CLINICAL APPROACHTO A PATIENT WITHDYSPEPSIA
HISTORY TAKING   PROPER HISTORY TO      • Elicit symptoms classical of specific        disorder, e.g.: peptic ulcer      ...
MODE OF ENQUIRY ONSET        Acute      overeating, eating tooquick, eating high fat foods, eating duringstressful situat...
 RELATION TO FOOD Earlypost-prandial pain : acute gastritis, esophageal disease and gastric carcinoma Latepost-prandial...
 AGGRAVATING AND RELIEVING  FACTORS Milk, legumes  flatulence, bloating, excessive gas Food relieves duodenal ulcer pai...
 HISTORY OF MEDICATION Drugs that slow gut transit            narcotics, anti-cholinergics, calciumantagonisto NSAID PS...
ALARM FEATURES    Weight  loss      Anaemia      Vomiting   Hematemesis     Dysphagia   Palpable mass
PEPTIC ULCER   History of ulcers   NSAID use   Smoking   Family historyGERDo   Heart burn and regurgitationo   Epigast...
 PAST HISTORYo Cardiac, hepatic, renal, peptic  ulcer, pancreatic diseaseo Psychiatric illness FAMILY HISTORY     Psychi...
EXAMINATION1)   GENERAL EXAMINATION            Weight loss            Pallor            Icterus            Lymphadenopathy...
EXAMINATION OF GASTROINTESTINALSYSTEMo   ORAL CAVITY       Extensive loss of enamel dental          and exposed dentin    ...
ABDOMEN Palpate for abdominal mass Murphy’s sign Signs of liver failure
INVESTIGATIONS               DYSPEPSIA            ALARM FEATURES   Yes                       NoEndoscopy                  ...
TREATMET   Acid Suppressing 0r Neutralizing Medications        H2 receptor antagonists         Proton Pump Inhibitors    ...
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Clinical approach to patient with dyspepsia

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Clinical approach to patient with dyspepsia

  1. 1. CLINICAL APPROACHTO A PATIENT WITHDYSPEPSIA
  2. 2. HISTORY TAKING PROPER HISTORY TO • Elicit symptoms classical of specific disorder, e.g.: peptic ulcer • Detect alarm features requiring urgent investigation • Detect atypical symptoms more suggestive of other disorders
  3. 3. MODE OF ENQUIRY ONSET Acute overeating, eating tooquick, eating high fat foods, eating duringstressful situations, or drinking too muchalcohol or coffee Chronic functionaldyspepsia, malignancy and other extraintestinal causes
  4. 4.  RELATION TO FOOD Earlypost-prandial pain : acute gastritis, esophageal disease and gastric carcinoma Latepost-prandial pain : gastric outlet obstruction, impaired digestive and absorptive process Relief of pain is characteristic of duodenal ulcer (due to neutralization of acid)
  5. 5.  AGGRAVATING AND RELIEVING FACTORS Milk, legumes flatulence, bloating, excessive gas Food relieves duodenal ulcer pain LOSS OF WEIGHT: as in malignancy
  6. 6.  HISTORY OF MEDICATION Drugs that slow gut transit narcotics, anti-cholinergics, calciumantagonisto NSAID PSYCHOLOGICAL FACTORS anxiety and depression : cause oraggravate symptoms HISTORY OF SYSTEMIC DISEASE like cardiac or renal disease
  7. 7. ALARM FEATURES  Weight loss  Anaemia  Vomiting  Hematemesis  Dysphagia  Palpable mass
  8. 8. PEPTIC ULCER History of ulcers NSAID use Smoking Family historyGERDo Heart burn and regurgitationo Epigastric pain may radiate to throat and worsen when patient bends down or lies flato Esophageal spasm : sharp, stabbing sub-sternal paino At night or after consumption of large meal
  9. 9.  PAST HISTORYo Cardiac, hepatic, renal, peptic ulcer, pancreatic diseaseo Psychiatric illness FAMILY HISTORY Psychiatric illness PERSONAL HISTORY Alcohol Smoking Drugs
  10. 10. EXAMINATION1) GENERAL EXAMINATION Weight loss Pallor Icterus Lymphadenopathy: Virchow’s Node Acanthosis nigricans VITALS Pulse : tachycardia blood B.P. : Hypotension loss
  11. 11. EXAMINATION OF GASTROINTESTINALSYSTEMo ORAL CAVITY Extensive loss of enamel dental and exposed dentin erosion GERD
  12. 12. ABDOMEN Palpate for abdominal mass Murphy’s sign Signs of liver failure
  13. 13. INVESTIGATIONS DYSPEPSIA ALARM FEATURES Yes NoEndoscopy <55yrs >55yrs Test for H. Pylori Endoscopy +ve -ve Eradication Symptomatic Rxsymptoms resolve symptoms persist No follow up Endoscopy
  14. 14. TREATMET Acid Suppressing 0r Neutralizing Medications H2 receptor antagonists Proton Pump Inhibitors Antacidso H. Pylori infection Eradicationo Gastrointestinal Motor Stimulantso Other Options
  15. 15. THANK YOU….

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