CT 2.3 Dyspepsia

Question 1

what are the common causes of dyspepsia

Answer 1

functional dyspepsia (as high as 75%)

GORD

• peptic ulcer disease
• HPB = gallstones

exclude other systems other than GI aswell
eg metabolic hypercalcemia + PTH
CNS - N+V
cardiac
MSK

Question 2

for a diagnosis of gord to be made what is required

Answer 2

an OGD:

oesophagitis may be seen due to mucosal erosive disease
is classified by LA criteria and must be bad enough to C or D grade oesophagitis

peptic stricture

baretts oesophagus

biopsy proven reflux changes

Question 3

what are atypical symptoms of gord

Answer 3

chest pain
dysphagia
odynophagia
globus

Question 4

what are extra-oesophageal symptoms of gord

Answer 4

cough
hoarseness
wheeze
dentition

Question 5

symptoms of peptic ulcer disease

Answer 5

epigastric pain/dyspepsia

Question 6

what are complications of peptic ulcer disease

Answer 6

haemorrhage
perforation
gastro-oesophageal outlet obstruction
stricture

Question 7

which ulcers are more common

Answer 7

duodenal

M>F pattern

higher rates of ulcers in those with h.pylori infection

Question 8

what are causes of PUD

Answer 8

h.pylori
NSAIDs
gastric cancer

triad makes up more than 90% of cases

other rarer causes include:
- zollinger ellison syndrome
-stress (burns,trauma etc)
- crohns/sarcoidosis
-MEN1
-ischaemic

Question 9

what tests for h.pylori infection

Answer 9

• stool antigen test
• rapid urease test (on biopsy)
• histological on biopsy
• urea breath test
• serological test ( for antibodies against bacteria)

Question 10

what is the treatment for h.pylori eradication

Answer 10

triple therapy

PPI - lansoprazole
amoxicillin (use metronidazole if allergic)
clarithromycin

7 or 14 days

Question 11

what criteria is used when making a diagnosis of functional dyspepsia

Answer 11

rome IV
- post prandial fullness
- early satiety
- epigastric pain or burning

one of above for at least 3 months with an onset of at least 6 months ago

is also used for IBS as both are diagnoses of exclusion

Question 12

what treatment options are available for functional dyspepsia

Answer 12

test + treat for H.pylori

PPI

TCA/SSRI

prokinetics

low FODMAP diet, CBT

Question 13

complications of gallstones

Answer 13

• acute cholecystitis
• empyema
• perforation
• cholangitis
• pancreatitis
• mirizzi syndrome

Question 14

what is mirizzi syndrome

Answer 14

rare condition in which gallstones lodged in the cystic duct or neck of the gallbladder cause external compression of the common hepatic duct, leading to obstruction and jaundice. It is associated with inflammation, scarring, and, in some cases, fistula formation between the gallbladder and bile ducts.