HEARTBURN

Ask the Following Questions:

1. Is there frequent regurgitation? If there is frequent regurgitation, the most likely diagnosis is reflux esophagitis and hiatal hernia. Gastritis and a previous gastrectomy will also cause frequent regurgitation.
2. Is there recurrent nausea or vomiting? If there is recurrent nausea or vomiting, the most likely diagnosis is cholecystitis and cholelithiasis. Chronic pancreatitis can cause the same symptoms, however.
3. Is the heartburn precipitated by exercise and/or relieved by nitroglycerin? These findings suggest coronary insufficiency.
4. Is there associated hematemesis or recurrent black stool? The presence of hematemesis or recurrent black stools should suggest a peptic ulcer.
5. Is there relief with lidocaine hydrochloride (Xylocaine® Viscous Solution)? The relief of the pain on viscous lidocaine suggests reflux esophagitis, hiatal hernia, and previous gastrectomy with bile esophagitis. Gastritis is not usually relieved by viscous Xylocaine®.

DIAGNOSTIC WORKUP

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.

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.

Other Book Chapters Related to Heartburn

Read excerpts from these other book chapters related to Heartburn:

Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Heartburn

• Back to symptom: Heartburn: Introduction (review 148 causes)
• Next Book Extract About Heartburn: Heartburn (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Heartburn

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

 » Next page: Heartburn (In a Page: Signs and Symptoms)

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