Dyspepsia, gastritis, peptic ulcer

Question 1

Dyspepsia

Answer 1

Persistent or recurrent pain or discomfort centered in the upper abdomen with no organic cause.

Classification 
1.Dysmotility-like Symptoms Dominant 
2.Ulcer-like Symptoms Dominant

Rome III diagnostic criteria for functional
dyspepsia.
At least 3 months, with onset at least 6 months
previously, of one or more of the following:
bothersome postprandial fullness
early satiation
epigastric pain
epigastric burning
AND
• no evidence of structural disease
•(including upper endoscopy)
Symptoms; nausea, vomiting, epigastrium pain, bloating, early satiation.
Treatment
Discontinue what ever is triggering the symptoms
Anti depressants Prozac
Prokinetic agents like metoclopramide
proton pump inhibitors (PPIs)
Omeprazol lansoprazol

Question 2

Gastritis

Answer 2

This is the inflammation of the mucosal lining of the stomach causing atrophic changes of the glandular epithelium.
Etiology
Diet, alcohol H.pylori infection, alcohol, smoking, caffeine, stress, NSAIDS
Symptoms
Epigastric pain after eating spicy, oily foods, dyspepsia, anemic syndrome, asthenic syndrome, irritability
Classification
Type A- autoimmune
Type B- bacterial
Complications , MALT lymphoma,
Treatment
PPI, H2 histamine blockers, antacids, misoprostol,

Question 3

Peptic ulcer

Answer 3

Definition-are diseases that causes a break in the superficial epithelial lining penetrating down mucularis mucosa of either stomach or duodenum

Etiology- H.pylori infection, stress, smoking, alcohol, genetic, drugs
Classification
1.according to location
Major
- gastric ulcer
- Duodenal ulcer
Minor
-esophageal ulcer
-meckel’s diverticulum ulcer

2.according to modified johnson classification of peptic ulcer
Type 1-ulcer along the curve lesser curve of stomach
Type 2-two ulcer present-one gastric ,one duodenal
Type 3-prepyloric ulcer
Type 4-proximal gastroesophageal ulcer
Type 5-anywhere (associated with chronic Nsaid use)

Symptoms
* Recurrent burning stomach pain that occurs at night and worsens when patient is hungry
* Feeling of fullness, bloating or belching
* Intolerance to fatty foods
* Heartburn
* Nausea, weight loss
Diagnosis
Serology, urea-breath test, stool antigen test, endoscopy,PCR, biopsy
Treatment
Triple therapy
Clarityromycin 500mg+omeprazole 20mg+amoxicillin 1000mg
Quadruple therapy
Bismuth subsalicylate 120mg 4x daily+ metronidazole 400mg 3x daily+ tetracycline 500 4x daily+ PPI 20-40mg 2x daily