dyspepsia

Question 1

dyspepsia

Answer 1

postprandial fullness, early satiation, epigastric pain or burning

Question 2

causes of dyspepsia

Answer 2

20% by peptic ulcer dis

other common cuases: GERD, functional dyspepsia

Question 3

peptic ulcer disease

Answer 3

mucosal damage secondary to pepsin and gastric acid secretion

usu in stomach and proximal duodenum

Question 4

alarm symptoms that would prompt you to get upper GI endoscopy

Answer 4

unintentional weight loss
progressive dysphagia
recurrent vomiting
odynophagia
unexplained anemia
GI bleeding
family hx of cancer, or cancer of upper GI
hx of gastric surgery
jaundice

Question 5

early diagnostic endoscopy should be considered in whom?

Answer 5

pts w/ new onset dyspepsia >55 or who have symptoms possibly associated w upper GI malignancy

Question 6

what type of ulcers are more common?

Answer 6

duodenal

but gastric are more common in NSAID users`

Question 7

risk factors for PUD

Answer 7

H pylori
NSAIDs
cigarettes
personal or family hx of PUD

Question 8

testing for H pylori

Answer 8

stool antigen-now preferred
serologic testing for anti-H pylori antibodies (can’t distinguish active from treated infec)

urea breath testing (to confirm active infection or eradication after tx)

gold standard: endoscopy with biopsy testing for H pylori

Question 9

management of suspected PUD

Answer 9

CBC for anemia
basic chemistry studies (if person hasn’t been eating or has been vomiting)

liver enzymes, amylase, lipase (when biliary or pancreatic dis suspected)
EKG (if cardiac cause suspected)
upright CXR (for possible adb perf)
abd US (if suspect gallstones)
preg test (on reproductive age women)
cervical cultures (if suspect infec)

dyspepsia in pts younger than age 55 yrs w/o alarm symptoms–noninvasive H pylori test and treatment

pts older than 55 or with alarm symptoms: upper GI endoscopy to exclude malignancy. if older than 50, should also get colonoscopy

Question 10

classic symptoms of PUD

Answer 10

epigastric abd pain improved w eating

or pain that develops few hrs after eating