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Dyspepsia Flashcards

1
Q

Pain or discomfort centred at the upper

abdomen that is chronic or recurrent in nature.

A

Dyspepsia

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2
Q

Excessive wind. It includes belching,

abdominal bloating or passing excessive flatus

A

Flatulence

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3
Q

A central retrosternal or epigastric burning

sensation that spreads upwards to the throat

A

Heartburn

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4
Q

Excessive belching has been associated with?

A
  • Common in anxious people who gulp food and drink

* Associated hypersalivation

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5
Q

Diagnoses to consider in dyspeptic
patients

Gastrointestinal disorders

A

Gastro-oesophageal reflux, including hiatus hernia
Functional (non-ulcer) dyspepsia
Oesophageal motility disorders (dysmotility)
Peptic ulcer
Upper GIT malignancies (e.g. oesophagus, stomach, pancreas)
Hepatobiliary disease (e.g. hepatitis, biliary dyskinesia, cholelithiasis)

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6
Q

Diagnoses to consider in dyspeptic
patients

Non GI Causes

A 
Myocardial ischaemia
Drug reaction
Alcohol effect
Somatisation
Anxiety/stress
Depression
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7
Q

What to exclude if excessive flatus

A
  • malabsorption
  • irritable bowel syndrome
  • anxiety → aerophagy
  • drugs, especially lipid-lowering agents
  • lactose intolerance
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8
Q

Dyspepsia or indigestion is a common complaint; ______of the population will have experienced it at some time.

A

80%

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9
Q

Ten per cent of people in the community develop ____

A

peptic ulcer (PU) disease

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10
Q

The pain of _______classically occurs at night

A

duodenal ulcer (DU)

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11
Q

NSAIDs mainly cause gastric ulcers (_______, ________ and ______) with the duodenum
affected to a lesser extent

A

GU, gastric

antrum and prepyloric region

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12
Q

Dyspeptic symptoms correlate poorly with ________

A

NSAID associated

ulcer

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13
Q

_______l discomfort indicates oesophageal
disorders or angina, while__________
suggests disorders of the biliary system, stomach and
duodenum

A

Retrosternal

epigastric discomfort

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14
Q

Character of the pain

• burning pain → \_\_\_\_\_\_\_\_
• constricting pain → ischaemic heart disease or
oesophageal spasm
• deep gnawing pain →\_\_\_\_\_\_\_\_\_\_
• heavy ache or ‘killing’ pain → \_\_\_\_\_\_\_
A

gastro-oesophageal reflux (GORD)

PU

psychogenic pain

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15
Q

Aggravating factors:

• eating fried or fatty foods will aggravate _____
• bending will aggravate_______
• alcohol may aggravate GORD, oesophagitis,
gastritis, PU, pancreatitis

A

biliary disease, functional dyspepsia and oesophageal
disorders

GORD

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16
Q

Most DUs and about two-thirds of GUs have been attributed to________

A

H. pylori infection

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17
Q

Dx of H. pylori

(sensitivity 85–90%, specificity 90–99%); excellent for diagnosis, not for follow-up

A

IgC antibodies

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18
Q

Dx of H. pylori

urea breath test__________

A

(high sensitivity 97% and

specificity 96%), good for follow-up

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19
Q

Dx of H. pylori

stool antigen test ________

A

(sensitivity 96%, specificity 97%)

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20
Q

________during endoscopy can

detect H. pylori through histology or rapid urease testing or H. pylori culture

A

gastric mucosal biopsy

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21
Q

T or F

Regurgitation of feeds because of gastro-oesophageal reflux is an uncommon physiological event in newborn
infants.

A

F

common

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22
Q

Reflux gradually improves with time and usually ceases soon after ______
Most cases clear up completely by the age of ________, when the baby is sitting

A

solids are introduced into the diet.

9 or 10 months

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23
Q

MX of GERD in children

A

The infant should be placed on the left side for sleeping with the head of the cot elevated about 20– 30 degrees

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24
Q

Red flags for Endoscopy

A
  • Anaemia (new onset)
  • Dysphagia
  • Odynophagia (painful swallowing)
  • Haematemesis or melaena
  • Unexplained weight loss >10%
  • Vomiting
  • Older age >50 years
  • Chronic NSAID use
  • Severe frequent symptoms
  • Family history of upper GIT or colorectal cancer
  • Short history of symptoms
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25
Q
  • Usually a metaplastic response to prolonged reflux

* A premalignant condition (adenocarcinoma

A

Barrett oesophagus

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26
Q

Site for Barrett oesophagus

A

Lower oesophagus lined with gastric mucosa (at

least 3 cm)

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27
Q

Dxtics for GERD

A

Endoscopy
• Barium swallow and meal
• 24-hour ambulatory oesophageal pH monitoring

28
Q

What drugs to avoid in GERD

A

anticholinergics, theophylline,

calcium-channel blockers, doxycycline

29
Q

What drugs can cause Pillinduced

oesophagitis

A

especially with tetracyclines, slow-release potassium, iron sulphate, corticosteroids, NSAIDs

30
Q

What antacid to give?

A

best is liquid alginate/antacid mixture e.g. Gaviscon/Mylanta plus 20 mL on demand or 1–2 hours before meals and bedtime

31
Q

SE of NACOs and CAcCO3 antacids

A

Excess is prone to cause
alkalosis—apathy, mental
changes, stupor, kidney
dysfunction, tetany

32
Q

SE of

Aluminium hydroxide_______

Magnesium trisilicate:________

A

Constipation

Diarrhoea

33
Q

SE of

Sodium bicarbonate

A

Alkalosis
Milk alkali syndrome
Aggravation of hypertension

34
Q

SE of

Calcium carbonate:

A

Alkalosis
Constipation
Milk alkali syndrome
Hypercalcaemia

35
Q

What to do with GERD (Step 2) if not responsive to conservative

A

Proton-pump inhibitor (PPI) for 4 weeks
(preferred agent) 30–60 minutes before food

H 2 -receptor antagonists (oral use for 8 weeks) famotidine 20 mg bd

36
Q

Surgery is usually for young patients with severe reflux. The gold standard is a short loose_____

A

360-degree

fundoplication

37
Q

This term applies to the 60% of patients presenting with dyspepsia in which there is discomfort on eating in the absence of demonstrable organic disease

A

Functional (non-ulcer) dyspepsia

38
Q

Categories of Functional (non-ulcer) dyspepsia

A

• ulcer-like dyspepsia
or
• dysmotility-like dyspepsia

39
Q

Ulcer-like dyspepsia MX

A

Treat as for GORD. A practical approach is to
commence with a 4-week trial of a PPI or an H 2 -
receptor antagonist and cease if symptoms resolve

40
Q

WHat is the dx?

  • Discomfort with early sense of fullness on eating
  • Nausea
  • Overweight
  • Emotional stress
  • Poor diet
A

Dysmotility-like dyspepsia

41
Q

Mx of Dysmotility-like dyspepsia

A 
• Treat as for GORD (stage 1).
• Include antacids.
• If not responsive:
— Step 1: H 2 -receptor antagonists
— Step 2: prokinetic agents
42
Q

DU or GU

MC in men?

A

DU

43
Q

NSAIDs 2–4 times increase in ______

A

GU and ulcer

complications

44
Q

What are the different types of ulcers

A

— lower oesophageal
— gastric
— stomal (postgastric surgery)
— duodenal

45
Q

When is PUD ‘silent’

A

May be ‘silent’ in elderly on NSAIDs

46
Q

Investigations for PUD pts

A

• Endoscopy (investigation of choice) :12 92%
predictive value
• Barium studies: 54% predictive value
• Serum gastrin (consider if multiple ulcers)
• H. pylori test

47
Q

MX of bleeding PUD

This can be treated with endoscopic haemostasis with ________.

Also IV omeprazole 80 mg bolus, then 8 mg/hr IV infusion for 3 days

A

heater probe or injection of adrenaline or both

48
Q

What is the diff bet GU and DU MX

A

The treatment of a GU is similar to that for a DU except that GUs take about 2 weeks longer to heal and

the increased risk of malignancy has to be considered

49
Q

What kind of pts do we take caution in PPI

A

• the elderly
• those on drugs, especially warfarin,
anticonvulsants, beta blockers
• liver disease

50
Q

Associations of H. pylori

A 
benign non-drug induced GU), gastric cancer
and maltoma (a gastric lymphoma) because of mucosalinfection.
51
Q

risk of gastric CA in patients with H. pylori

A

gastric cancer in up to 2%.

52
Q

First line of Tx for H. pylori

A 
PPI (e.g. omeprazole or esomeprazole 20 mg)
plus
clarithromycin 500 mg
plus
amoxycillin 1 g

All orally twice daily for 7 days and is the
preferred regimen

53
Q

Alternatives to first line of Tx in H. pylori

PPI + clarithromycin + metronidazole 400 mg
(twice daily for 7 days)—if hypersensitive to
________

A

penicillin

54
Q

What is the quadruple therapy

A

other combinations: quadruple therapy e.g.
bismuth + PPI + tetracycline + metronidazole
(for failed triple combination

55
Q

Resistance to metronidazole is common

(>50%) and to clarithromycin is increasing (about 5% plus) but uncommon with __ and ____

A

tetracycline and

amoxycillin

56
Q

When to offer Sx in pts with H. pylori/PUD

A 
• failed medical treatment after 1 year
• complications:
— uncontrollable bleeding
— perforation
— pyloric stenosis
• suspicion of malignancy in GU
• recurrent ulcer after previous surgery
57
Q

Prevention of NSAID of NSAID Ulcers

A 
esomeprazole 20 mg daily
or
omeprazole 20 mg daily
or
pantoprazole 40 mg daily
58
Q

This is an inflammatory condition with antibodies to

parietal cells and intrinsic factor

A

Autoimmune gastritis 7

59
Q

Cx of Autoimmune gastritis

A

pernicious anaemia

60
Q

SSx of Gastic CA

A 
• Usually asymptomatic early
• Consider if upper GIT symptoms in patients over
40 years, especially weight loss
• Recent-onset dyspepsia in middle age
• Dyspepsia unresponsive to treatment
61
Q

RF for gastric CA

A

↑ age, blood group A, smoking,

atrophic gastritis

62
Q

Tx of GAstric CA

A

• Surgical excision: may be curative if diagnosed early but overall survival is poor

63
Q

______ is a rare but important cause of

oesophagitis

A

Scleroderma

64
Q

Epigastric pain aggravated by any food, relieved by antacids = ______

A

chronic GU

65
Q

A change in the nature of symptoms with a GU suggests the possibility of ______

A

malignant change

66
Q

Avoid the long-term use of ____

A

water-soluble antacids

MC (90 decks)

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