Dyspepsia

Question 1

What is dyspepsia

Answer 1

It is not a diagnosis but a symptom of upper GIT comprising of pain, bloatedness, early satiety

Question 2

What is characteristic of peptic ulcer disease

Answer 2

Epigastric pain is common symptom
Related to meals
Maybe related to certain drugs.

Question 3

What is characteristic of gastro-oesophageal malignancy

Answer 3

Pain tends to be vague and mild early in the disease but get worse as disease progress. Other symptoms evolve with disease progression

Question 4

What is characteristic of billiary pain

Answer 4

Episodic pain in RUQ, epigastric or substernal which may radiate to right shoulder blade.
* Nausea and Vomiting
* Lasts for about 30 minutes, plateaus within an hour.
* Typical phenotypic features.

Question 5

What is characteristic of pancreatitis

Answer 5

• Epigastric pain radiate to the back
• Usually after alcohol binge
• Relieve by leaning forward
• Chronic pancreatitis: Longstanding alcohol use

Question 6

What are characteristic symptoms of gastro-oesophageal reflux

Answer 6

• Heartburn
• Retrosternal chest pain
• Volume reflux
• Extra-esophageal symptoms

Question 7

Which drugs commonly lead to drug induced dyspepsia

Answer 7

• NSAIDS may cause dyspepsia even in absence of ulcers.
• Cox2 inblibitors
• Calcium channel inhibitors
• Iron tablets
• VitaminD

Question 8

What si characteristic of functional dyspepsia

Answer 8

• Diagnosis of exclusion once all other causes are excluded
• Defined by 2 or more of this symptoms: Postprandid fullness, early satiety, epigastric pain, burning
• Symptoms should have been present for past 3 months
• No evidence of structural disease to explain symptoms

Question 9

What is the pathophysiology of dyspepsia

Answer 9

Gastric emptying:
- Due to impaired gastric accommodation it causes early satiety
- A gastric motility disorder, reduced emptying leads to dilatation and pains

Gastric hypersensitvity:
- Low threshold for pain in response to distention

Helicobacter pylori infection:

Psychosocial dysfunction:
- Common in patients with anxiety disorder

Question 10

What is the approach for dyspepsia

Answer 10

History:
- Heartburn: GERD
- NSAIDS: Drug-induced dyspepsia
- Significant weightloss, anaemia, vomiting, dysphagia: malignancy
- Episodic RUQ pain radiating to scapula: Gall stones

Examination usually normal

Lab tests:
- LFT
- Lipase and Amylase
- FBC
- U&E