Dyspepsia (indigestion) Flashcards
(11 cards)
Features
Dyspepsia is a pain burning or discomfort centred in the upper abdomen which is chronic or recurrent in nature.
Functional dyspepsia is a diagnosis of exclusion after normal investigation.
Heartburn is a central retrosternal or epigastric burning sensation that spreads upwards to the throat.
Probability diagnosis
Irritable upper GIT (functional dyspepsia)
Gastro-oesophageal reflux
Gastritis
Oesophageal motility disorder (dysmotility)
Serious disorders not to be missed
Cancer:
- stomach
- pancreas
- oesophagus
Cardiovascular:
- ischaemic heart disease
- congestive cardiac failure
Pancreatitis
Peptic ulcer (PU)
Pitfalls (often missed)
- Myocardial ischaemia
- Food allergy (e.g. lactose intolerance)
- Pregnancy (early)
- Biliary motility disorder
- Other gall bladder disease
- Post vagotomy
- Duodenitis
- Rarities:
- hyperparathyroidism
- mesenteric ischaemia
- Zollinger–Ellison syndrome
- kidney failure
- scleroderma
Masquerades checklist
Depression
Diabetes (rarely)
Drugs, esp. NSAIDs, aspirin
Is the patient trying to tell me something?
Anxiety and stress are common associations of which pts are often unaware.
Consider irritable bowel syndrome.
Key history
what the patient means by ‘indigestion’ or ‘heartburn’.
Note the relationship of the symptoms to eating.
Exclude ischaemic heart disease.
Analyse the presenting symptom;
- site and radiation
- character of discomfort
- aggravating and relieving factors
- associated symptoms.
Drug history and PMHx is important, especially NSAID use.
Key examination
This does not provide the key to the diagnosis, but perform very careful palpation and inspection
Look for evidence of anaemia and jaundice
Key investigations
Do not overinvestigate.
The investigation of choice is gastroscopy, which is indicated for ‘alarm symptoms’ such as ;
- dysphagia
- bleeding
- unexplained weight loss
Test for Helicobacter pylori
Diagnostic tips
Epigastric pain aggravated by any food and relieved by antacids indicates chronic gastric ulcer.
Pain before meals relieved by food indicates chronic duodenal ulcer.
Triple loss of appetite, weight and colour is a feature of cancer of the stomach.
