Chapter 20, Module 7; Heartburn and Indigestion Flashcards

1
Q

Infants: Spitting up 3-5 times a day
Adults: Pain occurs after a meal and lasts a few minutes
No other symptoms

A

GER

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2
Q

PHYSICAL FINDINGS OF GER?

A

NONE

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3
Q

DIAGNOSTIC STUDIES FOR GER?

A

NONE

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4
Q

Heartburn, pyrosis Possible extraesophageal symptoms, laryngitis, wheezing, cough Infants: Weight loss, arching of back, vomiting, irritability

A

GERD

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5
Q

PHYSICAL FINDINGS OF GERD ARE?

A

None
Possible wheezing with asthma
Obesity
Growth chart change

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6
Q

DIAGNOSTIC STUDIES FOR GERD?

A

Trial of antacids
Trial of PPI
pH monitoring
Endoscopy for refractory symptoms to rule out erosions

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7
Q

Odynophagia, dysphagia, retrosternal pain; possible fever, nausea, and vomiting

A

Infective esophagitis

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8
Q

PHYSICAL FINDING OF Infective esophagitis?

A

None

Possible fever

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9
Q

DIAGNOSTIC STUDIES FOR Infective esophagitis?

A

Endoscopy: ulcerations, exudates

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10
Q

Young children and adolescents: Dyspepsia, heartburn, vomiting, irritability, food refusal, early satiation
Adults: Heartburn, epigastric or chest pain, dysphagia, and food impaction
Personal or family history of allergic disorders

A

AEE

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11
Q

PHYSICAL FINDINGS ARE AEE?

A

None

Possible allergic rhinitis, atopic dermatitis

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12
Q

DIAGNOSTIC STUDIES FOR AEE?

A

Endoscopy: linear furrowing and multiple rings

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13
Q

Medication history: tetracycline, potassium chloride, ferrous sulfate, NSAIDs, and bisphosphonates Takes medication at bedtime with insufficient water, and/or lying down directly after taking Acute discomfort followed by progressive retrosternal pain

A

Pill esophagitis

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14
Q

PHYSICAL FINDINGS FOR Pill esophagitis?

A

NONE

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15
Q

DIAGNOSTIC STUDIES FOR Pill esophagitis?

A

Endoscopy: focal lesion

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16
Q

Burning retrosternal discomfort or pain Symptoms present for the last 3 mo

A

Functional heartburn

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17
Q

PHYSICAL FINDINGS FOR Functional heartburn?

A

NONE

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18
Q

DIAGNOSTIC STUDIES Functional heartburn ?

A

Endoscopy

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19
Q

Pain in epigastrium or lower chest that worsens on reclining; relieved on standing Pain may be retrosternal with radiation down left arm

A

Hiatal hernia

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20
Q

PHYSICAL FINDINGS FOR Hiatal hernia?

A

None
Large hernia may create dullness on percussion over the left lung base, absent breath sounds, or bowel sounds resent in the chest

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21
Q

DIAGNOSTIC STUDIES Hiatal hernia?

22
Q

Episodic gnawing or epigastric pain usually 2-5 hr after meals or on empty stomach Nighttime awakening because of pain; symptom relief with food intake, antacids, or antisecretory agents Fullness, bloating, early satiation, vomiting, indigestion, loss of appetite, heartburn, hematemesis, back pain, and unexplained weight loss Medication history: NSAIDs, aspirin, high dose corticosteroids, bisphosphonates, mycophenolate, potassium chloride, and fluorouracil Children may present with generalized abdominal pain Older patients may be asymptomatic, but may also present with nonspecific complaints including confusion, restlessness, abdominal distention, and falls

23
Q

PHYSICAL FINDINGS OF PUD?

24
Q

DIAGNOSTIC STUDIES PUD

A

Endoscopy: ulcers; H. pylori testing CBC if suspect anemia FOBT for bleeding

25
Alarm  symptoms:  dysphagia  (solids or  liquids),  odynophagia,  anorexia, and  unintentional  weight  loss Repeated  exposure  to  irritants  such as  smoking,  alcohol History  of  Barrett  esophagus
Esophageal cancer
26
PHYSICAL FINDINGS Esophageal cancer?
Advanced  disease:  cachexia, ipsilateral  Horner  syndrome (miosis,  ptosis,  absence  of sweating  on  ipsilateral  face and  neck),  supraclavicular adenopathy,  hoarseness, halitosis
27
DIAGNOSTIC STUDIES Esophageal cancer?
Endoscopy
28
Dyspepsia  unrelieved  by  antacids, epigastric  discomfort,  usually lessened  by  fasting,  and  exacerbated  by  food  intake  and  early satiation Alarm  symptoms  of  dysphagia, anorexia,  and  weight  loss
Gastric  cancer
29
PHYSICAL FINDINGS Gastric  cancer?
Epigastric  swelling  or  mass  may be  present  on  palpation Advanced  disease:  cachexia, palpable  left  supraclavicular (Virchow)  node,  palpable  hard lymph  node  in  umbilicus A  hard,  nodular  liver  indicates metastatic  disease May  be  pale  from  anemia Ascites,  pleural  effusions  may indicate  metastasis
30
DIAGNOSTIC STUDIES Gastric  cancer?
Endoscopy +  FOBT
31
Dyspepsia  with  abdominal  pain, indigestion,  heartburn,  and epigastric  discomfort  that  is worse  after  eating,  loss  of  appetite,  sense  of  fullness,  nausea, occasional  vomiting,  burning  or gnawing  feeling  in  the  stomach between  meals  or  at  night Excessive  alcohol  use,  chronic vomiting,  stress,  or  the  ingestion of  aspirin,  NSAIDs,  or  steroid. Bile  gastritis  can  occur  after  partial gastrectomy,  truncal  vagotomy and  pyloroplasty  for  peptic  ulcer reflux,  or  cholecystectomy Bile  reflux  can  cause  severe  epigastric  abdominal  pain,  accompanied by  bilious  vomiting,  and  weight loss
Gastritis
32
PHYSICAL FINDINGS Gastritis?
Possible  epigastric  tenderness
33
DIAGNOSTIC STUDIES Gastritis
Endoscopy  for  patients with  alarm  features  or persistent  symptoms Additional  workup  may include  testing  for H.  pylori CBC  if  anemia  suspected FOBT  for  bleeding
34
Epigastric  pain  or  burning  with postprandial  fullness,  early satiation Symptoms  for  3-6  mo
Dyspepsia
35
PHYSICAL FINDINGS Dyspepsia ?
Dyspepsia
36
DIAGNOSTIC STUDIES Dyspepsia?
Endoscopy:  for  patients 55  yr  and  older,  those with  weight  loss,  progressive  dysphagia,  recurrent vomiting,  evidence  of  Gl bleeding,  or  family  history of  cancer,  new-onset dyspepsia H.  pylori  testing:  patients 55  yr  and  younger  with¬ out  alarm  features
37
Risk  factors:  excessive  amounts of  caffeine  or  alcohol,  smoking, steroids,  NSAIDs,  living  in  an  area with  high  prevalence  of  H.  pylori
Functional dyspepsia (nonulcer dyspepsia)
38
PHYSICAL FINDINGS Functional dyspepsia (nonulcer dyspepsia)?
NONE
39
DIAGNOSTIC STUDIES Functional dyspepsia (nonulcer dyspepsia)?
H.  pylori  testing Testing  for  structural disease,  negative findings
40
Abdominal  discomfort,  vague  feelings  of  indigestion;  abdominal bloating,  belching,  chest  pain Ingestion  of  flatulogenic  foods, Gl  stasis,  constipation,  malabsorption,  air  swallowing  (aerophagia),  hurried  eating  or  drinking, smoking  or  chewing  gum,  poorly fitting  dentures,  or  dry  mouth from  anxiety  or  anticholinergics Pain  worsens  by  bending  over  or wearing  tight  garments  and  is relieved  by  passage  of  flatus
Gas/gas entrapment
41
PHYSICAL FINDINGS OF Gas/gas entrapment?
Possible  distended  abdomen with  hyperresonance  on percussion
42
DIAGNOSTIC STUDIES OF Gas/gas entrapment?
NONE
43
Severe,  oppressive,  constricting, retrosternal  discomfort  lasting longer  than  30  min Possible  prior  history  of  Ml  or angina
Acute  coronary insufficiency
44
PHYSICAL FINDINGS OF Acute  coronary insufficiency?
Possible  abnormal  heart  sounds such  as  paradoxical  S2  during pain;  transient  S3  (ventricular gallop)  or  mitral  regurgitation murmur  at  the  apex;  S4  (atrial gallop)
45
DIAGNOSTIC STUDIES OF Acute  coronary insufficiency?
ECG:  intermittent  ischemic changes  or  normal Cardiac  isoenzymes normal
46
Chest  pain  typically  described  as substernal  chest  pressure  or heaviness,  radiating  to  the left  shoulder  and  arm,  neck, or  jaw Onset  brought  on  and  exacerbated by  exercise  and  stress;  typically lasts  2  to  10  min Alleviated  with  rest  and/or nitroglycerin
Stable  angina
47
PHYSICAL FINDINGS OF Stable  angina?
Possible  diaphoresis  and shortness  of  breath Transient  S4  gallop  during  an episode  of  pain
48
DIAGNOSTIC STUDIES OF Stable  angina?
ECG  during  an  episode of  pain;  ST  segment depression  and  T  wave inversions,  or  the  findings can  be  normal
49
Sudden  onset  of  pain  at  rest Persistent,  often  severe,  deep, central  chest  pain;  and  may radiate  to  the  throat  or  neck, across  both  sides  of  the  chest to  the  shoulder,  and/or  down  the medial  aspect  of  either  or  both arms Nitroglycerin  does  not  relieve  the pain Possible  sense  of  impending doom Risk  factors:  Men  45  yr  and older;  women  55  yr  and  older; cigarette  smoker;  hyperlipidemia; hypertension;  diabetes;  obesity; history  of  CAD;  family  history of  CAD
Ml
50
PHYSICAL FINDINGS OF Ml?
Skin  pallor,  cool  diaphoretic  skin Hypertensive  or  hypotensive Possible  transient  paradoxical S2  or  abnormal  rhythms including  tachycardia  and bradycardia
51
DIAGNOSTIC STUDIES OF Ml?
ECG:  ST  segment  elevations,  T  wave  inversions, and  Q  waves Cardiac  enzymes  elevated