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 excessive caffeine intake, dyspepsia without other pathology indicates impaired digestive function.
Dyspepsia is primarily caused by GI disorders and, to a lesser extent, by cardiac, pulmonary, and renal disorders and by the effects of drugs. It apparently results when altered gastric secretions lead to excessive 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 of time. 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: 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 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.
Medical causes
Cholelithiasis
Dyspepsia may occur with gallstones, commonly after intake of 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, low-grade fever, petechiae, bleeding tendencies, jaundice with pruritus, dark urine, and clay-colored stools.
Cirrhosis
In this chronic disorder, dyspepsia varies in intensity and duration and is relieved by ingestion of 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, 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 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 1½ to 3 hours after eating and is relieved by food or 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 this life-threatening disorder. Accompanying dyspepsia are nausea and vomiting, upper abdominal distention, a succussion splash, and apathy. The patient may display signs and symptoms of dehydration, such as poor skin turgor and dry mucous membranes, and of electrolyte imbalance, such as irregular pulse and muscle weakness. Gastric bleeding may produce hematemesis and melena.
Gastric ulcer
Dyspepsia and heartburn after eating may occur in the early stages of a gastric ulcer. The cardinal symptom, however, is epigastric pain that may occur with vomiting, fullness, and abdominal distention and may not be relieved by food. Weight loss and GI bleeding are also characteristic.
Gastritis (chronic)
In this disorder, 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
This type of cancer usually produces chronic dyspepsia. Other features include anorexia, fatigue, jaundice, melena, hematemesis, constipation, and abdominal pain.
Heart failure
Common in 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, cough, crackles, ventricular and atrial gallops, nocturia, elevated diastolic blood pressure, and cool, pale skin.
Hepatitis
Dyspepsia occurs in two of the three stages of hepatitis. The preicteric phase produces moderate to severe dyspepsia, fever, malaise, arthralgia, coryza, myalgia, nausea, vomiting, an altered sense of taste or smell, and hepatomegaly. Jaundice marks the onset of the icteric phase, which also includes continued dyspepsia, anorexia, irritability, and severe pruritus. As jaundice clears, dyspepsia and other GI effects also diminish. In the recovery phase, only fatigue remains.
Hiatal hernia
In this disorder, dyspepsia results when the lower portion of the esophagus and the upper portion of the stomach rise into the chest as abdominal pressure increases.
Pancreatitis (chronic)
Dyspepsia is usually accompanied by severe continuous or intermittent epigastric pain that radiates to the back or through the abdomen. Anorexia, nausea, vomiting, jaundice, dramatic weight loss, hyperglycemia, and steatorrhea may also occur. The patient may have Turner’s or Cullen’s sign.
Pulmonary embolism
Sudden dyspnea characterizes this potentially fatal disorder; however, dyspepsia may occur as an oppressive, severe, substernal discomfort. Other findings include anxiety, tachycardia, tachypnea, 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 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, 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 also 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, so have food available at all times, and give an antacid 30 minutes before or 1 hour after a meal. Because various drugs can cause dyspepsia, give these after meals, if possible.
Provide a calm environment to reduce stress, and make sure 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 determine 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.
Patient counseling
Advise the patient to eat frequent small meals and to avoid foods known to cause symptoms as well as coffee, tea, chocolate, alcohol, and tobacco.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Heartburn
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- HEARTBURN
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- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "Nursing: Interpreting Signs and Symptoms" (2007)
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- HEARTBURN
- "Differential Diagnosis in Primary Care" (2007)
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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Heartburn
» Next page: dysphagia/Heartburn (Field Guide to Bedside Diagnosis)
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