INDIGESTION

INDIGESTION: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is there a history of drug or alcohol ingestion? Alcohol, tobacco, aspirin, other nonsteroidal anti-inflammatory drugs, steroids, caffeine, and antibiotics are just a few of the drugs that may irritate the stomach.
2. Is the indigestion brought on by exertion? A history of indigestion brought on by exertion should suggest angina pectoris.
3. Is there a loss of appetite and weight? These findings would suggest not only a GI neoplasm but also pernicious anemia, chronic pancreatitis and pyloric obstruction, and chronic gastritis. Chronic organ failure should also be entertained, such as uremia, cirrhosis, or congestive heart failure.
4. Is the indigestion or pain relieved by food or antacids? These findings would suggest a duodenal ulcer, hiatal hernia, and esophagitis.
5. Is the indigestion or pain brought on by food? These findings would suggest cholecystitis, gastric ulcer, or toxins in food such as monosodium glutamate (MSG) or sulfites.
6. Is the indigestion or pain unrelated to meals? These findings would suggest a chronic appendicitis, chronic intestinal obstruction, or tabes dorsalis.
7. Is there no pain associated with the indigestion? This finding would suggest functional dyspepsia.

DIAGNOSTIC WORKUP

Routine tests include a CBC, urinalysis, chemistry panel, VDRL test, thyroid profile, serum B ₁₂ and folic acid, an upper GI series, esophagogram, and stools for occult blood and ovum and parasites. The next step is a cholecystogram or gallbladder ultrasound.

If these studies are negative, a gastroenterologist should be consulted. He will do esophagoscopy, gastroscopy, and duodenoscopy. He may also perform esophageal motility studies or esophageal pH monitoring. A Bernstein test may be of value in solving the diagnostic dilemma. He may also want to order a CT scan of the abdomen or a small bowel series.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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