Diagnostic Tests for Heartburn
Heartburn Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Heartburn:
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Heartburn Diagnosis: Book Excerpts
Diagnosis of Heartburn: medical news summaries:
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Diagnostic Tests for Heartburn: Online Medical Books
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for more information about the diagnostic tests for Heartburn.
HEARTBURN:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The workup begins with an upper GI series and esophagogram and stools for occult blood. If there is recurrent vomiting and right upper quadrant pain, a gallbladder ultrasound or cholecystogram should be done. If these are negative, it is best to refer the patient to a gastroenterologist for esophagoscopy and gastroscopy. The gastroenterologist may do a Bernstein test, which will reproduce symptoms by an infusion of dilute hydrochloric acid into the distal esophagus, or perform esophageal manometry or pH monitoring of the distal esophagus. An exercise tolerance test and coronary angiography also have their place in the diagnostic armamentarium.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
INDIGESTION:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
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.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
REGURGITATION, ESOPHAGEAL:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Most disorders will be diagnosed by an upper GI series with an esophagogram and esophagoscopy with a biopsy. A Bernstein test, esophageal pH monitoring, and esophageal manometry may be useful in diagnosing reflux esophagitis. A CBC, serum iron, ferritin, and iron-binding capacity will help diagnose Plummer-Vinson syndrome. An ANA titer and skin biopsy will help diagnose scleroderma. A CT scan of the mediastinum will help diagnose most mediastinal masses, and angiography will be useful in diagnosing an aortic aneurysm.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Dyspepsia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Dyspepsia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has the patient had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking any prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect it for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate it for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting any tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
dysphagia/Heartburn:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Dysphagia, a sensation of sticking usually occurs at the level of the obstruction, although distal esophageal obstruction may be referred to the suprasternal notch. Odynophagia (painful swallowing) is usually caused by infectious esophagitis (Candida, HSV, CMV), severe reflux, or pill-induced esophagitis. Phagophobia (fear of swallowing) can occur in patients with hysteria, rabies, tetanus, or pharyngeal paralysis.
Weight loss may occur with dysphagia of any cause, but a major loss disproportionate to the dysphagia suggests cancer. Hoarseness occurring before dysphagia is consistent with a laryngeal lesion. Hoarseness occurring after the onset of dysphagia suggests recurrent laryngeal involvement with esophageal or bronchogenic cancer or laryngitis due to reflux or neuromuscular disease. Hiccups signal a problem in the terminal esophagus (cancer, achalasia, hiatal hernia). Progressive dysphagia is usually caused by cancer or a peptic stricture, while intermittent dysphagia is most often due to a lower esophageal ring. Unilateral wheezing with dysphagia indicates a mediastinal mass involving both the esophagus and bronchus.
History differentiates mechanical obstruction from motor disorders with 80% accuracy.
Heartburn is typically a retrosternal burning, occurring after meals or awakening the patient from sleep. Patients may regurgitate acid and small amounts of undigested food without nausea or retching. Less common symptoms include water brash, a foamy reflex hypersalivation, and globus, the constant sensation of a lump in the throat. The correlation between severity of heartburn and endoscopic grade of esophagitis is poor.
Early evaluation is indicated by coincident symptoms such as dysphagia, severe nausea, vomiting, weight loss or bleeding, lack of response to empiric therapy, or increase in symptoms with exertion (suggesting angina). Heartburn can mimic angina, with chest pressure radiating to the jaw or shoulder. Pain
or difficulty swallowing suggests active inflammation, malignancy, achalasia, or stricture. Nocturnal pain relieved by intake of food, milk, or antacids favors
peptic ulcer disease. Pain increased by meals and not interfering with daily
activities favors nonulcer dyspepsia.
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Source: Field Guide to Bedside Diagnosis, 2007
Dyspepsia:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting any tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dyspepsia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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