Dyspepsia
Dyspepsia refers to an uncomfortable fullness after meals that's associated with nausea, belching, heartburn and, possibly, cramping and abdominal distention. Frequently aggravated by spicy, fatty, or high-fiber foods and by excess caffeine intake, dyspepsia without other pathology indicates impaired digestive function.
Dyspepsia is caused by GI disorders and, to a lesser extent, by cardiac, pulmonary, and renal disorders and the effects of drugs. It apparently results when altered gastric secretions lead to excess stomach acidity. This symptom may also result from emotional upset and overly rapid eating or improper chewing. It usually occurs a few hours after eating and lasts for a variable period. Its severity depends on the amount and type of food eaten and on GI motility. Additional food or an antacid may relieve the discomfort. (See Dyspepsia: Common causes and associated findings
History and physical examination
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.
Medical causes
Cholelithiasis.
Dyspepsia may occur with gallstones, usually after eating fatty foods. Biliary colic, a more common symptom of gallstones, causes acute pain that may radiate to the back, shoulders, and chest. The patient may also have diaphoresis, tachycardia, chills, a low-grade fever, petechiae, bleeding tendencies, jaundice with pruritus, dark urine, and clay-colored stools.
Cirrhosis
With cirrhosis, dyspepsia varies in intensity and duration and is relieved by taking an antacid. Other GI effects are anorexia, nausea, vomiting, flatulence, diarrhea, constipation, abdominal distention, and epigastric or right upper quadrant pain. Weight loss, jaundice, hepatomegaly, ascites, dependent edema, a fever, bleeding tendencies, and muscle weakness are also common. Skin changes include severe pruritus, extreme dryness, easy bruising, and lesions, such as telangiectasis and palmar erythema. Gynecomastia or testicular atrophy may also occur.
Duodenal ulcer
A primary symptom of a duodenal ulcer, dyspepsia ranges from a vague feeling of fullness or pressure to a boring or aching sensation in the middle or right epigastrium. It usually occurs 1.5 to 3 hours after a meal and is relieved by eating food or taking an antacid. The pain may awaken the patient at night with heartburn and fluid regurgitation. Abdominal tenderness and weight gain may occur; vomiting and anorexia are rare.
Gastric dilation (acute)
Epigastric fullness is an early symptom of gastric dilation, alife-threatening disorder. Accompanying dyspepsia are nausea and vomiting, upper abdominal distention, succussion splash, and apathy. The patient may display signs and symptoms of dehydration, such as poor tissue turgor and dry mucous membranes, and of electrolyte imbalance, such as an irregular pulse and muscle weakness. Gastric bleeding may produce hematemesis and melena.
Gastric ulcer
Typically, dyspepsia and heartburn after eating occur early in gastric ulcer. The cardinal symptom, however, is epigastric pain that may occur with vomiting, fullness, and abdominal distention and may not be relieved by eating food. Weight loss and GI bleeding are also characteristic.
Gastritis (chronic)
With chronic gastritis, dyspepsia is relieved by antacids; lessened by smaller, more frequent meals; and aggravated by spicy foods or excessive caffeine. It occurs with anorexia, a feeling of fullness, vague epigastric pain, belching, nausea, and vomiting.
GI cancer
GI cancer usually produces chronic dyspepsia. Other features include anorexia, fatigue, jaundice, melena, hematemesis, constipation, and abdominal pain.
Heart failure
Common with right-sided heart failure, transient dyspepsia may occur with chest tightness and a constant ache or sharp pain in the right upper quadrant. Heart failure also typically causes hepatomegaly, anorexia, nausea, vomiting, bloating, ascites, tachycardia, jugular vein distention, tachypnea, dyspnea, and orthopnea. Other findings include dependent edema, anxiety, fatigue, diaphoresis, hypotension, a cough, crackles, ventricular and atrial gallops, nocturia, diastolic hypertension, and cool, pale skin.
Hepatitis
Dyspepsia occurs in two of the three stages of hepatitis. The preicteric phase produces moderate to severe dyspepsia, a fever, malaise, arthralgia, coryza, myalgia, nausea, vomiting, an altered sense of taste or smell, and hepatomegaly. Jaundice marks the onset of the icteric phase, along with continued dyspepsia and anorexia, irritability, and severe pruritus. As jaundice clears, dyspepsia and other GI effects also diminish. In the recovery phase, only fatigue remains.
Hiatal hernia
Dyspepsia is a result of the lower portion of the esophagus and the upper portion of the stomach rising into the chest when abdominal pressure increases.
Pulmonary embolism
Sudden dyspnea characterizes pulmonary embolism, a potentially fatal disorder; however, dyspepsia may occur as an oppressive, severe, substernal discomfort. Other findings include anxiety, tachycardia, tachypnea, a cough, pleuritic chest pain, hemoptysis, syncope, cyanosis, jugular vein distention, and hypotension.
Pulmonary tuberculosis
Vague dyspepsia may occur along with anorexia, malaise, and weight loss. Common associated findings include a high fever, night sweats, palpitations on mild exertion, a productive cough, dyspnea, adenopathy, and occasional hemoptysis.
Uremia
Of the many GI complaints associated with uremia, dyspepsia may be the earliest and most important. Others include anorexia, nausea, vomiting, bloating, diarrhea, abdominal cramps, epigastric pain, and weight gain. As the renal system deteriorates, the patient may experience edema, pruritus, pallor, hyperpigmentation, uremic frost, ecchymoses, sexual dysfunction, poor memory, irritability, a headache, drowsiness, muscle twitching, seizures, and oliguria.
Other causes
Drugs
Nonsteroidal anti-inflammatory drugs, especially aspirin, commonly cause dyspepsia. Diuretics, antibiotics, antihypertensives, corticosteroids, and many other drugs can cause dyspepsia, depending on the patient's tolerance of the dosage.
Surgery
After GI or other surgery, postoperative gastritis can cause dyspepsia, which usually disappears in a few weeks.
Special considerations
Changing the patient's position usually doesn't relieve dyspepsia, but providing food or an antacid may. Have food available at all times, and give an antacid 30 minutes before a meal or 1 hour after it. Because various drugs can cause dyspepsia, give these after meals, if possible.
Provide a calm environment to reduce stress, and make sure that the patient gets plenty of rest. Discuss other ways to deal with stress, such as deep breathing and guided imagery. In addition, prepare the patient for endoscopy to evaluate the cause of dyspepsia.
Pediatric pointers
Dyspepsia may occur in adolescents with peptic ulcer disease, but it isn't relieved by food. It may also occur in congenital pyloric stenosis, but projectile vomiting after meals is a more characteristic sign. It may also result from lactose intolerance.
Geriatric pointers
Most older patients with chronic pancreatitis experience less severe pain than younger adults; some have no pain at all.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Heartburn
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