STUDY - Technical - New Dacian's Medicine
Dyspepsia
(Classical / Allopathic Medicine)
Dyspepsia refers
to an uncomfortable fullness after meals that are associated
with epigastric gnawing pain, nausea, belching, heartburn, and
abdominal cramping and distention. Typically aggravated by
spicy, fatty, or high-fiber foods and by excess caffeine
intake, dyspepsia without other pathology indicates impaired
digestive function.
Dyspepsia is
caused by GI disorders (such as ulcers) and, to a lesser
extent, by cardiac, pulmonary, and renal disorders and adverse
drug effects. It results when altered gastric secretions lead
to excess stomach acidity. This symptom may also result from
stress, overly rapid eating, or improper chewing. It usually
occurs a few hours after eating and lasts for a variable
period of time. Its severity depends on the amount and type of
food eaten and on GI motility. Additional food or an antacid
may relieve the discomfort.
HISTORY:
Ask the patient to describe his dyspepsia. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it?
Ask the patient if he experiences associated signs and symptoms, such as nausea, vomiting, melena, hematemesis, cough, and chest pain.
Ask the patient if he has noticed a change in the amount or color of his urine.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about work-related problems.
Review the patient's medical history for renal, cardiovascular, and pulmonary disease or recent surgery.
Ask the patient to describe his dyspepsia. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it?
Ask the patient if he experiences associated signs and symptoms, such as nausea, vomiting, melena, hematemesis, cough, and chest pain.
Ask the patient if he has noticed a change in the amount or color of his urine.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about work-related problems.
Review the patient's medical history for renal, cardiovascular, and pulmonary disease or recent surgery.
PHYSICAL
ASSESSMENT:
Inspect the abdomen for distention, ascites, scars, jaundice, uremic frost, and bruising.
Auscultate for bowel sounds, and characterize the motility.
Palpate and percuss the abdomen, noting any tenderness, pain, guarding, rebound, organ enlargement, or tympany.
Examine other body systems. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
Inspect the abdomen for distention, ascites, scars, jaundice, uremic frost, and bruising.
Auscultate for bowel sounds, and characterize the motility.
Palpate and percuss the abdomen, noting any tenderness, pain, guarding, rebound, organ enlargement, or tympany.
Examine other body systems. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
SPECIAL
CONSIDERATIONS:
Changing the patient's position usually doesn't relieve dyspepsia but providing food or an antacid may. Because various drugs can cause dyspepsia, give these after meals, if possible.
Changing the patient's position usually doesn't relieve dyspepsia but providing food or an antacid may. Because various drugs can cause dyspepsia, give these after meals, if possible.
PEDIATRIC
POINTERS:
Dyspepsia may occur in adolescents with peptic ulcer disease, but it isn't relieved by food.
Congenital pyloric stenosis may cause dyspepsia, but projectile vomiting after meals is a more characteristic sign.
Dyspepsia in infants may result from lactose intolerance.
Dyspepsia may occur in adolescents with peptic ulcer disease, but it isn't relieved by food.
Congenital pyloric stenosis may cause dyspepsia, but projectile vomiting after meals is a more characteristic sign.
Dyspepsia in infants may result from lactose intolerance.
AGING ISSUES:
Most older patients with chronic pancreatitis experience less-severe epigastric pain than younger adults; some have no pain at all.
Most older patients with chronic pancreatitis experience less-severe epigastric pain than younger adults; some have no pain at all.
PATIENT
COUNSELING:
Advise the patient to eat frequent, small meals. Also, tell him to avoid foods and substances that are known to cause dyspepsias, such as coffee, tea, chocolate, alcohol, and tobacco.
Advise the patient to eat frequent, small meals. Also, tell him to avoid foods and substances that are known to cause dyspepsias, such as coffee, tea, chocolate, alcohol, and tobacco.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)