Case 8: Dyspepsia Flashcards
What is dyspepsia?
Recurrent epigastric pain or symptoms of acid regurgitation leading to bloating.
What are some other terms for dyspepsia?
- Heart burn
- Acid reflux
What are some of the causes of dyspepsia?
- Oesophageal reflux
- GORD
- Gastroenteritis
- Gastritis
- Functional dyspepsia
- Peptic Ulcer disease
- Stress
- Coeliac disease
- Inflammatory bowel disease
- Gallbladder disease
- Coronary heart disease
- Upper GI malignancies
What are the symptoms of Oesophageal reflux?
- Burping
- Excess saliva production (water brash)
What does GORD stand for?
Gastro-Oesophageal Reflux Disease
What is gastroenteritis and what are its symptoms?
Inflammation of stomach and bowels caused by infection (e.g. rotavirus or salmonella)
- Fever
- Vomiting
- Watery, loose Diarrhoea
What is gastritis?
Inflammation of stomach lining which can be caused by infection, excess alcohol etc.
What is the difference between gastritis and gastroenteritis?
Gastritis is inflammation of solely the stomach lining and symptoms include vomiting and pain. It does NOT include diarrhoea, unlike Gastroenteritis.
What type of pain is common in gallbladder disease?
Colicky pain
What is colicky pain?
Pain that comes in spasms due to gallstones/wind/intestinal obstruction.
What are the symptoms of upper GI malignancies? FLAWS
- Weight loss
- Bleeding (anaemia)
- Palpable mass
- Haematemesis (blood in vomit)
- Dysphagia (inability to swallow)
- Upper abdominal pain
- Odynophagia (pain upon swallowing)
F
Lethargy
Anaemia
Weight loss
Sweat at night
What are indicators of serious underlying conditions/pathology called?
Red flag symptoms
When is an urgent (2-week-wait) referral considered for a person with suspected upper GI cancer?
If they have an upper abdominal mass consistent with stomach cancer
When is an urgent upper GI endoscopy offered?
For people
- with dysphagia
or
- aged 55 with weight loss and either upper abdominal pain, reflux or dyspepsia.
When is non-urgent upper GI endoscopy offered?
- For people with haematemesis
- For people >55 with treatment resistant dyspepsia/ low Hb levels with abdominal pain/ raised platelet count with dyspepsia or pain/ nausea with other cancer symptoms
What basic investigations are carried out for a patient reporting heartburn?
- Stool antigen test
- FBC
- ECG
- Weight check
- Thorough alcohol history
- Liver function test (opportunistic test for those with high alcohol intake)
- Medication history
What is the stool antigen test for?
Testing for H. pylori
What is the purpose of conducting a full blood count?
To check for HB levels and platelets.
If anaemia is discovered, it could be a sign of GI bleeding or reduced erythropoiesis.
What is the recommended alcohol intake for both men and women?
14 units per week, evenly distributed
Why is medication history important?
Over the counter drugs, beta blockers and calcium channel inhibitors can all loosen the lower oesophageal sphincter, increasing likelihood of acid reflux.
When would a digital rectal examination be done?
If malaena (blood in stool) is found
What can H-pylori cause?
- Gastritis
- Peptic Ulcer disease
- Gastric malignancies (e.g. adenocarcinoma, MALT lymphoma)
How can it cause inflammation?
- Acid neutralisation
- Locomotion
- Adherence to host cell
- Release of toxins
What viral enzyme is responsible for acid neutralisation (1st step)?
UREASE.
Urea + H20 -> Ammonia + CO2
Why is acid neutralisation important?
Although H. pylori can survive in acid, it is not an acidophile so needs to enter the mucosa swiftly.
How does H. pylori move into the mucosa (2nd step)?
Via its flagella
How does it adhere to host cells (3rd step)?
Via
- BabA
- Lipopolysaccharides (LPS)
What toxins can H. pylori release?
- cagA
2. vacA
How does cagA cause inflammation?
It disrupts tight junctions b/w cells -> inflammation