Dyspepsia Flashcards
What is meant by dyspepsia?
Indigestion - Dyspepsia describes symptoms such as discomfort, bloating and nausea, which are thought to originate from the upper gastrointestinal tract.
What are common oesophageal symptoms of dyspepsia?
Heartburn
Odynophagia
Dysphagia
What are common gastroduodenal symptoms of dyspepsia?
Epigastric pain or discomfort
Nausea + vomitting
Bloating / Belching
What are common general symptoms of dyspepsia?
Appetite
Weight changes
Odynophagia
Pain when swallowing
What are the clinical signs of dyspepsia?
Often minimal clinical signs: Pallor Enlarged cervical lymph nodes Abdominal tenderness Abdominal masses Abdominal scars
What is the common cause of oesophageal dyspepsia?
GORD
GORD
Gastro-oesophageal reflux disease
What are some of the gastroduodenal causes of dyspepsia?
Peptic ulceration
Gastric cancer
Functional dyspepsia
What other other causes that can cause dyspepsia separate from the gastrointestinal tract.
Biliary diseases such as gallstones
Pancreatic diseases
Heart diseases
What are the ‘ alarm’ features of dyspepsia?
- Weight loss
- Anaemia
- Vomiting
- Haematemesis and/or melaena
- Dysphagia
- Palpable abdominal mass
Haematemesis
Haematemesis is the vomiting of blood, either bright or altered blood (so-called ‘coffee grounds’ vomitus), due to the action of acid on the blood.
Melaena
Melaena is the passage of black tarry stools containing blood.
Summary of GORD - read not memorise.
Heartburn describes retrosternal, burning discomfort, often rising up into the chest and sometimes accompanied by regurgitation of acidic or bitter fluid into the throat. These symptoms often occur after meals, on lying down or with bending, straining or heavy lifting. They are classical symptoms of gastro-oesophageal reflux but up to 50% of patients present with other symptoms, such as chest pain, belching, halitosis, chronic cough or sore throats. In young patients with typical symptoms and a good response to dietary changes, antacids or acid suppression investigation is not required, but in patients over 55 years of age and those with alarm symptoms or atypical features urgent endoscopy is necessary.
What investigations are carried out for a patient with dyspepsia?
Oesophagoduodenogastroscopy
What hormones, neurotransmitters and substrates are involved in gastric acid secretion and what is their effect?
- histamine (a stimulatory local hormone)
- gastrin (a stimulatory peptide hormone)
- acetylcholine (a stimulatory neurotransmitter)
- prostaglandins E 2 and I 2 (local hormones that inhibit acid secretion)
- somatostatin (an inhibitory peptide hormone)
How does somatostatin affect gastric acid secretion?
Exerts paracrine inhibitory actions on gastrin release from G cells, histamine release from ECL cells, as well as directly on parietal cell acid output.
How do Prostaglandins affect gastric acid secretion?
Prostaglandins E 2 and I 2 inhibit acid, stimulate mucus and bicarbonate secretion, and dilate mucosal blood vessels.
Which prostaglandins inhibit gastric acid secretion?
E2 and I2
What are the pre-disposing factors for GORD?
Obesity Smoking Alcohol Fatty / Spicy foods Lying flat Pregnancy
How may GORD affect the oesophagus?
May cause oesophagitis - inflammatory reaction caused by acid.
What is the treatment for GORD?
Lifestyle changes - weight loss, head elevation in bed.
Antacids / Alginates
Acid suppressors - proton pump inhibitors / H2 receptor antagonist.
Surgery - Nissen fundoplication.
What do alginates do?
Alginates are believed to increase the viscosity and adherence of mucus to the oesophageal mucosa.
What is the pathogenesis of GORD?
Abnormal relaxation of the lower oesophageal sphincter.
Hiatus hernia - where part of the stomach is about the diaphragm.
What is Barrett’s oesophagus?
Intestinal metaplasia - change in the squamous epithelium that lines the oesophagus to columnar epithelium.
Barrett’s oesophagus affects 5-15% of patients affected with GORD.
Barrett’s oesophagus affects 10% of patients affected with GORD. - Understood.
Barrett’s oesophagus increases of the risk of developing what?
Oesophageal adenocarcinoma
How is Barrett’s oesophagus diagnosed?
This requires multiple systematic biopsies to maximise the chance of detecting intestinal metaplasia and/or dysplasia.