STUDY - Technical - New Dacian's Medicine
Indigestion
(1)
Translation Draft
Indigestion is a term commonly used by patients to describe various symptoms, generally regarded as upper abdominal discomfort, often associated with food intake.
Indigestion is a term commonly used by patients to describe various symptoms, generally regarded as upper abdominal discomfort, often associated with food intake.
The term is nonspecific
and may not have the same meaning for the patient and doctor.
Therefore, in addressing the patient with indigestion, it is
important to first obtain an accurate description of this
suffering. For some patients, indigestion means effective
abdominal pain or pressure, which may be accompanied by
postprandial fullness, early satiety, nausea or bloating, and
which is generally called dyspepsia.
Others may use the term indigestion to describe either a vague sensation that digestion has not occurred normally, or that there is an intolerance to specific foods. Others may use it to describe eructations, an excessive gas sensation or flatulence. When heartburn is the dominant symptom, the patient is assumed to have gastroesophageal reflux disease. Once the patient's definition of indigestion has been established it is important to determine: 1. the location and duration of discomfort, 2. the temporal relationship of symptoms with food intake and 3. the possible relationship of symptoms with the ingestion of certain types of foods (e.g. milk, fatty foods) or medicines.
Indigestion can also occur in association with diseases of the gastrointestinal tract or pathological states of other organic systems. As a result of a systematic clinical and laboratory investigation, it can sometimes be demonstrated that a physiopathological process, which can be defined, can be designated as responsible for symptoms in a particular case of indigestion. Frequently, however, a clear etiological explanation for the patient's accusations of indigestion cannot be established and descriptive names are applied.
For example, the term nonulcerous dyspepsia is often used to describe ulcer-like symptoms when no ulcers are found. The term flatulent dyspepsia is used when eructations, abdominal distension and early satiety are the main symptoms (the term dyspepsia type dismotility has been applied to the same group of symptoms). Unfortunately, these terms do not assume that the symptoms described are attributed to a particular pathogenic process.
The term functional dyspepsia is used interchangeably with nonulcerous dyspepsia, when clinical evaluation fails to reveal an explanation for indigestion. In some cases of functional dyspepsia, sophisticated testing of gastrointestinal electrical activity and manometric studies may reveal disorders of gastrointestinal motility, although the cause-and-effect relationship between such findings and the patient's symptoms may be difficult to prove. Indeed, some patients with functional dyspepsia also have characteristics of irritable bowel syndrome, suggesting a diffuse disorder of intestinal motility.
Now it is necessary to describe the syndromes commonly described as indigestion, and I will begin with the pain. A careful analysis of the nature of pain can bring important diagnostic information. Visceral abdominal pain is mediated by the visceral afereant nerves that accompany the sympathetic abdominal pathways. Visceral pain is described as deaf and continues as nature, with a diffuse localization on the midline or as a feeling of fullness or pressure. The localization of discomfort generally corresponds to the segmental level of nerve innervation of the affected organ.
Visceral abdominal pain, which can be produced experimentally by artificially increasing pressure in a cavitary organ, results from the distension or exaggerated muscle contraction of the visceral. Inflammation generally lowers the threshold for pain in these stimuli. Visceral pain in indigestion should be differentiated from the characters of sharp, localized pain, from many acute abdominal processes of interest to the peritoneum. In contrast to visceral pain, this somatic pain is mediated by the aferential nerves. Regarding the diffuse nature of visceral abdominal pain, the main indication of the cause comes from the localization of pain and the corresponding segmental level of nerve innervation (however, in any given segmental region there is no way to accurately determine the visceral that is the source of the pain).
I will now make a brief list of the distribution of visceral pain and give some examples of disorders that frequently involve a certain organ: 1. the esophagus has the usual location of retrosternal pain, especially in peptic esophagitis, stricture, disorder of esophageal motility and carcinoma, 2. the stomach has localized (ordinary) epigastric pain, especially in gastritis, gastric ulcer and carcinoma , 3. duodenum (first and second portion) has localized epigastric pain, especially in duodenal ulcer, 4. the small intestine (excluding the first and second portion of the duodenum) has pain localized in the periombilical region, especially in infectious gastroenteritis, Crohn's disease, lymphoma and intestinal occlusion, 5. the gallbladder usually has pain located in the epigastrum, right hypochondrium, upper right back, especially in cholelithiasis and cholecystitis, 6. the pancreas has localized pain in the epigastrium, left hypochondria and left back, in pancreatitis and pancreatic carcinoma, 7. the liver "manifests" pain in the right hypochondria, in hepatitis, cirrhosis or passive congestion and 8. the colon usually has subombilical painful manifestations, in infectious colitis, ulcerative colitis or Crohn's colitis, carcinoma or partial occlusion.
The following rules, already described so far in the completed posts, are useful: retrosternal pain of gastrointestinal origin usually comes from disorders of the esophagus or cardia of the stomach. Since pain in this area can come from the heart, heart disease should be carefully evaluated and eliminated. Epigastric pain is generally of gastric, duodenal, biliary or pancreatic origin. The epigastrium is also a frequent localization for "functional" pain. As the pathological processes of the bile ducts or pancreas become more intense, the pain can lateralize and locate, for example, bile pain in the right hypochondrium and at the tip of the scapula and pancreatic pain in the left hypochondrium and back. Periombilical pain is generally associated with small intestine disorders. Subombilical pain is often of appendix, colonic or pelvic origin.
Establishing the temporal relationships of the patient's symptoms often provides additional diagnostic clues. It is important to know whether symptoms are constant (continuously present over long periods of time), as happens with an infiltrating gastric carcinoma, or intermittent, as in acute gastritis or biliary colic. Symptoms can have a daily character, as in reflux esophagitis, in which pain often occurs during the night and in clinostatism. Pain that wakes the patient from a deep sleep can occur in the duodenal ulcer. Sometimes symptoms are seasonal, as in peptic ulcer disease, in which patients experience more intense discomfort in spring and autumn compared to other periods.
Another useful diagnostic feature is the relationship of pain with food intake. Early postprandial symptoms may reflect esophageal disease, acute gastritis or gastric carcinoma. Late postprandial indigestion, i.e. occurring a few hours after eating, may reflect the inability of the stomach to empty properly, as in the obstruction of gastric discharge, gastroparesis and other disorders of gastric motility, or duodenal ulcer, in which pain results from exposure of the ulcerated mucosa to acid secreted by the stomach and not buffered by food. Conversely, pain relief following food or antacid ingestion is characteristic for duodenal ulcers and is likely due to acid neutralization. Late postprandial ingestion can also result from digestive processes and faulty absorption, as in pancreatic insufficiency.
It is important to recognize that the relationships with food ingestion and the characters of pain described above are generalizations and many cases do not conform to the classic "manual" descriptions. For example, although pain limited to the right hypochondrium is often caused by gallbladder pain, about half of patients with such suffering report only epigastric pain. similarly, there are patients with duodenal ulcers whose pain is not relieved by food or antacids, while there are other patients with functional indigestion and even gastric carcinoma whose pain improves with food and antacids.
Nonulcerous dyspepsia refers to symptoms that suggest a diagnosis of peptic ulcer despite the documented absence of an endoscopy ulcer or radiological barium investigation and the absence of any other demonstrable organic disorder (e.g. bile duct disease) or evidence of irritable bowel syndrome that could explain the symptoms. Nonulcerous dyspepsia is at least two pores more common than peptic ulcer and can affect up to 20-30% of the population. Only 20-30% of patients with dyspepsia seek medical attention.
The pathogenesis of nonulcerous dyspepsia is little understood, with most patients having normal gastric acid secretion and a relationship between nonulcerous dyspepsia and duodenitis or duodenal ulcers not demonstrated. Similarly, the role played by Helicobacter pylori and chronic gastritis associated in determining dyspeptic symptoms in people without peptic ulcer is unproven. Damage to gastroduodenal motility and small intestine seems to explain some cases of nonulcerous dyspepsia. Between 25-50% of patients with nonulcerous dyspepsia have postprandial anthral hypomotility and delayed gastric discharge. In addition, 50% experience abdominal discomfort in response to balloon distension at lower volumes than those that cause pain in healthy individuals, suggesting visceral hypersensitivity.
Heartburn is a sensation of heat or burning located retrosternal or up in the epigastrium that radiates into the neck and sometimes in the arms. Occasional heartburn is common in normal people, but frequent and severe heartburn is generally a manifestation of oesophageal dysfunction. Heartburn may result from abnormal motor activity or distension of the esophagus, sensitivity of the esophageal mucosa to acid or bile reflux, or inflammation of the esophageal mucosa (esophagitis). Heartburn is most commonly associated with gastroesophageal reflux.
Under these conditions, heartburn usually occurs after an abundant meal, bending or bending, or when the patient is lying down. It may be accompanied by spontaneous appearance in the mouth of saltable liquid ("burning water"), sour (gastric contents) or bitter and green or yellow (ball). Heartburn may occur as a result of ingestion of certain foods (e.g. citrus juices) or medicines (e.g. alcohol and aspirin). Characteristically, heartburn is promptly improved, even if only temporarily, by antacids.
We still have to talk about indigestion and on June 16th...
Others may use the term indigestion to describe either a vague sensation that digestion has not occurred normally, or that there is an intolerance to specific foods. Others may use it to describe eructations, an excessive gas sensation or flatulence. When heartburn is the dominant symptom, the patient is assumed to have gastroesophageal reflux disease. Once the patient's definition of indigestion has been established it is important to determine: 1. the location and duration of discomfort, 2. the temporal relationship of symptoms with food intake and 3. the possible relationship of symptoms with the ingestion of certain types of foods (e.g. milk, fatty foods) or medicines.
Indigestion can also occur in association with diseases of the gastrointestinal tract or pathological states of other organic systems. As a result of a systematic clinical and laboratory investigation, it can sometimes be demonstrated that a physiopathological process, which can be defined, can be designated as responsible for symptoms in a particular case of indigestion. Frequently, however, a clear etiological explanation for the patient's accusations of indigestion cannot be established and descriptive names are applied.
For example, the term nonulcerous dyspepsia is often used to describe ulcer-like symptoms when no ulcers are found. The term flatulent dyspepsia is used when eructations, abdominal distension and early satiety are the main symptoms (the term dyspepsia type dismotility has been applied to the same group of symptoms). Unfortunately, these terms do not assume that the symptoms described are attributed to a particular pathogenic process.
The term functional dyspepsia is used interchangeably with nonulcerous dyspepsia, when clinical evaluation fails to reveal an explanation for indigestion. In some cases of functional dyspepsia, sophisticated testing of gastrointestinal electrical activity and manometric studies may reveal disorders of gastrointestinal motility, although the cause-and-effect relationship between such findings and the patient's symptoms may be difficult to prove. Indeed, some patients with functional dyspepsia also have characteristics of irritable bowel syndrome, suggesting a diffuse disorder of intestinal motility.
Now it is necessary to describe the syndromes commonly described as indigestion, and I will begin with the pain. A careful analysis of the nature of pain can bring important diagnostic information. Visceral abdominal pain is mediated by the visceral afereant nerves that accompany the sympathetic abdominal pathways. Visceral pain is described as deaf and continues as nature, with a diffuse localization on the midline or as a feeling of fullness or pressure. The localization of discomfort generally corresponds to the segmental level of nerve innervation of the affected organ.
Visceral abdominal pain, which can be produced experimentally by artificially increasing pressure in a cavitary organ, results from the distension or exaggerated muscle contraction of the visceral. Inflammation generally lowers the threshold for pain in these stimuli. Visceral pain in indigestion should be differentiated from the characters of sharp, localized pain, from many acute abdominal processes of interest to the peritoneum. In contrast to visceral pain, this somatic pain is mediated by the aferential nerves. Regarding the diffuse nature of visceral abdominal pain, the main indication of the cause comes from the localization of pain and the corresponding segmental level of nerve innervation (however, in any given segmental region there is no way to accurately determine the visceral that is the source of the pain).
I will now make a brief list of the distribution of visceral pain and give some examples of disorders that frequently involve a certain organ: 1. the esophagus has the usual location of retrosternal pain, especially in peptic esophagitis, stricture, disorder of esophageal motility and carcinoma, 2. the stomach has localized (ordinary) epigastric pain, especially in gastritis, gastric ulcer and carcinoma , 3. duodenum (first and second portion) has localized epigastric pain, especially in duodenal ulcer, 4. the small intestine (excluding the first and second portion of the duodenum) has pain localized in the periombilical region, especially in infectious gastroenteritis, Crohn's disease, lymphoma and intestinal occlusion, 5. the gallbladder usually has pain located in the epigastrum, right hypochondrium, upper right back, especially in cholelithiasis and cholecystitis, 6. the pancreas has localized pain in the epigastrium, left hypochondria and left back, in pancreatitis and pancreatic carcinoma, 7. the liver "manifests" pain in the right hypochondria, in hepatitis, cirrhosis or passive congestion and 8. the colon usually has subombilical painful manifestations, in infectious colitis, ulcerative colitis or Crohn's colitis, carcinoma or partial occlusion.
The following rules, already described so far in the completed posts, are useful: retrosternal pain of gastrointestinal origin usually comes from disorders of the esophagus or cardia of the stomach. Since pain in this area can come from the heart, heart disease should be carefully evaluated and eliminated. Epigastric pain is generally of gastric, duodenal, biliary or pancreatic origin. The epigastrium is also a frequent localization for "functional" pain. As the pathological processes of the bile ducts or pancreas become more intense, the pain can lateralize and locate, for example, bile pain in the right hypochondrium and at the tip of the scapula and pancreatic pain in the left hypochondrium and back. Periombilical pain is generally associated with small intestine disorders. Subombilical pain is often of appendix, colonic or pelvic origin.
Establishing the temporal relationships of the patient's symptoms often provides additional diagnostic clues. It is important to know whether symptoms are constant (continuously present over long periods of time), as happens with an infiltrating gastric carcinoma, or intermittent, as in acute gastritis or biliary colic. Symptoms can have a daily character, as in reflux esophagitis, in which pain often occurs during the night and in clinostatism. Pain that wakes the patient from a deep sleep can occur in the duodenal ulcer. Sometimes symptoms are seasonal, as in peptic ulcer disease, in which patients experience more intense discomfort in spring and autumn compared to other periods.
Another useful diagnostic feature is the relationship of pain with food intake. Early postprandial symptoms may reflect esophageal disease, acute gastritis or gastric carcinoma. Late postprandial indigestion, i.e. occurring a few hours after eating, may reflect the inability of the stomach to empty properly, as in the obstruction of gastric discharge, gastroparesis and other disorders of gastric motility, or duodenal ulcer, in which pain results from exposure of the ulcerated mucosa to acid secreted by the stomach and not buffered by food. Conversely, pain relief following food or antacid ingestion is characteristic for duodenal ulcers and is likely due to acid neutralization. Late postprandial ingestion can also result from digestive processes and faulty absorption, as in pancreatic insufficiency.
It is important to recognize that the relationships with food ingestion and the characters of pain described above are generalizations and many cases do not conform to the classic "manual" descriptions. For example, although pain limited to the right hypochondrium is often caused by gallbladder pain, about half of patients with such suffering report only epigastric pain. similarly, there are patients with duodenal ulcers whose pain is not relieved by food or antacids, while there are other patients with functional indigestion and even gastric carcinoma whose pain improves with food and antacids.
Nonulcerous dyspepsia refers to symptoms that suggest a diagnosis of peptic ulcer despite the documented absence of an endoscopy ulcer or radiological barium investigation and the absence of any other demonstrable organic disorder (e.g. bile duct disease) or evidence of irritable bowel syndrome that could explain the symptoms. Nonulcerous dyspepsia is at least two pores more common than peptic ulcer and can affect up to 20-30% of the population. Only 20-30% of patients with dyspepsia seek medical attention.
The pathogenesis of nonulcerous dyspepsia is little understood, with most patients having normal gastric acid secretion and a relationship between nonulcerous dyspepsia and duodenitis or duodenal ulcers not demonstrated. Similarly, the role played by Helicobacter pylori and chronic gastritis associated in determining dyspeptic symptoms in people without peptic ulcer is unproven. Damage to gastroduodenal motility and small intestine seems to explain some cases of nonulcerous dyspepsia. Between 25-50% of patients with nonulcerous dyspepsia have postprandial anthral hypomotility and delayed gastric discharge. In addition, 50% experience abdominal discomfort in response to balloon distension at lower volumes than those that cause pain in healthy individuals, suggesting visceral hypersensitivity.
Heartburn is a sensation of heat or burning located retrosternal or up in the epigastrium that radiates into the neck and sometimes in the arms. Occasional heartburn is common in normal people, but frequent and severe heartburn is generally a manifestation of oesophageal dysfunction. Heartburn may result from abnormal motor activity or distension of the esophagus, sensitivity of the esophageal mucosa to acid or bile reflux, or inflammation of the esophageal mucosa (esophagitis). Heartburn is most commonly associated with gastroesophageal reflux.
Under these conditions, heartburn usually occurs after an abundant meal, bending or bending, or when the patient is lying down. It may be accompanied by spontaneous appearance in the mouth of saltable liquid ("burning water"), sour (gastric contents) or bitter and green or yellow (ball). Heartburn may occur as a result of ingestion of certain foods (e.g. citrus juices) or medicines (e.g. alcohol and aspirin). Characteristically, heartburn is promptly improved, even if only temporarily, by antacids.
We still have to talk about indigestion and on June 16th...
Until then, let's hear it
for good!
Dorin, Merticaru