DYSPEPSIA
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DYSPEPSIA
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DyspepsiaImplies chronic• GORD• IBS• Ulcers• Gall Stones• Cancer• ‘Functional’
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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
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Dyspepsia
GORD• Heartburn• Waterbrash• Volume reflux• Response to PPIs• Dysphagia
Diagnosis??Management
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OSOPHAGITIS
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Laparoscopic FundoplicationNormal Subject
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Laparoscopic Fundoplication24 hour trace of severe GOR
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Laparoscopic FundoplicationInterpretation of 24h tape of severe GOR
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Dyspepsia
IBS• Abdominal pain - sites• Bloating• Distension• Variable bowel habit• Relation to stress
How to talk to them!
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Dyspepsia
UlcersDUs - • Foregut• Nature of pain• The 3 best features of history …GUs ….The two big causes• Treatment• Remember NSAIDs
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Abdominal Pain 2002
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Dyspepsia
Gall Stones• SEVERE foregut pain• duration• distribution• vomiting• recovery
Other vague symptoms .......
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Dyspepsia
Cancer• ‘New’ dyspepsia• Cancer age group• ‘Alarm’ symptoms• or signs• Dilemma
Surgery?? Results??
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Common dyspeptic cancers
• Oesophagus• Stomach• Pancreas• Liver mets
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* ENDOSCOPY STRICTURES *
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Dyspepsia
‘Functional’• Upper abdominal pain• Investigations negative• Relation to food, stress• Vomiting unusual
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Investigation
(The conventional sequence)But really what is the question• Cancer?? Or reassurance• Cause of dyspepsia• Helicobacter status• Does it really matter?? - answer
Or just treat and see??• What conditions not
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WHICH INVESTIGATION?
– QUESTION• MUCOSA /
THERAPEUTICS
• ANATOMY / FUNCTION
• MOTILITY
• FUNCTION / REFLUX
-INVESTIGATION• ENDOSCOPY
• BARIUM SWALLOW• CT
• MANOMETRY
• OESOPHAGEAL Ph• PPI TEST
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ACHALASIA DIAGNOSIS MANOMETRY - BARIUM
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Implies chronicGORDIBSUlcersGall StonesCancer‘Functional’(Alcoholic gastropathy)
DYSPEPSIAImplies chronicGORDIBSUlcersGall StonesCancer‘Functional’