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Case: Dyspepsia in 46 yo WM

Case: Dyspepsia in 46 yo WM. HPI: epigastric discomfort sharp, nonradiating, after meals with bloating and occ. GERD sx; no N/V/D/fever PMH: GERD PSH: neg Meds: BASA; prilosec qhs Fhx: neg SH: + 1 PPD; occ. ETOH PE: VSS, afeb; mild epigastric TTP Labs: nml LFT, chem, CBC.

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Case: Dyspepsia in 46 yo WM

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  1. Case: Dyspepsia in 46 yo WM • HPI: epigastric discomfort sharp, nonradiating, after meals with bloating and occ. GERD sx; no N/V/D/fever • PMH: GERD PSH: neg • Meds: BASA; prilosec qhs • Fhx: neg SH: + 1 PPD; occ. ETOH • PE: VSS, afeb; mild epigastric TTP • Labs: nml LFT, chem, CBC

  2. Dyspepsia • Definition: Rome III criteria (one or more) * postprandial fullness * early satiety * epigastric pain or burning • Differential diagnosis of dyspeptic sx: ? • Alarm sx in dyspepsia: ?

  3. Functional (40-60%) PUD GERD Biliary / gallbladder Chronic abdominal wall pain Medications: NSAIDS, steroids, narcs, lopid, antibiotics Malignancy: gastric, esophageal, liver Gastroparesis (DM) Pancreatitis COH malabsorption Infiltrative: Crohn’s; sarcoidosis Metabolic: hypercalcemia, hyperkalemia Dyspepsia: Differential Dx

  4. Carnett’s Test for abdominal wall pain

  5. Dyspepsia • Definition: Rome III criteria (one or more) * postprandial fullness * early satiety * epigastric pain or burning • Differential diagnosis of dyspepsia: ? • Alarm symptoms in dyspepsia: ?

  6. Weight loss Persistent vomiting Dysphagia Odynophagia Anemia / IDA Hematemesis Abdominal mass / lymphadenopathy Family hx GI malignancy (esp. gastric) Previous gastric surgery Jaundice Dyspepsia: Alarm Symptoms

  7. Dyspepsia: 3 Common Patterns • Ulcer-like or acid dyspepsia • Dysmotility-like dyspepsia • Unspecified dyspepsia

  8. Dyspepsia: Initial Management

  9. Dyspepsia: management based on age and alarm symptoms

  10. Dyspepsia: failed empiric therapy

  11. Functional Dyspepsia: Management

  12. Dyspepsia: When to refer to GI • New dyspepsia in patient > 55 yo • Alarm symptoms in any age patient • PPI’s have failed and HP negative / successfully treated with persistent sx • Persistent symptoms despite all interventions

  13. Dyspepsia: clinical pearls • PPI’s: ensure taken correctly * switch if one not working; increase dose • NSAID’s: even BASA can cause PUD • H pylori: ensure eradication (Breath test) • GERD: 90% of symptoms are diet and lifestyle related • Tobacco: stop ETOH: minimize • EGD: have low threshold for referral

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