A 38-year-old woman presents with upper abdominal pain worse after meals but no other symptoms. Her H. pylori test is positive. The doctor treats her empirically with Prevpac. A year later, she reports frequent heartburn. Lifestyle modifications and PPI treatment are recommended. She does not need an endoscopy unless symptoms fail to improve.
Dyspepsia is one of the most common symptoms in the adult population, and affects 20-40% of adults annually. We present an evidence based approach to this common topic, incorporating the latest guidelines.
This document provides information on dyspepsia, including its definition, causes, investigations, and management guidelines. It begins by defining dyspepsia and outlining its prevalence in the UK population. It then discusses the common and rare causes of dyspepsia and how to investigate patients. The document reviews guidelines from NICE on investigating and managing dyspepsia. It provides examples of case histories and questions to help apply the guidelines. Key points are emphasized, such as addressing lifestyle factors, empirically treating dyspepsia, and referring patients with red flag symptoms urgently for endoscopy.
- Chronic or recurrent upper gastrointestinal symptoms affect 25-40% of adults and account for a substantial economic burden. Appropriate management is essential to reduce costs.
- The document discusses controversies in the management of uninvestigated dyspepsia, including the choice of empirical treatment strategy and the benefits of early endoscopy in older patients.
- Empirical treatment with a proton pump inhibitor or a test-and-treat approach for Helicobacter pylori are discussed as first-line strategies, with test-and-treat having additional long-term benefits like reducing gastric cancer risk.
Formal case ( 5 problems duodenal ulcer , hypertension , anemia , smoking , h...Aya Ali
A 55-year-old African American male presented with epigastric abdominal pain, dizziness, and darkening of stool. He has a history of hypertension and takes furosemide. He also takes ibuprofen and antacids over-the-counter without relief of symptoms. Physical exam revealed mild abdominal tenderness and a positive fecal occult blood test. Endoscopy showed multiple gastric ulcers. He was assessed with NSAID-induced duodenal ulcer, secondary gastric ulcers, and anemia. Treatment included stopping ibuprofen and starting omeprazole to prevent complications and promote healing.
Common liver Disease in Primary Care SettingChernHaoChong
- The document discusses common liver problems encountered in primary care, including abnormal liver function tests, abnormal findings on liver ultrasound, and viral hepatitis serology interpretations.
- Studies show that only a small percentage of abnormal liver function tests are actually due to liver disease, while the majority are caused by cancer, cardiovascular disease, or respiratory disease.
- Non-alcoholic fatty liver disease is increasingly common in Asia, with genetic factors playing a stronger role. Screening and management of metabolic complications is important when NAFLD/NASH is identified.
- Assessment for significant liver fibrosis or cirrhosis is important for high-risk NAFLD/NASH patients, while lifestyle modifications remain the first-line
This document provides guidance on managing dyspepsia in adults in primary care. It recommends:
- Urgent specialist referral for patients with alarm symptoms like bleeding or weight loss.
- Considering endoscopy for patients over 55 if symptoms persist after testing and treating H. pylori.
- Providing initial treatment with a PPI or testing/treating H. pylori for uninvestigated dyspepsia. Long-term management involves annual reviews and stepping down treatment when possible.
Diabetic Gastroparesis adversely affects 20-40% of longstanding type 1 diabetics and may worsen blood glucose control, but our diabetic patients may not have any other symptoms! Discover the effects of high and low sugar on the normal and neuropathic gut, and learn what you can do help manage this difficult disorder.
This document discusses gastroparesis, a condition where the stomach takes too long to empty its contents. It describes a case study of a 52-year-old woman with symptoms of fullness, nausea, and vomiting. The document outlines various diagnostic tests for gastroparesis including gastric scintigraphy and discusses treatments including dietary changes, medications, gastric electrical stimulation, and surgery. It provides details on the Enterra therapy device and clinical trials showing improvement in symptoms, gastric emptying, and quality of life for many patients.
Dyspepsia is one of the most common symptoms in the adult population, and affects 20-40% of adults annually. We present an evidence based approach to this common topic, incorporating the latest guidelines.
This document provides information on dyspepsia, including its definition, causes, investigations, and management guidelines. It begins by defining dyspepsia and outlining its prevalence in the UK population. It then discusses the common and rare causes of dyspepsia and how to investigate patients. The document reviews guidelines from NICE on investigating and managing dyspepsia. It provides examples of case histories and questions to help apply the guidelines. Key points are emphasized, such as addressing lifestyle factors, empirically treating dyspepsia, and referring patients with red flag symptoms urgently for endoscopy.
- Chronic or recurrent upper gastrointestinal symptoms affect 25-40% of adults and account for a substantial economic burden. Appropriate management is essential to reduce costs.
- The document discusses controversies in the management of uninvestigated dyspepsia, including the choice of empirical treatment strategy and the benefits of early endoscopy in older patients.
- Empirical treatment with a proton pump inhibitor or a test-and-treat approach for Helicobacter pylori are discussed as first-line strategies, with test-and-treat having additional long-term benefits like reducing gastric cancer risk.
Formal case ( 5 problems duodenal ulcer , hypertension , anemia , smoking , h...Aya Ali
A 55-year-old African American male presented with epigastric abdominal pain, dizziness, and darkening of stool. He has a history of hypertension and takes furosemide. He also takes ibuprofen and antacids over-the-counter without relief of symptoms. Physical exam revealed mild abdominal tenderness and a positive fecal occult blood test. Endoscopy showed multiple gastric ulcers. He was assessed with NSAID-induced duodenal ulcer, secondary gastric ulcers, and anemia. Treatment included stopping ibuprofen and starting omeprazole to prevent complications and promote healing.
Common liver Disease in Primary Care SettingChernHaoChong
- The document discusses common liver problems encountered in primary care, including abnormal liver function tests, abnormal findings on liver ultrasound, and viral hepatitis serology interpretations.
- Studies show that only a small percentage of abnormal liver function tests are actually due to liver disease, while the majority are caused by cancer, cardiovascular disease, or respiratory disease.
- Non-alcoholic fatty liver disease is increasingly common in Asia, with genetic factors playing a stronger role. Screening and management of metabolic complications is important when NAFLD/NASH is identified.
- Assessment for significant liver fibrosis or cirrhosis is important for high-risk NAFLD/NASH patients, while lifestyle modifications remain the first-line
This document provides guidance on managing dyspepsia in adults in primary care. It recommends:
- Urgent specialist referral for patients with alarm symptoms like bleeding or weight loss.
- Considering endoscopy for patients over 55 if symptoms persist after testing and treating H. pylori.
- Providing initial treatment with a PPI or testing/treating H. pylori for uninvestigated dyspepsia. Long-term management involves annual reviews and stepping down treatment when possible.
Diabetic Gastroparesis adversely affects 20-40% of longstanding type 1 diabetics and may worsen blood glucose control, but our diabetic patients may not have any other symptoms! Discover the effects of high and low sugar on the normal and neuropathic gut, and learn what you can do help manage this difficult disorder.
This document discusses gastroparesis, a condition where the stomach takes too long to empty its contents. It describes a case study of a 52-year-old woman with symptoms of fullness, nausea, and vomiting. The document outlines various diagnostic tests for gastroparesis including gastric scintigraphy and discusses treatments including dietary changes, medications, gastric electrical stimulation, and surgery. It provides details on the Enterra therapy device and clinical trials showing improvement in symptoms, gastric emptying, and quality of life for many patients.
This document discusses the gastrointestinal complications of diabetes mellitus. It notes that diabetes can impact the entire GI tract from the esophagus to the large intestine. Common problems include gastroparesis, diarrhea, constipation, and an increased risk of liver disease and cancer. The document provides details on the mechanisms, clinical presentations, and management of various GI issues associated with diabetes.
Diabetic Gastroparesis is a form of gastric paralysis that results in chronic symptoms from delayed gastric emptying without mechanical obstruction. Common symptoms include nausea, vomiting, bloating, early satiety, and abdominal pain. Gastroparesis is diagnosed by demonstrating delayed gastric emptying through tests like scintigraphy in symptomatic individuals after excluding other causes. Treatment involves nutrition therapy, glycemic control, prokinetic agents, antiemetics, and other modalities like botulinum toxin injection or gastric electrical stimulation.
This document discusses post-surgical gastroparesis. It begins by describing a patient's presentation of nausea, vomiting and abdominal distension following surgery. It then covers the pathogenesis, clinical manifestations including nausea and bloating, evaluation using gastric emptying scans and wireless motility capsules, and treatment including prokinetic medications and dietary recommendations. Surgical options are mentioned as a last resort for refractory cases.
Gastroparesis is a condition in which a human stomach cannot empty itself of food in a normal manner. Gastroparesis disorder is also known as delayed gastric emptying.
This document summarizes guidelines for the diagnosis, surveillance, and management of Barrett's esophagus. It defines Barrett's esophagus as the replacement of the normal squamous epithelial lining of the esophagus with metaplastic columnar epithelium. Surveillance aims to detect early cancers but has not been proven to reduce mortality in randomized trials. Management involves surveillance of non-dysplastic Barrett's and treatment of dysplastic areas, with options including ablation, endoscopic resection, or surgery depending on the stage. Guidelines recommend a multidisciplinary team approach and further research is still needed.
Gastroparesis is delayed gastric emptying without mechanical obstruction. It is commonly caused by autonomic neuropathy like in diabetes. Symptoms include nausea, vomiting, bloating and weight loss. Diagnosis involves ruling out obstruction and scintigraphy showing retained food after meals. Treatments include prokinetic medications, botulinum toxin injections, enteral feeding tubes, and gastric pacemakers which use electrical stimulation to increase motility. While many can live normally with treatment, diabetes-related gastroparesis often requires more intensive intervention.
Mr. Z, a 53-year-old male with necrotizing pancreatitis and multiple comorbidities, was admitted for 28 days with severe malnutrition evidenced by a 25-pound weight loss over 6 months. His nutrition care included initiating enteral nutrition via G-tube to improve immune function and wound healing for pressure ulcers. Multiple formula changes were needed due to intolerance. His condition declined and he was transferred with a critical prognosis and poor nutrition status despite nutrition interventions.
This document provides guidelines for managing common acid-related gastrointestinal conditions like GERD, peptic ulcer disease, and dyspepsia. It recommends initial assessment including looking for precipitating medications and red flag symptoms. For patients with GERD symptoms, it recommends lifestyle interventions and short-term PPI or H2 blocker use. For patients with dyspepsia, it provides an algorithm for testing and treating H. pylori depending on prevalence, and trying PPI or H2 blocker if symptoms persist. It emphasizes using the lowest effective dose of medications and tapering or stopping long-term PPI use when possible.
Enfermería clínica del adulto y adulto mayor.KevinDaniel88
This document discusses the causes, symptoms, diagnosis and treatment of obesity. It begins by explaining that obesity is a multifactorial chronic disease characterized by excessive fat accumulation. It then describes the main symptoms of obesity such as edema, difficulty performing daily tasks, and various metabolic and cardiovascular complications. The diagnosis of obesity involves calculating the body mass index and measuring waist circumference. Treatment focuses on lifestyle modifications like diet, exercise and behavior therapy, as well as potential drug or surgical interventions in severe cases.
gutCARE IBS Talk on 20/5/2020.
In this talk, we update Singapore local epidemiology about increasing trend of IBS locally since 1998. There is also challenges in diagnosing IBS confidently in primary care due to patient presentation and symptoms.
We also update audience about latest diagnostic criteria for IBS.
New treatment for IBS, relationship between Small intestine bacterial overgrowth and IBS and the role of hydrogen breath testing in managing IBS.
We hope you enjoy the slides.
Recent advances in diabetic gastroparesisViraj Shinde
This document discusses current and emerging medical therapies for gastroparesis. It begins by introducing gastroparesis and its symptoms. The main current treatments include prokinetics like metoclopramide and domperidone, antiemetics, dietary changes, and correcting underlying conditions in diabetics. Emerging therapies target serotonin receptors, motilin receptors, accommodation, pyloric function, and more. Several drug candidates are discussed, including TD-5108, prucalopride, and motilin receptor agonists without antibiotic activity.
Current Trends in Management of Gastroesophageal Reflux DiseaseAadil Sayyed
The document discusses prevalence rates of gastroesophageal reflux disease (GERD) around the world, ranging from 7.4-22% depending on the region. It then provides information on the pathophysiology of GERD, including abnormal lower esophageal sphincter function and increases in abdominal pressure. The clinical manifestations of GERD are described as well as different phenotypic presentations such as nonerosive reflux disease, erosive esophagitis, and Barrett's esophagus. Diagnostic approaches and management strategies for GERD are summarized based on guidelines from the American College of Gastroenterology and World Gastroenterology Organization. Proton pump inhibitors are described as first-line treatment options for G
Functional GI disorder is common in children. Rome IV criteria are helpful in differentiating organic causes from functional disorders. this presentation shows the difference between Rome III and IV criteria.
This 57-year-old man with type 2 diabetes, obesity, and hypothyroidism presents for follow-up. He has high blood pressure, dyslipidemia, and early-stage diabetic nephropathy. Treatment is recommended including metformin, an ACE inhibitor, and statin to control blood sugar, blood pressure, and cholesterol. Lifestyle modifications including diet, exercise, and weight loss are also emphasized to manage his conditions. Monitoring of labs and symptoms is planned to assess treatment effectiveness and prevent further complications.
Gastroesophageal Reflux Disease (GERD) is a common disorder that has undergone many paradigm changes in the last 15 years. We discuss the current paradigms in the pathophysiology, diagnosis and management of GERD.
Formal case Presentation (care plan for patient has duodenal ulcer caused by...Aya Ali
1. A 55-year-old man presents with epigastric abdominal pain, dark stool, and dizziness. Endoscopy shows multiple gastric ulcers. He takes NSAIDs and has a family history of peptic ulcer disease.
2. His treatment plan includes stopping NSAIDs and antacids, starting omeprazole 20mg twice daily, monitoring for symptoms and complications, and patient education on lifestyle changes and medication adherence.
3. Follow up in 2-4 weeks includes repeat endoscopy in 6-8 weeks to confirm ulcer healing before tapering medications to prevent recurrence.
The cause of preeclampsia is unknown, but it is characterized by vasospasm, activation of coagulation systems, oxidative stress, and ischemic changes. Preeclampsia is more than just hypertension - it is a systemic syndrome with life-threatening complications even with mild blood pressure elevations. It can affect the heart, kidneys, coagulation system, liver, and central nervous system. Diagnosis involves assessing blood pressure history, lab tests of organ function and blood work, and monitoring fetal growth by ultrasound.
This document discusses the gastrointestinal complications of diabetes mellitus. It notes that diabetes can impact the entire GI tract from the esophagus to the large intestine. Common problems include gastroparesis, diarrhea, constipation, and an increased risk of liver disease and cancer. The document provides details on the mechanisms, clinical presentations, and management of various GI issues associated with diabetes.
Diabetic Gastroparesis is a form of gastric paralysis that results in chronic symptoms from delayed gastric emptying without mechanical obstruction. Common symptoms include nausea, vomiting, bloating, early satiety, and abdominal pain. Gastroparesis is diagnosed by demonstrating delayed gastric emptying through tests like scintigraphy in symptomatic individuals after excluding other causes. Treatment involves nutrition therapy, glycemic control, prokinetic agents, antiemetics, and other modalities like botulinum toxin injection or gastric electrical stimulation.
This document discusses post-surgical gastroparesis. It begins by describing a patient's presentation of nausea, vomiting and abdominal distension following surgery. It then covers the pathogenesis, clinical manifestations including nausea and bloating, evaluation using gastric emptying scans and wireless motility capsules, and treatment including prokinetic medications and dietary recommendations. Surgical options are mentioned as a last resort for refractory cases.
Gastroparesis is a condition in which a human stomach cannot empty itself of food in a normal manner. Gastroparesis disorder is also known as delayed gastric emptying.
This document summarizes guidelines for the diagnosis, surveillance, and management of Barrett's esophagus. It defines Barrett's esophagus as the replacement of the normal squamous epithelial lining of the esophagus with metaplastic columnar epithelium. Surveillance aims to detect early cancers but has not been proven to reduce mortality in randomized trials. Management involves surveillance of non-dysplastic Barrett's and treatment of dysplastic areas, with options including ablation, endoscopic resection, or surgery depending on the stage. Guidelines recommend a multidisciplinary team approach and further research is still needed.
Gastroparesis is delayed gastric emptying without mechanical obstruction. It is commonly caused by autonomic neuropathy like in diabetes. Symptoms include nausea, vomiting, bloating and weight loss. Diagnosis involves ruling out obstruction and scintigraphy showing retained food after meals. Treatments include prokinetic medications, botulinum toxin injections, enteral feeding tubes, and gastric pacemakers which use electrical stimulation to increase motility. While many can live normally with treatment, diabetes-related gastroparesis often requires more intensive intervention.
Mr. Z, a 53-year-old male with necrotizing pancreatitis and multiple comorbidities, was admitted for 28 days with severe malnutrition evidenced by a 25-pound weight loss over 6 months. His nutrition care included initiating enteral nutrition via G-tube to improve immune function and wound healing for pressure ulcers. Multiple formula changes were needed due to intolerance. His condition declined and he was transferred with a critical prognosis and poor nutrition status despite nutrition interventions.
This document provides guidelines for managing common acid-related gastrointestinal conditions like GERD, peptic ulcer disease, and dyspepsia. It recommends initial assessment including looking for precipitating medications and red flag symptoms. For patients with GERD symptoms, it recommends lifestyle interventions and short-term PPI or H2 blocker use. For patients with dyspepsia, it provides an algorithm for testing and treating H. pylori depending on prevalence, and trying PPI or H2 blocker if symptoms persist. It emphasizes using the lowest effective dose of medications and tapering or stopping long-term PPI use when possible.
Enfermería clínica del adulto y adulto mayor.KevinDaniel88
This document discusses the causes, symptoms, diagnosis and treatment of obesity. It begins by explaining that obesity is a multifactorial chronic disease characterized by excessive fat accumulation. It then describes the main symptoms of obesity such as edema, difficulty performing daily tasks, and various metabolic and cardiovascular complications. The diagnosis of obesity involves calculating the body mass index and measuring waist circumference. Treatment focuses on lifestyle modifications like diet, exercise and behavior therapy, as well as potential drug or surgical interventions in severe cases.
gutCARE IBS Talk on 20/5/2020.
In this talk, we update Singapore local epidemiology about increasing trend of IBS locally since 1998. There is also challenges in diagnosing IBS confidently in primary care due to patient presentation and symptoms.
We also update audience about latest diagnostic criteria for IBS.
New treatment for IBS, relationship between Small intestine bacterial overgrowth and IBS and the role of hydrogen breath testing in managing IBS.
We hope you enjoy the slides.
Recent advances in diabetic gastroparesisViraj Shinde
This document discusses current and emerging medical therapies for gastroparesis. It begins by introducing gastroparesis and its symptoms. The main current treatments include prokinetics like metoclopramide and domperidone, antiemetics, dietary changes, and correcting underlying conditions in diabetics. Emerging therapies target serotonin receptors, motilin receptors, accommodation, pyloric function, and more. Several drug candidates are discussed, including TD-5108, prucalopride, and motilin receptor agonists without antibiotic activity.
Current Trends in Management of Gastroesophageal Reflux DiseaseAadil Sayyed
The document discusses prevalence rates of gastroesophageal reflux disease (GERD) around the world, ranging from 7.4-22% depending on the region. It then provides information on the pathophysiology of GERD, including abnormal lower esophageal sphincter function and increases in abdominal pressure. The clinical manifestations of GERD are described as well as different phenotypic presentations such as nonerosive reflux disease, erosive esophagitis, and Barrett's esophagus. Diagnostic approaches and management strategies for GERD are summarized based on guidelines from the American College of Gastroenterology and World Gastroenterology Organization. Proton pump inhibitors are described as first-line treatment options for G
Functional GI disorder is common in children. Rome IV criteria are helpful in differentiating organic causes from functional disorders. this presentation shows the difference between Rome III and IV criteria.
This 57-year-old man with type 2 diabetes, obesity, and hypothyroidism presents for follow-up. He has high blood pressure, dyslipidemia, and early-stage diabetic nephropathy. Treatment is recommended including metformin, an ACE inhibitor, and statin to control blood sugar, blood pressure, and cholesterol. Lifestyle modifications including diet, exercise, and weight loss are also emphasized to manage his conditions. Monitoring of labs and symptoms is planned to assess treatment effectiveness and prevent further complications.
Gastroesophageal Reflux Disease (GERD) is a common disorder that has undergone many paradigm changes in the last 15 years. We discuss the current paradigms in the pathophysiology, diagnosis and management of GERD.
Formal case Presentation (care plan for patient has duodenal ulcer caused by...Aya Ali
1. A 55-year-old man presents with epigastric abdominal pain, dark stool, and dizziness. Endoscopy shows multiple gastric ulcers. He takes NSAIDs and has a family history of peptic ulcer disease.
2. His treatment plan includes stopping NSAIDs and antacids, starting omeprazole 20mg twice daily, monitoring for symptoms and complications, and patient education on lifestyle changes and medication adherence.
3. Follow up in 2-4 weeks includes repeat endoscopy in 6-8 weeks to confirm ulcer healing before tapering medications to prevent recurrence.
The cause of preeclampsia is unknown, but it is characterized by vasospasm, activation of coagulation systems, oxidative stress, and ischemic changes. Preeclampsia is more than just hypertension - it is a systemic syndrome with life-threatening complications even with mild blood pressure elevations. It can affect the heart, kidneys, coagulation system, liver, and central nervous system. Diagnosis involves assessing blood pressure history, lab tests of organ function and blood work, and monitoring fetal growth by ultrasound.
It’s been 10 years since the conference endorsing the principles under the so-called global standard to ensure transparency and better governance of natural resources. What has been the progress so far? Let us tell you in numbers.
ExamPro assures your Residents the best chance of success. Our Written Boards pass rate average for US grads, first-time takers is 97%. Most of the nation's OB/GYNs choose ExamPro. You should too.
The document discusses updates in obstetrics and gynecology, focusing on Millennium Development Goals 4 and 5 which aim to reduce child and maternal mortality. It then outlines key topics including hyperemesis gravidarum, miscarriages, molar pregnancy, and ectopic pregnancy. For each topic, it defines terms, discusses risk factors, clinical presentation, diagnosis, and management approaches.
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits without any organic cause. It affects 3-22% of the population worldwide. While the exact cause is unclear, it is believed to involve altered gut motility, hypersensitivity, and psychosocial factors. Diagnosis is made based on symptoms according to the Rome criteria and excludes other conditions. Treatment involves dietary modifications, medications to target predominant symptoms such as fiber for constipation or alosetron for diarrhea, and treatment of accompanying psychiatric conditions like anxiety or depression.
This document discusses gastritis, irritable bowel syndrome (IBS), their epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, management, and nursing care. It provides details on the types and causes of gastritis and IBS. It notes that the prevalence of H. pylori infection and IBS increases with age. Management involves lifestyle changes, medications, dietary modifications, and treatment of underlying infections or conditions. Nursing focuses on education, dietary guidance, monitoring for complications, and addressing patient anxiety.
1. Mr. Al-Momtan, a 56-year-old male, presented with epigastric abdominal pain for 2 weeks which was worse after eating. Clinical exams and tests diagnosed him with a peptic ulcer disease.
2. He was prescribed a triple therapy of antibiotics and a PPI for 3 weeks to treat his condition.
3. Dyspepsia is a common gastrointestinal condition with many potential causes including non-ulcer dyspepsia, GERD, peptic ulcers, and H. pylori infection. Guidelines recommend lifestyle changes, antacids, and empirical PPI therapy as first-line treatment options.
The document provides tips for using a PowerPoint presentation on chronic pancreatitis. It recommends:
1) Allowing free editing and modification of the slides.
2) Noting that half the slides are blank except for the title to allow for active student participation.
3) Showing blank slides, asking students for input, and then showing slides with content.
4) Repeating this process of blank slides followed by content slides.
5) This approach facilitates active learning through multiple revisions.
Non Cardiac Chest Pain is a common problem in both primary care and hospital settings. This presentation provides a simplified approach to non cardiac chest pain. It uses a case study to cover the evaluation, differential diagnosis, investigations and management for this common medical problem.
Part IV Gasitrointesitinal disorders pharmacotherapy.pptxAbdiIsaq1
This document provides an outline for a lecture on gastrointestinal disorders and pharmacotherapy. It begins with an overview of gastrointestinal tract evaluation, including important components of the patient history, physical examination, and diagnostic tests. Common symptoms of gastrointestinal dysfunction are described. The document then discusses specific diagnostic studies and procedures used to evaluate gastrointestinal disorders, including radiographic, endoscopic, and imaging approaches. Evaluation of gastrointestinal reflux disease is reviewed in detail.
This document provides an overview of peptic ulcer disease including its causes, risk factors, types, diagnostic findings, medical and surgical management, and nursing care. Peptic ulcer disease results from damage to the stomach or duodenal lining from gastric acid and pepsin. Key causes include H. pylori infection, NSAID use, and Zollinger-Ellison syndrome. Nursing management involves assessing for pain and nutrition status, providing education, administering medications, monitoring for complications, and teaching home self-care.
This document provides an overview of peptic ulcer disease including its classification, pathophysiology, causes, risk factors, clinical manifestations, assessment, diagnosis, medical management, surgical management, and nursing management. The nursing management section outlines the nursing process including assessment, diagnosis, care planning, interventions, and evaluation for patients with peptic ulcer disease. The goals are to relieve pain, reduce anxiety, maintain nutrition, educate on management and prevention of recurrence, and prevent complications.
1. Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain associated with changes in bowel habits.
2. IBS affects 5-10% of the population and has a substantial negative impact on quality of life.
3. IBS has no definitive biomarkers and diagnosis relies on symptom criteria. Treatment aims to improve symptoms but does not alter the chronic nature of the condition.
1. Involuntary weight loss of over 5% in 6 months often indicates an underlying disease and requires investigation of possible causes. Common causes include chronic infections, cancer, gastrointestinal issues, and systemic diseases.
2. A thorough history, physical exam, and basic lab tests are needed to evaluate for potential physiological or pathological causes of unexplained weight loss. Further testing like imaging may be needed depending on initial findings.
3. Constipation is defined as less than 3 bowel movements per week and can be caused by gastrointestinal, neurological, metabolic/endocrine issues or medications. Initial evaluation of constipation includes a digital rectal exam, blood tests, sigmoidoscopy and trial of fiber/laxatives. Further testing may be
Why Does My Stomach Ache? - Dennis Han, MD, Gastroenterologist - Morristown &...Summit Health
Do you have stomach issues which are bothering you and you can't figure out why? Learn about conditions that could be causing abdominal pain or discomfort at this virtual program. Our expert will discuss different conditions such as: Irritable Bowel Syndrome; Inflammatory Bowel Disease; Celiac Disease and other conditions that require a gluten-free diet; and GERD (Reflux). He will explain the differences between these various conditions, how they are diagnosed, and treatment options available. Hosted by Morristown & Morris Township Public Library.
Gastroparesis is a syndrome of objectively delayed gastric emptying in the absence of a mechanical obstruction and cardinal symptoms of nausea, vomiting, early satiety, bloating, and/or upper abdominal pain
This document summarizes chronic conditions of the bowel, including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). IBS is characterized by abdominal pain and altered bowel habits without an organic cause. IBS is subtyped based on stool consistency. IBD includes ulcerative colitis and Crohn's disease, which are chronic inflammatory conditions of the gastrointestinal tract that are treated with medications like aminosalicylates, corticosteroids, immunomodulators, and biologics. Treatment depends on disease location and severity. Biologics are effective but carry risks of serious infections and lymphomas.
This document presents a case report of a 43-year-old male patient presenting with symptoms of gastroesophageal reflux disease (GERD) including mid-epigastric pain, chest burning, dry cough, and occasional regurgitation. On physical examination, his vital signs and physical exam were normal. The document then provides questions and answers about differential diagnoses, definitions, and management approaches for GERD. Key points addressed include the spectrum of GERD, from symptoms to complications like esophagitis, stricture, and Barrett's esophagus. Empiric PPI therapy is discussed as an initial management strategy.
This document provides tips and instructions for using a PowerPoint presentation on peptic ulcers. It discusses:
- Freely editing, modifying, and adding your name to the presentation.
- Many slides are blank except for the title to facilitate active learning sessions where students provide information before each slide is shown.
- The presentation can be used for self-study as well, with notes providing bibliographic references.
- The presentation covers topics on peptic ulcers including introduction/history, pathophysiology, etiology, clinical features, investigations, management, and prevention. Diagrams and explanations are provided for each topic.
This document discusses interventions for stomach disorders including gastritis, peptic ulcer disease, Zollinger-Ellison syndrome, and gastric cancer. It begins with an introduction to the anatomy and physiology of the stomach. Gastritis is then defined and the types, risk factors, pathogenesis, clinical features, diagnostic evaluation, and management are outlined. Peptic ulcer disease is similarly defined and the classifications, risk factors, etiological factors, pathogenesis, signs and symptoms, complications, diagnosis, and medical and non-medical management are described.
Chronic Diarrhea
references include the American Academy of Family Physicians AAFP
Special Thanks to my colleague Hadi Al Qurain for his participation in preparing this presentation
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
1. Gastrointestinal Disease
Case
A 38 year old woman presents to the office with complaints of upper abdominal pain. She describes
pain as intermittent gnawing discomfort, often worse after meals. She denies any change in bowel
habits, dark stool or blood in the stool. She has not had any weight loss.
• What is your differential diagnosis?
• What other features of the history and physical exam would you focus on?
The patient reports none of the “alarm” symptoms on history. On exam she has some mild
midepigastric tenderness, no palpable masses. Rectal exam is normal, stool is negative for occult
blood.
• How would you proceed with your work-up?
• Should she have an endoscopy?
• Should she be tested for H. Pylori?
Her H. Pylori serology is positive. You opt to treat empirically.
• What regimen would you use?
The patient completes her treatment and 1 month later reports that her symptoms have completely
resolved. The following year she comes in for her annual exam and mentions that she is having
frequent “heartburn”
• What lifestyle modifications would you recommend?
• How would you treat her?
• Does she need an endoscopy?
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2. Gastrointestinal Disease
Dyspepsia
Definitions
• Dyspepsia refers to pain or discomfort centered in the upper abdomen (mainly in
or around the midline as opposed to the right or left hypochondrium).
• Functional dyspepsia (normal dyspepsia)- normal endoscopy
• Structural dyspepsia – abnormal endoscopy
Peptic ulcer disease (duodenal and peptic ulcer)
Gastritis
Esophagitis
Gastric carcinoma
Functional dyspepsia (60%)
• Defined as 3 month h/o dyspepsia with no structural or biochemical explanation
• Etiology unclear
• Associated with GI dysmotility, altered visceral sensation, psychiatric d/o
• Most common form of dyspepsia
• Treatment controversial
• A number of medications have been tried (H2 blockers, prokinetic agents, PPI)
• Patient education, validation important
Peptic Ulcer Disease (15-25%)
• Pain occurs 2-5 hours after eating
• Pain described as gnawing, burning
• Most often localized to the epigastrum, may radiate to back
• Usually episodic
• Frequently nocturnal
• Relieved by food
• 95% duodenal ulcers, 70% of gastric ulcers caused by H. Pylori
• 70% of gastric ulcer caused by H. Pylori
Gastritis
• The term gastritis is used to denote inflammation associated with mucosal injury
• Most often caused by drugs (NSAIDs, alcohol) or Helicobacter pylori
Alarm symptoms: (Don’t want to miss gastric carcinoma!)
• Age > 55 with new-onset dyspepsia
• Unintended weight loss
• GI Bleeding
• Progressive dysphagia
• Odynophagia
• Unexplained iron deficiency anemia
• Persistent vomiting
• Palpable mass or lymphadenopathy
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3. • Family h/o UGI carcinoma
• Jaundice
H. Pylori
• In U.S. H. Pylori present in 10% of 18-30 yo, 50% in > 60 yo
• More common in black and Hispanic population and lower socioeconomic groups
• Transmission is oral-oral or fecal-oral
• Disrupts protective mucosal layer resulting in cell injury
• Diagnosis
o Blood test for specific antibodies
o Urea breath test
o Stool tests
o Endoscopy with tissue examination/culture
Treatment Regimens for H.Pylori
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4. Gastoresophageal reflux disease (GERD)
Clinical symptoms include heartburn, regurgitation and dysphagia
May mimic angina pectoris
Can lead to esophagitis
Complications may include reflux-induced asthma, laryngitis, cough
Less commonly may lead to Barrett’s esophagus, stricture, cancer
Treatment
o Lifestyle modification
• Small frequent meals
• Elevate head of bed
• Avoid alcohol, caffeine, smoking, caffeine
• Avoid citrus, tomato foods, chocolate, mints, fatty foods
• Weight management
o Medications
• Over-the-counter antacids
• H2 Blockers (Ranitidine 150 mg BID)
• Proton pump inhibitors
Indications for endoscopy for GERD
• Failure of empiric therapy
• Alarm symptoms
o Over 50 yo with new onset sxs
o GI Bleeding
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REGIMEN SIDE EFFECT CURE RATE
2- Drug Regimens
Amoxicillin + PPI Low-medium <70-80%
Clarithromycin +PPI Low-medium >70-90%
3-Drug Regimens
Clarithromycin + metronidazole + PPI Medium >80-90%
Clarithromycin + Amoxicillin + PPI Low-medium >80-90%
Amoxicillin + Metronidazole + PPI Medium >80-90%
Tetracycline + Metronidazole + Sulcrafate Medium >80-90%
4-Drug Regimens
Bismuth + Metronidazole + Tetracycline+ H2 Blocker Medium-high >80-90%
Bismuth + Metronidazole + Amoxicillin + PPI Medium-high >70-90%
Bismuth + Metronidazole + Tetracycline +PPI Medium-high >80-90%
Bismuth + Metronidazole + Clarithromycin + PPI Medium-high >80-90%
Combination Products
Helidac (Bismuth, metronidazole, tetracycline) + H2
blocker
Medium-high Up to 82%
Prevpac (Amoxiciliin, Clarithromycin,PPI) Low-medium 81-92%
Pylera (Bismuth, metronidazole, tetracyline Low-medium 84-94%
5. o Unintended Weight loss
o Anemia
o Dysphagia/odynophagia
o Long duration of frequent symptoms
Diarrhea
Acute < 14 days Most due to infectious and are self-
limited
Persistent >14 days
Chronic >30 days IBS, IBD, malabsorption, secretory
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Evaluation of Acute Diarrhea
6. Irritable Bowel Syndrome
• Female to male ratio of 2-3 :1
• Most common between ages of 20-40
Clinical Manifestations
• Crampy abdominal pain for > 3 months, usually lower quadrants, often on the left
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Specific Therapy for Diarrhea
7. • Altered bowel habits – diarrhea and/or constipation
• May have bloating, nausea, dyspepsia, early satiety, increased flatulence or
belching
• Patients with IBS often complain of a broad range of non-gastrointestinal
symptoms including impaired sexual function, dysmenorrhea, dyspareunia, and
increased urinary frequency and urgency.
Work-up for IBS
1. Careful history and physical (exam should be normal)
2. Rule out dietary causes and/or medications (lactose , mg –containing antacids
cause diarrhea, anticholinergics, ca-channel blockers can cause constipation)
3. Look for other underlying etiologies such as depression, anxiety, physical, sexual
or substance abuse
4. Look for alarm symptoms
a. > 50 yo with new sxs
b. GI bleeding
c. Unintended weight loss
d. Family history of colon cancer
e. Recurring fever
f. Anemia
g. Chronic severe diarrhea.
5. Lab evaluation should include CBC, chemistries, and stool for WBC, Cx, O&P, c.
diff (to r/o infectious etiology)
6. Recommend flex sig/colonoscopy for patients with any alarm symptoms or for
persistent symptoms
Treatment of IBS
• Cure is not expected, but symptoms can be modified
• Most important element is reassuring, therapeutic patient-physician relationship
• Therapy should include
o Avoidance of foods the increase symptoms
o High fiber diet (25-35 gm fiber/day)
o Medication efficacy has not been established in RCTs
o Trial of medications may be warranted
• Antidiarrheal agents (loperamide, diphenoxylate)
• Anticholinergics (belladonna, dicylomine, hycosamine) for
pain/gas/bloating
• Tricyclic antidepressants may be helpful in pain-dominant
IBS
• Tegaserod (Zelnorm)
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8. o Removed from market
o Was for constipation-dominant IBS in women
Inflammatory Bowel Disease
• Incidence peaks in 2nd
and 3rd
decade
• Usually present with recurrent diarrhea and abdominal pain, fever
• Often anemic, may have leukocytosis, thrombocytosis
• May have electrolyte abnormalities and elevated ESR
• Diagnostic test = colonoscopy
• Extraintestinal manifestations of IBD include iritis, episcleritis, arthritis, and skin
involvement, as well as pericholangitis and sclerosing cholangitis.
Crohns disease Ulcerative Colitis
Involves all layers of the bowel
Can occur anywhere in GI tract
Lesions discontinuous with skip areas
Most commonly present with nonbloody
diarrhea
May recur after surgery
Involves only mucosa and submucosa
Only involves rectum and lg bowel
Lesions continuous with abrupt
demarcation
Most commonly present with bloody
diarrhea
Surgery usually curative
Medications for IBD
• Aminosalicylates (sulfasalazine, mesalamine) – used for maintenance therapy
• Steroids – used for acute attacks
• Immunosuppressants (Azathioprine) – useful for patients unable to tolerate
steroids
• Tumor Necrosis Inhibitors (Inflixamab) – used to induce remission in patients
unresponsive to other treatments
Complications of IBD
• Perforation, toxic megacolon (UC > Crohns)
• Strictures
• Fistulas and Abcesses (Crohns > UC)
• Colon cancer – risk increases with extent and duration of disease
Screening for Colon Cancer
Risk factor Age to initiate screening Interval of screening
Average risk 50 years
45 years for African American
FOBT yearly
Sigmoidoscopy q 5 yrs
Colonoscopy q 10 yrs
Family history Screen as average risk Interval as in average risk
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9. 1 second degree or third degree
relative
Family history
1 first degree or 2 second degree
relatives > 60 yrs
40 years Colonoscopy q 5-10 years
Family history
1 first degree or 2 second degree
relatives < 60 yrs
40 years or 10 years prior to the
index case, whichever comes first
Colonoscopy q 5-10 years
Familial adenomatous polyposis
(FAP)
10-12 years Yearly sigmoidoscopy. If genetic
test positive, colectomy
recommended
Hereditary nonpolyposis
colorectal cancer (HNPCC)
20-25 years or 10 years prior to
the youngest dx of colon cancer
in the family
Colonoscopy q 1-2 years
Inflammatory bowel disease Begin screening after 8-10 years
of disease
Yearly colonoscopy
Oral Defense Tips
I refer patients with dyspepsia for endoscopy if they have any “alarm symptoms”
(weight loss, blood in stool, unexplained anemia) or they are using chronic
NSAIDs
My initial treatment for dyspepsia is to do blood testing for H. Pylori and treat if
positive (Prevpac as directed)
I would counsel a woman with GERD symptoms to have small frequent meals,
elevate the head of the bed, avoid alcohol, caffeine, smoking, caffeine, avoid
citrus, tomato foods, chocolate, mints, fatty foods, and control weight.
My initial approach to the assessment of diarrhea is to determine duration of
symptoms, and look for signs of dehydration or inflammation (blood, fever). If
the sxs are less than 48 hours, there is no fever or blood in the stool and no signs
of dehydration, I recommend fluid, rest and bland diet.
My initial approach to the treatment of IBS is to recommend a high fiber diet (25-
35 gm/day) and I ask the patient to keep a food diary.
I recommend colon cancer screening to ALL women starting at 50 years old and
to African American women starting at 45 years old.
STUDY QUESTIONS
Yearly screening colonoscopy should be recommended for patients with:
A. Irritable bowel syndrome
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10. B. Occult blood on rectal exam
C. Familial adenomatous polyposis
D. A first degree family member diagnosed with colon cancer under
the age of 60.
A 32 year old woman returns from a camping trip and develops acute diarrhea.
The most likely organism is:
A. E. Coli
B. V.cholera
C. Campylobacter
D. Giardia
Updated 02/13
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