Dyspepsia Flashcards
True or False: Dyspepsia is a condition.
False, it is a symptom.
How can dyspepsia be described by a patient?
- Epigastric pain
- Heartburn
- Indigestion
- Pain/better with eating
Give some diagnosis of having dyspepsia.
- Malignancy
- Gastroenteritis
- Coeliac Disease
- Crohn’s Disease
- IBS
What do we do when patients may have dyspepsia?
Initial Investigation
- Alarm symptoms (Frequency, duration)
- Family (malignancy) and social history (Drinking, smoking, foods)
- Stress, anxiety, depression
- Patients medication
- Examine person: Weight loss, anaemia, abdominal masses/tenderness
- Raised platelet count
When you examine a patient, how do you assess them for signs of anaemia?
- Symptoms: Pallor, fatigue
-> Blood test
Why is it important to check anaemia if a patient is presenting with symptoms like dyspepsia?
It could suggest a GI bleed resulting in the loss of blood.
When a patient is presenting with symptoms like dyspepsia, what does a raised platelet count suggest? What is a raised platelet count called?
Malignancy.
-> Thrombocytosis
A patient who is over the age of 55 and has a new symptom of dyspepsia could possibly have what?
Malignancy -> Referred
True or False: If a patient is presenting with alarm symptoms but they under the age of 55, they shouldn’t be referred.
False. Clinical judgement should be used because even if the patient is slightly younger, they are still presenting with alarm symptoms.
What should patients be referred for if they are presenting with dyspepsia symptoms?
Endoscopy
What are some alarm symptoms?
- Abdominal distension
- Abdominal masses
- Abdominal pain
- Change in bowel habit
- Dyspepsia
- Dysphagia
- Nausea and Vomiting
- Reflux
- Haematemesis
- Rectal bleeding
- Weight loss
- Anaemia
- Raised platelet count
When may patients be referred for endoscopy?
- New dyspepsia symptom
- 55 and over
- Weight loss
- Raised platelet count
- Nausea and vomiting
- Reflux
How can we treat patients with no alarm symptoms?
- Lifestyle counselling: Healthy eating, weight reduction, smoking cessation, alcohol reduction
- Address stress, anxiety, depression
How is a patient diagnosed if they have a dyspepsia symptom but they have not been referred for an endoscopy?
Uninvestigated dyspepsia
How is uninvestigated dyspepsia treated?
One of the following:
- PPI for 4 weeks (lansoprazole, omeprazole)
- H.Pylori test and treat (breath/stool antigen test)
How is a H. Pylori tested?
Breath test:
1. Breathe into tube
2. Take urea tablet
-> H.Pylori will break down urea into ureases
4. Breathe back into tube
5. Positive
How is H.Pylori treated?
2 Antibiotics + 1 PPI
-> 7 days
What should be taken into account before a H.Pylori test?
- Antibiotics completed 28 days prior to test (can give false positive)
- PPIs stopped 14 days before test
- Stop H2RAs 3 days before test
- Can’t eat or drink 6 hours prior to test
Give some examples of PPIs.
- Lansoprazole
- Omeprazole
- Esomeprazole
Give some examples of antibiotics given for H.Pylori.
- Amoxicillin
- Clarithromycin
- Metronidazole
Which 2 antibiotics are usually given if a patient is allergic to penicillin.
- Clarithromycin
- Metronidazole
Which patient group should not be given metronidazole?
Patient’s who are alcohol dependent as it can make them ill.
Which antibiotic interacts with a lot of drugs?
Clarithromycin
If a patient with uninvestigated dyspepsia has had treatment with PPIs and antibiotics and their symptoms don’t improve, what should be done next?
- Assess alarm symptoms
- Alternative diagnosis
- Adherence to lifestyle advice and medications
- Consider H2RAs
- Long-term acid suppression therapy
- Review NSAIDs/antiplatelets
