Dyspepsia Describe the heart burn. Usually, a burning pain under the sternum radiating to the throat. Is there an epigastric pain? How often does it happen? More than once a week suggests GORD. Does it happen after meals or after lying down? Does the pain radiate across the chest down to your left arm or into your jaw? Suggests MI. Is the pain relieved by anti-acids? Do you suddenly experience a feeling of bitter testing fluid in your mouth? Typical of acid reg and acid reflux. Have you experienced the sudden appearance of a salty testing or tasteless fluid in your mouth? Waterbrash NOT GORD. Do you have trouble swallowing? Have you been troubled by a cough when you lie down? Differentials Oesophageal causes: GERD, esophagitis, oesophageal cancer, oesophageal compression. Epigastric or retrosternal pain Worse when bending forward or lying down. Reflux or regurgitation. Gastric or duodenal causes: PUD, H. pylori, gastritis, gastric cancer, gastric outlet obstruction, Zollinger ellison syndrome, celiac disease, Crohn’s disease Epigastric or umbilical pain Bloating Nausea Altered bowel habits Melena Weight loss Meds Biliary causes: Symptomatic cholelithiasis RUQ pain Pain is typically worse postprandially Risk factors -> 5Fs: Female Fertile Fat Fair Forty Pancreatic causes Chronic pancreatitis, pancreatic cancer Pain radiates to the back Worse postprandially Altered bowel habits Poor appetite Weight loss Shortness of breath Functional disorders IBS Functional heartburn Functional dyspepsia Rumination syndrome