Post on 19-Mar-2016
description
DYSPEPSIA
DyspepsiaImplies chronic• GORD• IBS• Ulcers• Gall Stones• Cancer• ‘Functional’
Dyspepsia
Perspective• 10% of all GP consultations• 9,000 endoscopies per year at Walsgrave,
waiting time up to 9 months• Pragmatism in treatment and algorrhythms
Dyspepsia
GORD• Heartburn• Waterbrash• Volume reflux• Response to PPIs• DysphagiaDiagnosis??Management
OSOPHAGITIS
Laparoscopic FundoplicationNormal Subject
Laparoscopic Fundoplication24 hour trace of severe GOR
Laparoscopic FundoplicationInterpretation of 24h tape of severe GOR
Dyspepsia
IBS• Abdominal pain - sites• Bloating• Distension• Variable bowel habit• Relation to stressHow to talk to them!
Dyspepsia
UlcersDUs - • Foregut• Nature of pain• The 3 best features of history …GUs ….The two big causes• Treatment• Remember NSAIDs
Abdominal Pain 2002
Dyspepsia
Gall Stones• SEVERE foregut pain• duration• distribution• vomiting• recoveryOther vague symptoms .......
Dyspepsia
Cancer• ‘New’ dyspepsia• Cancer age group• ‘Alarm’ symptoms• or signs• DilemmaSurgery?? Results??
16
Common dyspeptic cancers
• Oesophagus• Stomach• Pancreas• Liver mets
16
* ENDOSCOPY STRICTURES *
Dyspepsia
‘Functional’• Upper abdominal pain• Investigations negative• Relation to food, stress• Vomiting unusual
Investigation
(The conventional sequence)But really what is the question• Cancer?? Or reassurance• Cause of dyspepsia• Helicobacter status• Does it really matter?? - answerOr just treat and see??• What conditions not
WHICH INVESTIGATION?
– QUESTION• MUCOSA /
THERAPEUTICS
• ANATOMY / FUNCTION
• MOTILITY
• FUNCTION / REFLUX
-INVESTIGATION• ENDOSCOPY
• BARIUM SWALLOW• CT
• MANOMETRY
• OESOPHAGEAL Ph• PPI TEST
ACHALASIA DIAGNOSIS MANOMETRY - BARIUM
Implies chronicGORDIBSUlcersGall StonesCancer‘Functional’(Alcoholic gastropathy)
DYSPEPSIAImplies chronicGORDIBSUlcersGall StonesCancer‘Functional’