Dyspepsia/Peptic ulcer/GORD

Question 1

Dyspepsia is?

caused by?

Answer 1

a group of symptoms related to the upper GI tract = epigastric pain related to food, bloating, heatburn, early satiety, postprandial fullness

causes: GORD/oesophagitis, peptic ulcer disease, gastritis, gastric malignancy, functional/non-ulcer dyspepsia

peptic ulcer disease = gastric and duodenal ulcers

Question 2

HPC

Answer 2

symptoms - (duodenal ulcers often made better by eating, stomach ulcers made worse)
NSAIDs and steroid use
smoking 
past Hx 
FHx of stomach cancer 
melaena 
weight loss
dysphagia 

ALARM symptoms = suggestive of cancer and indicate a gastroscopy

• anaemia
• losing weight
• anorexia
• recent onset of progressive symptoms
• melaena

Question 3

Examination

Answer 3

Hands to face - anaemia
Abdominal exam
- tender epigastrium 
- Virchow's node for mets from gastric Ca 
- anaemia 
- Abdominal mass

Question 4

Investigations:

Answer 4

FBC - ?anaemia from bleeding (normocytic)
Urease Breath/blood antigen/fecal - ?H. Pylori
Gastroscopy +/- biopsy
CXR - ?free air = perforation
Barium Swallow = hiatus hernia or poor LOS function
24h oesophageal pH monitoring if endoscopy normal

Question 5

Differential Diagnosis

Answer 5

GORD/oesophagitis, peptic ulcer disease, gastritis, gastric malignancy, functional/non-ulcer dyspepsia, biliary pain, chronic pancreatitis, intestinal angina, crohn’s disease

Question 6

Management

Answer 6

Education/Lifestyle - avoid foods that worsen and stop smoking
Medication - H. pylori triple eradication therapy (omeprazole, clarithromycin and metronidazole/amoxicillin) for 7 days if present
Stop NSAIDs and steroids
Acid reduction with PPIs for 4 weeks (DU) and 8 weeks (GU)

Surgery

• Gastric surgery for severe bleeding or perforation
• All ulcers should be biopsied

Follow-up
- gastroscopy to confirm healing

Question 7

Complications of PUD

Answer 7

Perforation, bleeding, malignancy

Question 8

GORD - HPC

Answer 8

heart burn (retrosternal burning pain related to meals and lying down) 
acid regugitation 
odynophagia (painful swallowing) 
hoarse voice 
chronic cough 
nocturnal asthma 

RISK FACTORS: hiatus hernia, smoking, alcohol, obesity, LOS dysfunction, pregnancy, drugs (TCA and Nirtates)

Question 9

GORD exam and Ix:

Answer 9

exam:
?anaemia
?throat
?abdo exam

Ix:
Barium swallow (?hiatus hernia and assess LOS function)
Scope to look for cobble stoning

Question 10

Management of GORD

Answer 10

E/L: avoid triggers, weight loss, decrease alcohol and stop smoking
Acid reduction: antacids then PPI then H2 antagonists

Question 11

Complications of GORD:

Answer 11

Oesophagitis, Oesophageal stricture, Barret’s oesophagus (metaplasia from squamous to columnar), Fe deficiency anaemia