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Up to 50% of all gastrointestinal disorders are associated with no _______, _______, or _________?
anatomical changes, physical findings, positive test results.
What is the definition of dyspepsia?
Dyspepsia = persistent or recurrent pain or discomfort centered in the upper abdomen.
True or false: Dyspepsia is a precise term, describing a medical complaint not often seen by health care professionals.
False -> Dyspepsia is an imprecise term and is one of the most common medical complaints
Name 7 etiologies of dyspepsia.
1) Food/drug intolerance -> 2) Gastric tract dysfunction -> 3) Helicobacter pylori infection -> 4) Pancreatic disease -> 5) Biliary tract disease -> 6) Other conditions, such as pregnancy -> 7) Functional dyspepsia (no obv. organic cause.
What are some alarming symptoms associated with dyspepsia?
Anemia, odynophagia, hematemesis, melena, hematochezia, occult blood, unintentional weight loss, persistent vomiting, abdominal mass
What are some common characteristics of non-ulcer dyspepsia patients?
They tend to be younger, have a variety of abdominal/gastrointestinal symptoms, or show signs of anxiety or depression.
What are some common characteristics of peptic ulcer patients?
Peptic ulcer patients tend to be older, be smokers, or have pain which is changed with food or meds.
Dyspepsia Work-up: Younger patients should begin with ______ testing.
non-invasive H. pylori testing
What three other tests are used for a dyspepsia workup?
- 1) Urea breath test
- 2) Fecal antigen test
- 3) IgG serology
When should upper endoscopy be used?
- -Patients 45 or older with new onset dyspepsia
- -All patients with alarm Sx
What are the two general categories of treatment for dyspepsia?
- 1) Lifestyle changes
- 2) Drugs
What are some drugs used in the treatment of dyspepsia? (I have listed 4)
- 1) Antacids
- 2) H2 blockers
- 3) Proton pump inhibitors
- 4) Prokinetic agents
What medications are used for H-pylori positive patients?
Clarithromycin 500mg PO BID + Amoxicillin 1g PO BID + PPI PO BID for 10-14 days
Metronidazole 500mg BID can be substituted for amoxicillin
Nausea: a vague, intensely disagreeable sensation of sickness or 'queasiness' that may or may not be followed by vomiting
Vomiting: the forceful expulsion of gastric contents through a relaxed upper esophageal sphincter and open mouth
What are some stimulators of vomiting?
- -Gastrointestinal viscera
- -Vestibular system
- -Higher central nervous system
- -chemoreceptor trigger zone
What are the three general symptom sets of nausea/vomiting?
- 1) Acute symptoms w/o pain
- 2) Acute symptoms w/pain
- 3) Chronic vomiting
What can cause acute symptoms w/o pain?
-food poisoning, gastroenteritis, drug reactions, vestibular responses
What can cause acute symptoms w/pain?
-peritonitis, obstruction, pancreatic or biliary disease
What can cause chronic vomiting?
-PREGNANCY, gastric outlet obstruction, gastroparesis, intestinal dysmotility, psychogenic, CNS/systemic disorders
Name ALL SIX vomiting complications. (IMPORTANT)
- 1) Dehydration
- 2) Hypo kalemia
- 3) Metabolic Alkalosis
- 4) Aspiration
- 5) Boerhaave's syndrome: tear (scope)
- 6) Mallory-Weiss tear: due to over drinking then vomiting lots (scope)
Name some special examinations used for nausea/vomiting.
- -Vitals and Tilts
- -AAS -> looking for dilated loops, air/fluid levels
- - Lab studies
- - CNS studies - CT/MRI
What is the TOP priority in treatment for vomiting?
Determine the underlying cause
What is used for treatment of vomiting?
- -Correction of the complications from vomiting
What does the term 'constipation' refer to?
Stool that is too hard, small, infrequent, the act of straining to defecate, or a sense of incomplete evacuation
What is the normal frequency of BMs?
3 to 12 per week
What are the causes of constipation?
- -Diet: inadequate fiber (most common cause)
- -Structural abnormalities (obstructing colonic lesions)
- -Systemic Disease (neurological dysfunction, endocrine disorders, electrolyte abnormalities)
What are the refractory causes of constipation?
- -Slow colonic transit (normal transit time is approx. 35 hrs, longer than 72 hrs is abnormal)
- -Pelvic floor dysfunction (difficulty in moving stool out of the rectum or pelvis due to contraction of the anal sphincter and pelvic floor)
What makes up the first level of constipation evaluation?
- -Physical examination (w/rectal exam)
- -Stool testing for occult blood
- -If alarm symptoms, check CBC, electrolytes, glucose, TSH, and either C-Scope or Flex sig
What makes up the second level of constipation evaluation?
- -colon studies
- -colonic transit time studies
- -rectal ultrasound/manometry
- -nerve conduction studies
What is Defecography?
-Defecography is the radiographic examination of the operation of the defecation process under fluoroscopy. A thickened barium contrast putty is injected into the rectum and then excreted by the patient while the radiologist looks on
What are some dietary measures used in treatment of constipation?
- -Bulking agents -> Metamucil (psyllium), Citrucel (methylcellulose), Fibercon
- -Bran's / Fiber
- -Reinforce importance of fluids
What drugs are used in treatment of constipation?
- -Stool softeners (C olace)
- -Saline Laxatives (MOM)
- -Nonabsorbable sugars (Sorbitol)
- -Polyethylene glycol (PEG, Golytely)
- -Polyethylene glycol (PEG 3350, Miralax)
- -Magnesium hydroxide (Mag-citrate)
- -Stimulants (Bisacodyl)
What are some predisposing factors for fecal impaction?
- -Severe psychiatric disease
- -Neurogenic disease of colon/spine
What makes up the clinical presentation of fecal impaction?
- -decreased appetite
- -abdominal pain and distention
What are 3 studies for fecal impaction?
- -Digital exam (not only diagnostic, but usually therapeutic)
- -Radiographs (May show megarectum, fecaloma)
- -Air Contrast Barium Enema (ACBE) -> will give you more information
For treatment, what is used for impaction relief?
- -Digital rectal exams
For treatment, what is used for prevention of recurrence?
- -Gastrocolic reflex
- -Avoid prolonged bathroom sessions
- -Regular schedule