1. AHMAD MHD ALDHLAWIY
1

2. DEFINITION
MANEGEMENT
LOCATION
SOEPEL
CLINICAL
FEATURES
INVESTIGATION
CAUSES
2

3.  Subject:
A 35 year old patient admitted to the hospital cause of excessive
vomiting.
History:
the patient complain with abdominal pain, excessive vomiting, and
loss of weight.
3

4. Pain analysis:
1.
Site: epigastric.
2.
Onset: episodic.
3.
Character: burning.
4.
Associated factors: --
5.
Time/duration: 4 months.
6.
Exaggerated factors: after eating.
7.
relieving factors: medication.
8.
Severity: moderate
4

5.  Object: General examination & Abdominal examination.
 Evaluation (DD): achalasia, hiatal hernia.
 Plan: Endoscopy.
 Elaboration: change lifestyle.
 Learning goals: GERD.
5

6. highly variable chronic condition that is characterized by
periodic episodes of gastroesophageal reflux usually
accompanied by heartburn and that may result in
histopathologic changes in the esophagus.
6

7. 7

8.  HEART BURN: It is a major feuters, aggrevated by
bending, stopping or laying down which promote acid
exposure. The complain of pain well be during drinking
hot liquid or alcohol.
 REGURGITATION: Food and acid into the mouth
occurs particular on bending or layig flat.
8

9.  Obesity.
 Pregnancy.
 Certain medications, such as asthma medications,
calcium channel blockers, and many antihistamines,
pain killers, sedatives, and antidepressants.
 Smoking, or inhaling secondhand smoke.
9

10. Assess oesophagitis and hiatal hernia by endoscopy:
If there is oesophagitis or Barrett’s oesophagus, reflux is confirmed.
Document reflux by intraluminal monitoring:
24-hour intraluminal pH monitoring or impedance combined with
manometry is helpful if there is no response to PPI and should always be
performed to confirm reflux before surgery.
10

11. 11

12.  Change Lifestyle:
 losing weight, if needed
 wearing loose-fitting clothing around the stomach area.
 remaining upright for 3 hours after meals.
 raising the head of the bed 6 to 8 inches by securing wood blocks
under the bedposts––just using extra pillows will not help.
12

13. Medication:
 Alginate-containing antacids: (10 mL three times daily), if it contain
magnesium antacid it will cause to diarrehea, or if it contain aluminum it will cause
to concitipation.
 The dopamine antagonist prokinetic agents : they enhance peristalsis and
speed gastric emptying.
 H2-receptor antagonists: used for acid suppression if antacids fail as they can
often be obtained over the counter.
 Proton pump inhibitors: inhibit gastric hydrogen/potassium-ATPase. PPIs
reduce gastric acid secretion by up to 90% and are the drugs of choice for allbut
mild cases.
13

14. Surgery:
 Fundoplication.
 Endoscopic techniques.
14

15.  Kumar and clark’s 8th edition.
 Oxforf clinical medicine.
15