DYSPEPSIA

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DYSPEPSIA

description

DYSPEPSIA. Dyspepsia. Implies 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 - PowerPoint PPT Presentation

Transcript of 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’