37 of 39
What OTC treatment would you prescribe to a patient with constipation?
-Bulk forming laxatives e.g Fybogel Hi-fibre lemon,
-Senna e.g. Snokot Exlax Senna
-Sodium Picosulfate - Dulcolax
-Stool softener - liquid paraffin decussate sodium.
38 of 39
What lifestyle advice would you give to a patient with constipation?
-Drink plenty of fluid and avoid alcohol
-Increase fibre in the diet - wheat bran, oats and linseed.
- do not delay the urge to poo
- Try resting feet on a stool when going to the toilet
-Increase exercise.
39 of 39

Other cards in this set

Card 2

Front

What questions would you ask when diagnosing Haemorrhoids?

Back

- Duration?
-Pain & when does it occur?
-Rectal bleeding?
-Associated symptoms?
-Diet/Lifestyle?

Card 3

Front

What conditions should you eliminate before diagnosing haemorrhoids?

Back

Preview of the front of card 3

Card 4

Front

What OTC or treatment would you provide for Haemorrhoids?

Back

Preview of the front of card 4

Card 5

Front

When would refer someone with symptoms of haemorrhoids?

Back

Preview of the front of card 5
View more cards

Comments

No comments have yet been made

Similar Medicine resources:

See all Medicine resources »See all Medicine resources »