Dyspepsia Flashcards
What is dyspepsia?
dyspepsia = indigestion
- refers to discomfort or pain that occurs in the upper abdomen (upper GI tract), often after eating or drinking
= is a symptom not a disease
What are the diagnostic criteria for dyspepsia?
must fulfil one or more of the following:
- bothersome postprandial fullness (after eating)
- bothersome early satiation (feeling full quickly)
- bothersome epigastric pain (upper abdomen)
- bothersome epigastric burning (upper abdomen)
What are the symptoms of dyspepsia?
upper abdominal pain or discomfort heartburn acid reflux bloating belching flatulence intolerance to certain foods
will usually last for 4 weeks or more
What are the causes of dyspepsia?
smoking
- chemicals in cigarettes relax sphincter muscles = affects GIT
alcohol
- irritates mucosal lining
obesity
- puts pressure on the stomach
lifestyle factors
- fatty foods, stress, ageing and psychological factors (anxiety, depression)
pregnancy
- hormones release affect sphincter tone, as baby grows it can also increase pressure on sphincter
What are conditions that can display dyspepsia symptoms?
- diseases that have dyspepsia as a symptom
non-ulcer dyspepsia (functional)
- no cause found
gastritis
- inflammation of the lining of the stomach
gastroesophageal reflux disease (GORD)
- digestive disorder that affects the ring of muscle between your esophagus and your stomach
= stomach acid travels up towards the throat
peptic ulcer disease
- painful sores or ulcers develop in the lining of the stomach or the first part of the small intestine (duodenum)
hiatus hernia
- top part of stomach pushes up into lower chest through a defect in the diaphragm
What questions should be asked when talking to patients about dyspepsia?
who what are the symptoms - dyspepsia (central, heart burn (below the sternum), IBS/diverticulitis (lower) how long what actions have been taken any other medication
severity of pain (dyspepsia is mild-moderate)
any blood present
- black/berry stool = GI bleed and should be referred
vomiting blood
- ulcer/cancer
lifestyle changes
- caffeine, fatty foods, stress
When should patients be referred with dyspepsia?
signs of bleeding
- could be described as coffee grounds in vomit
dysphagia
- indicate a mass blocking oesophagus = swallowing difficulty
unintentional weight loss
- must always refer
persistent vomiting
iron deficiency anaemia - could be an internal bleed epigastric mass (upper abdomen)
refer irrespective of age
- 2 week referral rule
What are differential diagnosis of dyspepsia?
cardiac pain
- frequently mistaken for dyspeptic pain and is often very difficult to distinguish
adverse drug reaction
- NSAIDs, iron, bisphosphonates, corticosteroids can all induce dyspepsia
= most will be taken with proton pump inhibitors to reduce side effects
barrett’s oesophagitis
- flat pink lining of the esophagus that connects the mouth to the stomach becomes damaged by acid reflux, which causes the lining to thicken and become red
IBS
- presents with similar symptoms, especially accompanied by bloating
biliary colic
- gallbladder contracts and causes a gallstone to temporarily block the duct that drains the gallbladder.
cancer
What are lifestyles measures to treat dyspepsia?
lose weight stop smoking reduce alcohol intake avoid fatty foods and caffeine raise head when sleeping - do not use pillows, instead place books underneath bed frame avoid tight fitting clothes leave two hours between eating and bedtime
What pharmacological treatments for dyspepsia?
alginates
- gaviscon
antacids
- rennie
H2 antagonists
- cimetidine (tagamet), famotidine
proton pump inhibitors
- omeprazole (zanprol), pantoprazole (pantoloc)
How do alginates work? What are examples?
Gaviscon (sodium alginate) = 1st line treatment
- forms a raft on stomach contents (physical barrier by forming an alkaline layer)
- provides symptomatic relief from reflux
- protects from gastric mucosa
How do antacids work? What are examples? What are side effects?
Rennie (contain calcium and magnesium carbonate), Tums
- neutralises stomach acid (are alkaline)
- is fast acting (1 hour)
can impair absorption of other drugs
side effects
- aluminium salts = constipation
- magnesium salts = diarrhoea
How do H2 antagonists work? What are examples? What are side effects?
Cimetidine (tamaget) and Famotidine (Zantac)
- block histamine H2 receptors on parietal cells
- suppresses acid secretion
- fast acting (1 hour)
short term treatment only
must be over 16 yrs
cimetidine has many side effects
- inhibits the hepatic metabolism of the other drugs by binding to microsomal cytochrome PY450
= results in interactions with several drugs
How do proton pump inhibitors work? What are examples? What are side effects?
Omeprazole (Zanprol 10mg), Pantoprazole (Pantoloc)
- blocks hydrogen potassium adenosine triphosphatase (H-K ATPase) enzyme system
- inhibits acid secretion
for short term use only
- maximum 4 weeks use before referral
Why is GORD common in children? How long does it occur for?
gastroesophageal reflux disease
the sphincter muscle is not mature in young babies
- there is no actual muscle to prevent the backflow/reflux of the feed
- as a mixture of food/drink/acid travels back up, it can irritate the lining of the GI tract, making it sore
common in the first few weeks and months of life
- gradually improves
