bluestar
Forum Guru
Topics: 236
Posts: 724
|
on page 14, there are several practical approach to PUD:
1, a patient comes to see you with new-onset epigastic pain and dyspepsia. what clinical markers would make you consider a gastroenterologist referral?
2, the patient does not have these alarming clinical markers, what questions do you ask the patient that would help you consider your next step?
Could you help me answer these questions? thank you!
___________________
I leave no trace of wings in the air, but I am glad I have had my flight
|
| miky
Forum Senior
Topics: 16
Posts: 99
|
1, a patient comes to see you with new-onset epigastic pain and dyspepsia. what clinical markers would make you consider a gastroenterologist referral?
2, the patient does not have these alarming clinical markers, what questions do you ask the patient that would help you consider your next step?
there are some clinical symptoms / signs that should make you consider a prompt referral to a gastroenetrologist. They are also known as red flags. It means that you must suspect a serious underlying condition:
Red flags:
weight loss
anemia (palor)
blood vomit
peritoneal signs (even localized) or S/S of intestinal obstruction
protracted vomiting
severe or progressive dysphagia (for solids or mixed)
h/o NSAIDs / glucocorticoids use (either prescribed by a physician or taken over-the-counter) or any drug abuse
syncope / loss of consciousness
blood in stools / positive in-office occult blood test
jaundice (scleral most sensitive)
alcoholic
dyspepsia is too unspecific - pls. ask pt. more about that. it could hide many important S that are often overlooked.
However, new-onset epigastric pain should make you consider first the next immediate emergencies:
Myocardial infarction (inf)
Perforated / penetarting GDU
and :
acute pancreatitis
acute appendicitis
acute cholecystitis / cholangitis
acute gastritis
Of course, there are many conditions that may manifest as above.
If red flags are not present, you may ask next:
barium studies (upper GI series)
if you find sth. suspicious - next: endoscopy +/- biopsy
If I were you, I would obtain a complete history and try to perform a pertinent physical exam.
Hope it helped.
___________________
always happy and ready to serve and help my friends and patients as well.
|
| Dot
Forum Senior
Topics: 1
Posts: 168
|
I would like u to Harrison "Approach to patient with new onset pigastric pain and dyspepsia".Its big so i m not writing and i think u wil get some help from there.If i have time i wil try to post it.
___________________
have fun
|
| bluestar
Forum Guru
Topics: 236
Posts: 724
|
Thank you, Miky and Dot! I don't have Harrison's book with me. but I've checked the related chapter of CMDT. Thank you for the reminding!
___________________
I leave no trace of wings in the air, but I am glad I have had my flight
|
|
| |
| | | | |
