32. Dyspepsia (13%)

Question 1

In a patient presenting with dyspepsia, include what disease in the differential diagnosis?

Answer 1

include cardiovascular disease in the differential diagnosis.

Question 2

Define : Dyspepsia (3)

Answer 2

One of the following symptoms
* Postprandial fullness
* Early satiation
* Epigastric pain

Question 3

Name Precipitating factors : Dyspepsia (4)

Answer 3

• NSAID/ASA
• smoking
• alcohol
• high fat meals

Question 4

Describe : H pylori associated with dyspepsia (5)

Answer 4

• but treatment does not necessarily improve symptoms
• Incidence 20-40% in Canada
• Higher in First Nations (>50%)
• Lower in children born in Canada.
• Risk of ulcer (10-20% vs. 1-2%) and gastric cancer (33% relative reduction)

Question 5

Name DDX : Dyspepsia ()

Answer 5

• Functional/IBS (no organic cause) - 60%
• Peptic ulcer disease - 25%
• GERD
• GI Malignancy
• Drug-induced dyspepsia (NSAIDs and COX-2 inhibitors)
• Other: Celiac, chronic pancreatitis, gastritis, Crohn’s, cardiac

Question 6

Describe : Peptic ulcer disease (3)

Answer 6

• Upper abdominal pain prominent, back pain atypical
• Gastric worse with food, Duodenal better with food
• Postprandial belching, epigastric fullness, early satiation, N/V

Question 7

Name sx/signs : GI Malignancy

Answer 7

• Age
• Dysphagia, odynophagia
• Systemic signs (anemia, fatigue, weight loss)

Question 8

Name redflags : Dyspepsia

Answer 8

(VWBAAAD)

• Vomiting
• Weight Loss (Involuntary)
• Blood loss (melena, hematemesis, anemia)
• Age >50
• Anemia
• Abdominal mass or lymphadenopathy
• Dysphagia, odynophagia, early satiety
• Family history of upper GI cancer

Question 9

Describe physical exam : Dyspepsia (3)

Answer 9

• Carnett’s sign: Abdominal tenderness on muscle tensing (positive test), suggests abdominal wall pain rather than viscera
• Lymphadenopathy (left supraclavicular, periumbilical)
• Palpable abdominal mass (hepatoma), jaundice (liver mets), pallor (anemia)