TAILIEUCHUNG - Chapter 039. Nausea, Vomiting, and Indigestion (Part 6)

Gastric Motor Dysfunction Disturbed gastric motility is purported to cause acid reflux in some cases of indigestion. Delayed gastric emptying is also found in 25–50% of functional dyspeptics. The relation of these defects to symptom induction is uncertain; many studies show poor correlation between symptom severity and the degree of motor dysfunction. Impaired gastric fundus relaxation after eating may underlie selected dyspeptic symptoms like bloating, nausea, and early satiety. Visceral Afferent Hypersensitivity Disturbed gastric sensory function is proposed as a pathogenic factor in functional dyspepsia. Visceral afferent hypersensitivity was first demonstrated in patients with irritable bowel syndrome who had heightened perception of rectal. | Chapter 039. Nausea Vomiting and Indigestion Part 6 Gastric Motor Dysfunction Disturbed gastric motility is purported to cause acid reflux in some cases of indigestion. Delayed gastric emptying is also found in 25-50 of functional dyspeptics. The relation of these defects to symptom induction is uncertain many studies show poor correlation between symptom severity and the degree of motor dysfunction. Impaired gastric fundus relaxation after eating may underlie selected dyspeptic symptoms like bloating nausea and early satiety. Visceral Afferent Hypersensitivity Disturbed gastric sensory function is proposed as a pathogenic factor in functional dyspepsia. Visceral afferent hypersensitivity was first demonstrated in patients with irritable bowel syndrome who had heightened perception of rectal balloon inflation without changes in rectal compliance. Similarly dyspeptic patients experience discomfort with fundic distention to lower pressures than healthy controls. Some patients with heartburn exhibit normal esophageal acid exposure. These individuals with functional heartburn are believed to have heightened perception of normal esophageal pH. Other Factors Helicobacter pylori has a clear etiologic role in peptic ulcer disease but ulcers cause a minority of cases of dyspepsia. Infection with H. pylori is considered to be a minor factor in the genesis of functional dyspepsia. In contrast functional dyspepsia is associated with a reduced sense of physical and mental well-being and is exacerbated by stress suggesting an important role for psychological factors. Analgesics cause dyspepsia while nitrates calcium channel blockers theophylline and progesterone promote acid reflux. Other exogenous stimuli that induce acid reflux include ethanol tobacco and caffeine via LES relaxation. Genetic factors may contribute to development of acid reflux. Differential Diagnosis Gastroesophageal Reflux Disease Gastroesophageal reflux disease GERD is prevalent in Western society. Heartburn

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