ESOPHAGEAL OBSTRUCTION - rEMERGs

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NONULCER DYSPEPSIA DEFINITIONS ‣ Dyspepsia = a group of symptoms that suggest upper gastrointestinal tract disease. Often used to mean upper abdominal pain/discomfort but may include early satiety, postprandial bloating or distension, nausea/vomiting ‣ Functional Dyspepsia (nonulcer dyspepsia) = chronic or recurrent upper abdominal pain or discomfort that is not explained by biochemical or structural abnormalities on diagnostic evaluation. Also called essential dyspepsia, idiopathic dyspepsia. EPIDEMIOLOGY ‣ Prevelance of 30% for chronic dyspepsia (>1mo) and 6% for acute dyspepsia (
MEDICATION OPTIONS ‣ Gastric Acid Suppressants ‣ H2 antagonists and PPIs ‣ Generally shown to provide little help ‣ Improvement in dyspeptic symptoms w/ acid suppression has been shown to be only 25% better than placebo ‣ Prokinetics ‣ Metaclopramide (maxaran), Cisapride (propulsid), Domperidone ‣ More effective ‣ Improvement of symptoms 50% greater than placebo ‣ H. pylori erradication ‣ Controversial ‣ Reasonable for the FP who does not have endoscopic evidence of organic disease when treating dyspepsia empirically ‣ Psychotropic Medication ‣ TCAs, SSRIs, anxiolytics ‣ No data from controlled studies to support the use of these agents routinely ‣ Antinociceptive Agents ‣ Low dose TCAs, kappa opiod agonists (fedotozine), Serotonin receptor antagonists (ondansetron, granisetron), SST analogs (ocreotide) ‣ Role not yet determined APPROACH TO MANAGEMENT ‣ Interview important to initiate symptom based dx, explore pt concerns and expectations, explore psychosocial isssues, educate, and determine if pt has a fear of Ca ‣ Evidence of organic disease, Ca fear, or severe symptoms perceived by pt or Dr. ‣ Endoscopy ‣ Empiric Tx if nothing found ‣ No evidence of organic dz, or normal investigations ‣ Empiric Tx ‣ Approach three subgroups
Page 1 and 2: ESOPHAGEAL OBSTRUCTION ANATOMY ‣
Page 3 and 4: ESOPHAGEAL PERFORATION INTRODUCTION
Page 5 and 6: DYSPHAGIA DEFINITIONS ‣ Dysphagia
Page 7 and 8: INVESTIGATIONS ‣ Neck Xrays: look
Page 9 and 10: ‣ Resp Complications: recurrent c
Page 11 and 12: GASTROESOPHAGEAL REFLUX DISEASE Int
Page 13 and 14: ABDO PAIN: GASTRIC OR DUODENAL ORIG
Page 15 and 16: ‣ ‣ May present w/ Complication
Page 17: NSAID INDUCED ULCERS EPIDEMIOLOGY
Page 21 and 22: ‣ urease splits urea and produces

ESOPHAGEAL OBSTRUCTION - rEMERGs

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