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Etiology
25-40% : Underlying Organic cause ,the main
causes are peptic ulcer disease, GERD, gastric malignancy,
and NSAID-induced dyspepsia
History taking
Narrow the Differential diagnosis
- GERD : history of heartburn, regurgitation, or cough
- NSAID dyspepsia and peptic ulcer disease : pain radiate to the
back or personal or family history of pancreatitis may be indicative
of underlying chronic pancreatitis
- Malignancy : Significant weight loss, anorexia, vomiting,
dysphagia, odynophagia, and a family history of gastrointestinal
cancers
- Symptomatic cholelithiasis : severe episodic epigastric or RUQ
abdominal pain lasting > an hour or occurs at any time
Talley NJ, Vakil NB, Moayyedi P. American Gastroenterological Association technical review on the evaluation of dyspepsia. Gastroenterology 2005; 129:1756.
Physical examination
Palpable abdominal mass (eg, hepatoma)
Lymphadenopathy (eg, left supraclavicular or periumbilical
in gastric cancer)
Jaundice (eg, secondary to liver metastasis)
Pallor secondary to anemia
Ascites
Muscle wasting, loss of subcutaneous fat, and peripheral
edema due to weight loss
Physical examination
Epigastric tenderness cannot accurately distinguish organic
dyspepsia from functional dyspepsia
Carnetts sign : determine pain arising from the abdominal
wall rather than due to inflammation of the viscera
Carnetts sign + : Increased local tenderness during muscle
tensing, suggests the presence of abdominal wall pain
Carnetts sign - : Decreased tenderness, the origin of pain is
likely from an intra-abdominal organ, as the tensed
abdominal wall muscles protect the viscera
Physical examination
Abdominal wall pain can originate from a
hernia ,hematoma or the abdominal wall
musculature
Laboratory tests
CBC and blood chemistry including LFT
should be performed to identify patients with
alarm features (eg, iron deficiency anemia)
and underlying metabolic diseases that can
cause dyspepsia (eg, diabetes, hypercalcemia)
GI symptoms ;
Constipation, anorexia, and
nausea occur commonly
Pancreatitis and peptic ulcer
disease occur less frequently
Peptic ulcer disease has
been described in patients
with hypercalcemia due to
primary
hyperparathyroidism (may
caused by calcium-induced
gastrin secretion)