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Adult/Ped Medicine 4 > Dyspepsia Syndromes - Loyd > Flashcards

Dyspepsia Syndromes - Loyd Flashcards

1
Q

Esophageal Cancer

A
  • progressive dysphagia
  • (rapid) weight loss
  • GI bleeding
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2
Q

Dyspepsia Physical

A
  • Age
  • Weight/BMI
  • Vitals
  • Inspection: pale
  • Abdominal Exam
    • epigastric tenderness
    • rigidity
    • bowel sounds
    • massess
    • organomegaly
    • abdominal mass
    • weight loss
  • Rectal Exam
    • fecal occult blood
    • rectal tenderness
    • masses
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2
Q

Peptic Ulcer Disease

A

GI Bleed

  • hematemesis, hematochezia, anemia
  • hospitalize
  • more common > 60 years old

Perforation

  • abdominal pain, rigidity, NO bowel sounds
  • abdominal x-rays (EGD and Barium contraindicated)
  • hospitalize, surgical treatment

Penetration

  • erodes into adjacent organs
  • abdominal or back pain
  • nausea and vomiting

Gastric Outlet Obstruction

  • secondary to inflammation and scarring
  • abdominal pain, vomiting
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3
Q

Dyspepsia

A

epigastric pain or burning, early satiety, or postprandial fullness

associated with: heartburn, refulx, regurgitation, indigestion, bloating, post prandial fullness

alarm symptoms: weight loss, dysphagia, recurrent vomiting, evidence of bleeding or anemia **refer for an endoscopy**

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3
Q

Gastroesophageal Reflux Disease (GERD) Presentation

  • Typical Symptoms
  • Atypical Symptoms
  • Alarm Symptoms
A

Heartburn: retrosternal burning or discomfort after eating

Regurgitation: effortless return of esophageal contents to posterior pharynx

Atypical Symptoms

  • coughing or wheezing
  • chest pain
  • laryngitis
  • OM
  • enamel decay

Alarm Symptoms

  • Anorexia
  • Weight loss
  • Blood in vomit and/or stool
  • Pain produced by swallowing (odynophagia)
  • Difficulty swallowing (dysphagia)
  • Anemia
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4
Q

Peptic Ulcer Disease Treatment

A
  • Discontinue NSAIDs, Aspirin
  • Smoking cessation
  • Minimize alcohol intake
  • Stress reduction

< 45 with NO alarm symptoms

  • Test for H. pylori
      • erradicate
      • empiric treatment

> 45 or with alarm symptoms

  • EGD indicated
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5
Q

H. Pylori Eradication (Positive)

A

Current 2014 treat for 14 days:

  • Triple Therapy
    • PPI
    • bismuth
    • Clarithromycin
    • Amoxicillin
  • Quadruple Therapy - preferred in areas with high resistnace, pencillin allergy
    • Bismuth
    • PPI
    • tetracycline
    • metronidazole or tindazole

Follow-up/retest to determine efficacy

  • 4 weeks urea breath test
  • 8 weeks stool antigen
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6
Q

Dyspepsia: ALARM SYMPTOMS

A
  • weight loss
  • bleeding
  • older age
  • anorexia
  • fever
  • chest pain
  • early satiety
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8
Q

Gastroesophageal Reflux Disease (GERD)

A

symptoms of mucosal damage produced by abnormal reflux of gastric contents into esophagus

chronic, relapsing

pts may self-treat with OTCs

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8
Q

Gastroesophageal Reflux Disease (GERD) Pathophysiology

A

Lower Esophageal Sphincter (LES) Relaxation most common mechanism for GERD, nueral reflex thru the brain stem

Foods ↓ pressure

Medications ↓ pressure

Hormones ↓ pressure

Obesity ↑ pressure due to ↑ intra-abdominal pressure

Hiatal Hernia

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9
Q

Peptic Ulcer Disease

A

mucosal break 3 mm or greater

usually occurs in areas exposed to acid and pepsin

common cause of dyspepsia and GI bleed

most common patients: GI bleeding - older adults on NSAIDs

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10
Q

Gastroesophageal Reflux Disease (GERD) Aggravating & Alleviating Factors

A

Aggravating

  • meals
  • laying down
  • bending over

Alleviating

  • sitting up
  • standing
  • antacids

Contributing Factors

  • fatty foods
  • chocolate
  • tomato-based products
  • alcohol
  • caffeiene
  • citrus fruits
  • onion
  • garlic
  • peppers
  • overweight
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11
Q

Zollinger-Ellison Syndrome

A
  1. Peptic Ulcer Disease
  2. Gastric Acid Hypersecretion
  3. Non beta-cell gastrin producing tumor of pancreas
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11
Q

Peptic Ulcer Disease

A

Test for H. pylori

  • urea breath test
  • stool antigen
  • serum IgG antibodies

Labs

  • CBC (anemia, infection)
  • LFTs
  • Amylase/Lipase (pancreatitis)
  • Chem profile

Diagnostic Tests

  • EGD - test of choice can biopsy as well
  • Double contrat barium study
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12
Q

Peptic Ulcer Disease: Pathophysiology

A
  1. ** H. pylori **
  • continuous gastric inflammation
  • forms ulcers once there is a defect in the mucosa
  1. NSAIDS and Aspirin
  • damage mucosa by direct action
  • inhibiting prostaglandin synthesis
  1. Cigarrette Smoking
    * increases gastric acid secretion
  2. Stress
  3. Diet - exacerbates symptoms
  4. Associated Disease States
  • COPD
  • cirrhosis
  • renal failure
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13
Q

Functional Dyspepsia (Non-Ulcer Dyspepsia = NUD)

A

patients with chronic epigastric pain without:

  • evidence of organic lesions
  • reflux symptoms
  • dysphagia

treatment:

  • symptomatic: PPIs or H2 blockers prn
  • address psychosocial and lifestyle factors
15
Q

Gastroesophageal Reflux Disease (GERD) Diagnostics

A

Labs: typically not needed

Diagnostics Needed if:

  • > 50
  • alarm symptoms
  • Barium Study
  • EGD
  • Esophageal Manometry
  • 24-hr pH probe
17
Q

Gastroesophageal Reflux Disease (GERD) Treatment

A

Lifestyle Modifications

  • lose weight
  • avoid: caffeine, chocolate, citrus, tomato, alcohol
  • wait 3 hours after eating to lay down
  • elevate bed 4-6 inches
  • smoking cessation

Remove Offending Agents

  • NSAIDs
  • Aspirin

Pharmacologic Therapy

  • Anatacids
  • **H2 Recptor Antagonists: **Rantidine (Zantac), Cimetidine, Famotidine (Pepcid), Nizatidine
  • **Proton Pump Inhibitors: **Omeprazole, Lansoprazole, Dexlansoprazole, Raberprazole, Esomeprazole, Pantoprazole
  • Prostaglandin E1 Analogue: Misoprotsol
  • Prokinetics: Metaclopramide
18
Q

Gastroesophageal Reflux Disease (GERD) Compications

A
  • Esophagitis
  • Barret Esophagitis: squamous epithelieum of esophagus replaced by intestinal columnar epithelium
  • Respiratory complications: asthma, pneumonia, fibrosis
19
Q

Peptic Ulcer Disease Physical Exam

A
  • epigastric tenderness
  • guaiac positive stool
20
Q

Dyspepsia History

A

PMI:

  • OLD CHARTS
  • look out for alarm symptoms: weight loss, dysphagia, recurrent vomiting, evidence of bleeding or anemia

PMH:

  • illness
  • prior ulcers
  • medications (NSAIDs, steroids, abx, anticoagulants)

FH:

  • 1st degree relative with peptic ulcer disease

SH:

  • lifestyle, stressors
  • diet/current weight (BMI)
  • alcohol
  • smoking
22
Q

Peptic Ulcer Disease Symptoms

A
  • epigastric pain: gnawing, burning; 15 mins-3 hours after meals
  • nausea and vomiting
  • heartburn
  • chest discomfort
  • belching
  • bloating
  • distension
  • anorexia
  • weight loss
  • hematemesis
23
Q

H. Pylori (Negative)

A
  • Proton Pump Inhibitors (PPI)
  • H2 Receptor Antagonists
  • Misoprotosol (Cytotec)
    • inhibits gastric secretion

Adult/Ped Medicine 4 (17 decks)

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