Clinical Approach to GI Patient: Dyspepsia and Heartburn Flashcards
DDx for Dyspepsia/Heartburn/Indigestion?
- GERD
- Gastritis
- PUD
GERD Etiology? Risk factors?
- Motility disorder in which the LES allows stomach acid to reflux
- Increased abdomen girth and obesity
- Pregnancy
- Hiatal hernia/Scleroderma/ZES
- Fat rich diet/Caffiene/ Smoking/Alcohol
GERD Typical symptoms?
- Pyrosis
- Relationship to meals ~30 to 60 min after eating
- Sx when reclined
- Epigastric pain
- N/V
- Fullness
Atypical Extraesophageal manifestations of GERD?
- Chronic cough
- Laryngitis
- sleep apnea
- dental caries
What are the “alarm features” of GERD?
- Constant severe pain
- Dysphagia/Odynophagia
- Unexplained weight loss
- Persistent vomiting
- Melena
- Hematemesis
GERD diagnosis and treatment?
- Based on presentation, hx, and PE
- consider H.pylori testing and Hbg and Hct
- Empiric treatment if no alarm features
- trial of acid suppression and lifestyle modification
GERD complication?
Barret’s esophagus leading to esophageal adenocarcinioma
Acute gastritis etiology?
- Inflammatory changes in the gastric mucosa classified as erosive or non erosive
- non erosive usually caused by H.pylori
- Alcohol, medications, cocain, ischemia, viral, H.pylori, stress, radiation or allergy
Hx and PE of Acute Gastritis?
- Abdominal pain
- N/V
- anorexia
- Belching
- Bloating
- PE likely normal
Diagnosis and Treatment and complications of Acute Gastritis?
Dx:
- EGD with biopsy and H.pylori testing
Tx:
- Endoscopy intervention if bleeding
- PPI
- Treat/avoid underlying cause
- Avoid smoking/caffiene
- Treat H.pylori
Complication:
- PUD
- Bleeding
Chronic gastritis etiology
- Lymphocyte and plasma cell infiltrationi
- Autoimmune (type A in the fundus)
- loss of rugae
- Common in elderly
- Abs to parietal cells
- Anti intrinsic factor Abs
- H. pylori (Type B antrum of stomach) most common
Diagnosis of Chronic Gastritis Type B?
- Detection of H.pylori
- Fecal Ag test is sensitive
- Urea breath test
- IgA Abs in serum
- Upper endoscopy
Diagnosis of Chronic Gastritis Type A?
- CBC
- Serum B12
- IF abs
- Parietal cell Abs
Tx of type A and type B chronic gastrits?
A:
- Parenteral B12
B:
- Eradication of H.pylori
Complications of chronic gastritis type A and B?
Both:
- Increased risk gastric adenocarcinoma
A:
- Achlorhydria leading to hypergastrinemia leading to 5% of patients to develop carcinoid tumors
- Pernicious anemia
B:
- MALT lymphoma
How do you detect H.yplori?
- Fecal Ag test
- Urea breath test
- IgA abs
- Upper endoscopy with biopsy
Associations and compications with H. pylori?
- Gastritis can lead to atrophic gastritis and gastric cancer
- adenocarcinoma
- MALT lymphoma
Gastric Peptic Ulcer etiology and Risk factors?
- Primarily in lesser curvature of the antrum of stomach
- H. pylori (up to 75%)
- Smoking increases risk
- Risk factors for developing ulcers:
- Glucocorticoids
- Chronic NSAIDS
Hx and PE of Gastric Peptic Ulcer?
- Can be asymptomatic
- Dyspepsia
- Burning epigastric pain Within 30 min of eating food, symptoms worsen leading to food aversion
- Nausea
- Anorexia leading to weight loss
- Bloating
- Epigastric abdominal pain
Diagnosis of Gastric Peptic ulcer?
- EGD with biopsy (exclude malignancy)
- Hemoglobin/Hematocrit (anemia?)
- BUN/Creatinine (UGIB = increase in BUN)
- X-ray/CT/MRI if suspected perforation
- Nasogastric lavage considered
- DETECT H PYLORI
Treatment and Complications of Gastric PUD
Where is a duodenal peptic ulcer located? Causes?
- Anterior wall of proximal duodenum
- arise due to decreaSed mucosal protection and increased acid production
- 90-95% due to H.pylori
Hx and PE of Duodenal peptic ulcer?
- Burning Gnawing epigastric pain 1-3 hours after meal
- Relieved by food possibly leads to weight gain
Diagnostics of Duodenal PUD?
- EGD with biopsy
- Hbg and Hct
- BUN Creatine
- X ray CT MRI if suspect perforation
- Nasogastric lavage considered
- Negatve for blood does NOT rule out post pyloric DU
