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Dyspepsia Flashcards

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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
* Usually a metaplastic response to prolonged reflux | * A premalignant condition (adenocarcinoma
Barrett oesophagus
26
Site for Barrett oesophagus
Lower oesophagus lined with gastric mucosa (at | least 3 cm)
27
Dxtics for GERD
Endoscopy • Barium swallow and meal • 24-hour ambulatory oesophageal pH monitoring
28
What drugs to avoid in GERD
anticholinergics, theophylline, | calcium-channel blockers, doxycycline
29
What drugs can cause Pillinduced | oesophagitis
especially with tetracyclines, slow-release potassium, iron sulphate, corticosteroids, NSAIDs
30
What antacid to give?
best is liquid alginate/antacid mixture e.g. Gaviscon/Mylanta plus 20 mL on demand or 1–2 hours before meals and bedtime
31
SE of NACOs and CAcCO3 antacids
Excess is prone to cause alkalosis—apathy, mental changes, stupor, kidney dysfunction, tetany
32
SE of Aluminium hydroxide_______ Magnesium trisilicate:________
Constipation Diarrhoea
33
SE of Sodium bicarbonate
Alkalosis Milk alkali syndrome Aggravation of hypertension
34
SE of Calcium carbonate:
Alkalosis Constipation Milk alkali syndrome Hypercalcaemia
35
What to do with GERD (Step 2) if not responsive to conservative
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
Surgery is usually for young patients with severe reflux. The gold standard is a short loose_____
360-degree | fundoplication
37
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
Functional (non-ulcer) dyspepsia
38
Categories of Functional (non-ulcer) dyspepsia
• ulcer-like dyspepsia or • dysmotility-like dyspepsia
39
Ulcer-like dyspepsia MX
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
WHat is the dx? * Discomfort with early sense of fullness on eating * Nausea * Overweight * Emotional stress * Poor diet
Dysmotility-like dyspepsia
41
Mx of Dysmotility-like dyspepsia
``` • Treat as for GORD (stage 1). • Include antacids. • If not responsive: — Step 1: H 2 -receptor antagonists — Step 2: prokinetic agents ```
42
DU or GU MC in men?
DU
43
NSAIDs 2–4 times increase in ______
GU and ulcer | complications
44
What are the different types of ulcers
— lower oesophageal — gastric — stomal (postgastric surgery) — duodenal
45
When is PUD 'silent'
May be ‘silent’ in elderly on NSAIDs
46
Investigations for PUD pts
• Endoscopy (investigation of choice) :12 92% predictive value • Barium studies: 54% predictive value • Serum gastrin (consider if multiple ulcers) • H. pylori test
47
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
heater probe or injection of adrenaline or both
48
What is the diff bet GU and DU MX
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
What kind of pts do we take caution in PPI
• the elderly • those on drugs, especially warfarin, anticonvulsants, beta blockers • liver disease
50
Associations of H. pylori
``` benign non-drug induced GU), gastric cancer and maltoma (a gastric lymphoma) because of mucosalinfection. ```
51
risk of gastric CA in patients with H. pylori
gastric cancer in up to 2%.
52
First line of Tx for H. pylori
``` 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
Alternatives to first line of Tx in H. pylori PPI + clarithromycin + metronidazole 400 mg (twice daily for 7 days)—if hypersensitive to ________
penicillin
54
What is the quadruple therapy
other combinations: quadruple therapy e.g. bismuth + PPI + tetracycline + metronidazole (for failed triple combination
55
Resistance to metronidazole is common | (>50%) and to clarithromycin is increasing (about 5% plus) but uncommon with __ and ____
tetracycline and | amoxycillin
56
When to offer Sx in pts with H. pylori/PUD
``` • failed medical treatment after 1 year • complications: — uncontrollable bleeding — perforation — pyloric stenosis • suspicion of malignancy in GU • recurrent ulcer after previous surgery ```
57
Prevention of NSAID of NSAID Ulcers
``` esomeprazole 20 mg daily or omeprazole 20 mg daily or pantoprazole 40 mg daily ```
58
This is an inflammatory condition with antibodies to | parietal cells and intrinsic factor
Autoimmune gastritis 7
59
Cx of Autoimmune gastritis
pernicious anaemia
60
SSx of Gastic CA
``` • 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
RF for gastric CA
↑ age, blood group A, smoking, | atrophic gastritis
62
Tx of GAstric CA
• Surgical excision: may be curative if diagnosed early but overall survival is poor
63
______ is a rare but important cause of | oesophagitis
Scleroderma
64
Epigastric pain aggravated by any food, relieved by antacids = ______
chronic GU
65
A change in the nature of symptoms with a GU suggests the possibility of ______
malignant change
66
Avoid the long-term use of ____
water-soluble antacids

MC (90 decks)

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