Dyspepsia Syndromes - Loyd Flashcards Preview

Adult/Ped Medicine 4 > Dyspepsia Syndromes - Loyd > Flashcards

Flashcards in Dyspepsia Syndromes - Loyd Deck (23):
1

Esophageal Cancer

  • progressive dysphagia
  • (rapid) weight loss 
  • GI bleeding

2

Dyspepsia Physical

  • Age
  • Weight/BMI
  • Vitals
  • Inspection: pale
  • Abdominal Exam
    • epigastric tenderness
    • rigidity
    • bowel sounds
    • massess
    • organomegaly
    • abdominal mass
    • weight loss
  • Rectal Exam
    • fecal occult blood
    • rectal tenderness
    • masses

2

Peptic Ulcer Disease

GI Bleed

  • hematemesis, hematochezia, anemia
  • hospitalize
  • more common > 60 years old

Perforation

  • abdominal pain, rigidity, NO bowel sounds
  • abdominal x-rays (EGD and Barium contraindicated)
  • hospitalize, surgical treatment

Penetration

  • erodes into adjacent organs
  • abdominal or back pain
  • nausea and vomiting

Gastric Outlet Obstruction

  • secondary to inflammation and scarring
  • abdominal pain, vomiting

3

Dyspepsia

epigastric pain or burning, early satiety, or postprandial fullness

associated with: heartburn, refulx, regurgitation, indigestion, bloating, post prandial fullness

alarm symptoms: weight loss, dysphagia, recurrent vomiting, evidence of bleeding or anemia                   **refer for an endoscopy**

3

Gastroesophageal Reflux Disease (GERD) Presentation

 

  • Typical Symptoms
  • Atypical Symptoms
  • Alarm Symptoms

Heartburn: retrosternal burning or discomfort after eating

Regurgitation: effortless return of esophageal contents to posterior pharynx

Atypical Symptoms

  • coughing or wheezing
  • chest pain
  • laryngitis
  • OM
  • enamel decay

Alarm Symptoms

  • Anorexia
  • Weight loss
  • Blood in vomit and/or stool
  • Pain produced by swallowing (odynophagia)
  • Difficulty swallowing (dysphagia)
  • Anemia

4

Peptic Ulcer Disease Treatment

  • Discontinue NSAIDs, Aspirin
  • Smoking cessation
  • Minimize alcohol intake
  • Stress reduction

< 45 with NO alarm symptoms

  • Test for H. pylori  
    • +  erradicate 
    •  -  empiric treatment

> 45 or with alarm symptoms

  • EGD indicated

5

H. Pylori Eradication (Positive)

Current 2014 treat for 14 days:

  • Triple Therapy
    • PPI
    • bismuth
    • Clarithromycin
    • Amoxicillin
  • Quadruple Therapy - preferred in areas with high resistnace, pencillin allergy
    • Bismuth
    • PPI
    • tetracycline
    • metronidazole or tindazole

Follow-up/retest to determine efficacy

  • 4 weeks urea breath test
  • 8 weeks stool antigen

6

Dyspepsia: ALARM SYMPTOMS

  • weight loss
  • bleeding
  • older age
  • anorexia
  • fever
  • chest pain
  • early satiety

8

Gastroesophageal Reflux Disease (GERD)

symptoms of mucosal damage produced by abnormal reflux of gastric contents into esophagus

chronic, relapsing

pts may self-treat with OTCs

8

Gastroesophageal Reflux Disease (GERD) Pathophysiology

Lower Esophageal Sphincter (LES) Relaxation most common mechanism for GERD, nueral reflex thru the brain stem

Foods ↓ pressure

Medications ↓ pressure

Hormones ↓ pressure

Obesity ↑ pressure due to ↑ intra-abdominal pressure

Hiatal Hernia

9

Peptic Ulcer Disease

mucosal break 3 mm or greater

usually occurs in areas exposed to acid and pepsin

common cause of dyspepsia and GI bleed

most common patients: GI bleeding - older adults on NSAIDs

10

Gastroesophageal Reflux Disease (GERD) Aggravating  & Alleviating Factors

Aggravating
  • meals
  • laying down
  • bending over

Alleviating

  • sitting up
  • standing
  • antacids

Contributing Factors

  • fatty foods
  • chocolate
  • tomato-based products
  • alcohol
  • caffeiene
  • citrus fruits
  • onion
  • garlic
  • peppers
  • overweight

11

Zollinger-Ellison Syndrome

  1. Peptic Ulcer Disease
  2. Gastric Acid Hypersecretion
  3. Non beta-cell gastrin producing tumor of pancreas

11

Peptic Ulcer Disease

Test for H. pylori

  • urea breath test
  • stool antigen
  • serum IgG antibodies

Labs

  • CBC (anemia, infection)
  • LFTs
  • Amylase/Lipase (pancreatitis)
  • Chem profile

Diagnostic Tests

  • EGD - test of choice can biopsy as well
  • Double contrat barium study

12

Peptic Ulcer Disease: Pathophysiology

1.  H. pylori 

  • continuous gastric inflammation
  • forms ulcers once there is a defect in the mucosa

2. NSAIDS and Aspirin

  • damage mucosa by direct action
  • inhibiting prostaglandin synthesis

3. Cigarrette Smoking

  • increases gastric acid secretion

4. Stress

5. Diet - exacerbates symptoms

6. Associated Disease States

  • COPD
  • cirrhosis
  • renal failure

13

Functional Dyspepsia (Non-Ulcer Dyspepsia = NUD)

patients with chronic epigastric pain without:

  • evidence of organic lesions
  • reflux symptoms
  • dysphagia

treatment:

  • symptomatic: PPIs or H2 blockers prn
  • address psychosocial and lifestyle factors

15

Gastroesophageal Reflux Disease (GERD) Diagnostics

Labs: typically not needed

Diagnostics Needed if:

  • > 50
  • alarm symptoms
  • Barium Study
  • EGD
  • Esophageal Manometry
  • 24-hr pH probe

17

Gastroesophageal Reflux Disease (GERD) Treatment

Lifestyle Modifications
  • lose weight
  • avoid: caffeine, chocolate, citrus, tomato, alcohol
  • wait 3 hours after eating to lay down
  • elevate bed 4-6 inches
  • smoking cessation

Remove Offending Agents

  • NSAIDs
  • Aspirin

Pharmacologic Therapy

  • Anatacids
  • H2 Recptor Antagonists: Rantidine (Zantac), Cimetidine, Famotidine (Pepcid), Nizatidine
  • Proton Pump Inhibitors: Omeprazole, Lansoprazole, Dexlansoprazole, Raberprazole, Esomeprazole, Pantoprazole
  • Prostaglandin E1 Analogue: Misoprotsol
  • Prokinetics: Metaclopramide

18

Gastroesophageal Reflux Disease (GERD) Compications

  • Esophagitis
  • Barret Esophagitis: squamous epithelieum of esophagus replaced by intestinal columnar epithelium
  • Respiratory complications: asthma, pneumonia, fibrosis

19

Peptic Ulcer Disease Physical Exam

  • epigastric tenderness
  • guaiac positive stool

20

Dyspepsia History

PMI:

  • OLD CHARTS
  • look out for alarm symptoms:  weight loss, dysphagia, recurrent vomiting, evidence of bleeding or anemia

PMH:

  • illness
  • prior ulcers
  • medications (NSAIDs, steroids, abx, anticoagulants)

FH:

  •  1st degree relative with peptic ulcer disease

SH:

  • lifestyle, stressors
  • diet/current weight (BMI)
  • alcohol
  • smoking

22

Peptic Ulcer Disease Symptoms

  • epigastric pain: gnawing, burning; 15 mins-3 hours after meals
  • nausea and vomiting
  • heartburn
  • chest discomfort
  • belching
  • bloating
  • distension
  • anorexia
  • weight loss
  • hematemesis

23

H. Pylori (Negative)

  • Proton Pump Inhibitors (PPI)
  • H2 Receptor Antagonists
  • Misoprotosol (Cytotec)
    • inhibits gastric secretion