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1. CLINICAL APPROACH
TO A PATIENT WITH
DYSPEPSIA

2. HISTORY TAKING
 PROPER HISTORY TO
• Elicit symptoms classical of specific
disorder, e.g.: peptic ulcer
• Detect alarm features requiring urgent
investigation
• Detect atypical symptoms more
suggestive of other disorders

3. MODE OF ENQUIRY
 ONSET
Acute overeating, eating too
quick, eating high fat foods, eating during
stressful situations, or drinking too much
alcohol or coffee
Chronic functional
dyspepsia, malignancy and other extra
intestinal causes

4.  RELATION TO FOOD
 Earlypost-prandial pain : acute
gastritis, esophageal disease and gastric
carcinoma
 Latepost-prandial pain : gastric outlet
obstruction, impaired digestive and
absorptive process
 Relief
of pain is characteristic of duodenal
ulcer (due to neutralization of acid)

5.  AGGRAVATING AND RELIEVING
FACTORS
 Milk, legumes
flatulence, bloating, excessive gas
 Food relieves duodenal ulcer pain
 LOSS OF WEIGHT: as in malignancy

6.  HISTORY OF MEDICATION
 Drugs that slow gut transit
narcotics, anti-cholinergics, calcium
antagonist
o NSAID
 PSYCHOLOGICAL FACTORS
anxiety and depression : cause or
aggravate symptoms
 HISTORY OF SYSTEMIC DISEASE
like cardiac or renal disease

7. ALARM FEATURES
 Weight loss
 Anaemia
 Vomiting
 Hematemesis
 Dysphagia
 Palpable mass

8. PEPTIC ULCER
 History of ulcers
 NSAID use
 Smoking
 Family history
GERD
o Heart burn and regurgitation
o Epigastric pain may radiate to throat and worsen when
patient bends down or lies flat
o Esophageal spasm : sharp, stabbing sub-sternal pain
o At night or after consumption of large meal

9.  PAST HISTORY
o Cardiac, hepatic, renal, peptic
ulcer, pancreatic disease
o Psychiatric illness
 FAMILY HISTORY
Psychiatric illness
 PERSONAL HISTORY
Alcohol
Smoking
Drugs

10. EXAMINATION
1) GENERAL EXAMINATION
Weight loss
Pallor
Icterus
Lymphadenopathy: Virchow’s
Node
Acanthosis nigricans
VITALS
Pulse : tachycardia blood
B.P. : Hypotension loss

11. EXAMINATION OF GASTROINTESTINAL
SYSTEM
o ORAL CAVITY
Extensive loss of enamel dental
and exposed dentin erosion
GERD

12. ABDOMEN
 Palpate for abdominal mass
 Murphy’s sign
 Signs of liver failure

13. INVESTIGATIONS
DYSPEPSIA
ALARM FEATURES
Yes No
Endoscopy
<55yrs >55yrs
Test for H. Pylori Endoscopy
+ve -ve
Eradication Symptomatic Rx
symptoms resolve symptoms persist
No follow up Endoscopy

14. TREATMET
 Acid Suppressing 0r Neutralizing Medications
H2 receptor antagonists
Proton Pump Inhibitors
Antacids
o H. Pylori infection Eradication
o Gastrointestinal Motor Stimulants
o Other Options

15. THANK YOU….