B1 Dyspepsia

Question 1

What are the four main dyspepsia ailments?

Answer 1

1. GORD (Gastro-oesophageal reflux disease)
2. Gastritis (inflammation)
3. Peptic Ulceration
4. Zollinger-Ellison syndrome

Question 2

What is GORD?

Answer 2

The reflux of acidic stomach contents into the oesophagus
Patients complain of indigestion, burning feeling after eating, worsened by bending forwards, may be reflux of gastric contents into the mouth

Question 3

What are the causes of GORD?

Answer 3

A weak lower oesophageal sphincter

Some drugs are responsible for weakening the sphincter muscle

Question 4

What is gastritis and what can cause it?

Answer 4

Inflammation/irritation of stomach lining, can be caused by infection, NSAIDs and alcohol.
Gastritis can lead to peptic ulceration

Question 5

What is the most common form of peptic ulceration?

Answer 5

Duodenal ulceration

Question 6

What is the main cause of duodenal ulceration and gastric ulceration?

Answer 6

80-90% patients have an Helicobacter pylori infection (Gram -ve)

Question 7

What is the second most common cause of gastric ulceration?

Answer 7

70% patients have gastric ulcers induced by NSAID use

Question 8

What is Zollinger - Ellison syndrome?

Answer 8

Tumour that secretes gastrin hormone leading to increased gastric acid release

Question 9

What are symptoms?

Answer 9

A clinical change in a person that could suggest disease - perceived by that person. (PC = presenting complaint)

Question 10

What are signs?

Answer 10

A clinical change in a person that may be observed by a clinician and indicate a disease (OE = on examination)

Question 11

What could chest pains indicate in a patient?

Answer 11

Often muscoskeletal
Respiratory
Gastric origin - indigestion, GORD, relationship to food? Relieve by antacids?
Angina - induced by exercise, emotion, stress, pains down arm? Pain radiating to jaw? Relieved by rest or GTN Diagnosed by history, ECG changes
Heart attack - severe, no relieved by rest or GTN, nausea breathless, pains down arm/jaw? diagnosed by ECG changes or cardiac enzymes

Question 12

What could cause indigestion?

Answer 12

Acid stomach/dyspepsia?
Overeating 
Reflux oesophagitis 
Peptic ulcer
Stomach cancer (over 55yrs raises suspicion/warning sign)
Cardiac origin?

Question 13

Signs and symptoms of peptic ulceration?

Answer 13

1. Epigastric pain that can be identified by patient
2. Hunger pain, relieved by eating
3. Night pain relieved by food milk or antacids
4. Waterbrash - appearance of water in mouth
5. Nausea and less frequently vomitting
6. Vomitting blood (serious / red flag)

Question 14

Questions to ask in dyspepsia queries

Answer 14

Symptoms
Precipitating factors
Relieving factors 
Medicines tried 
Medication taken at present / past

Question 15

Warning signs when presented with dyspepsia symptoms

Answer 15

Aged over 55 years
Weight loss
Anaemia
Dysphagia (difficulty swallowing)
Haematemesis (vomiting blood)
Melaena (tarry stools)
Upper abdominal masses 
Persistent symptoms and repeat requests for OTC medicines

Question 16

Goals of treatment

Answer 16

Symptomatic relief or cure - may involve lifestyle changes e.g. avoiding causative drugs or foods, smoking cessation, GORD - propping up in bed and removing belts
Suppression of acid release or activity, and mucosal protection (PPI) allows natural healings
Eradication of H. pylori infection if necessary