Clinical case discussion （上海交大仁济临床医学院《医学专业英语》课件PPT）.pptVIP

Clinical case discussion Zhi Hua Ran Department of gastroenterology Ren Ji Hospital Questions What are the common causes of upper abdominal pain? Answer Gastroesophageal reflux Biliary colic Functional dyspepsia Peptic ulcer (duodenal ulcer, gastric ulcer) Gastric cancer Irritable bowel syndrome Questions How to differentiate the common causes of upper abdominal pain? Answer --- the clinical features Gastroesophageal reflux typically produces “heart burn”, or burning epigastric or mid-chest pain after meals and worse with recumbency Biliary colic caused by gallstones typically has an acute onset of severe pain located in the right upper quadrant or epigastrium precipitated by meals, fatty foods in particular lasts 30~60 min with spontaneous resolution more common in women Answer --- the clinical features Functional dyspepsia can be associated with fullness, early satiety, bloating or nausea can be intermittent or continuous may or may not be related to meals symptom persisting at least 12 weeks Irritable bowel syndrome is a diagnosis of exclusion suggested by chronic dysmotility symptoms --- bloating, cramping that is often relieved with defecation without weight loss or bleeding Answer --- the clinical features Peptic ulcer (duodenal ulcer, gastric ulcer) DU: the classic symptoms of duodenal ulcers are caused by the presence of acid without food or other buffers symptoms are typically produced after the stomach is emptied but food- stimulated acid production still persists, typically 2~5 h after a meal pain wake patients at night, when circadian rhythms increase acid production it is typically relieved within minutes by neutralization of acid by food or antacids GU: are more variable in their presentation food may actually worsen symptoms pain might not be relieved by antacids Answer --- the clinical features Gastric cancer 45y alarm symptoms: weight loss,