This document provides an overview of emerging trends in the management of gastroesophageal reflux disease (GERD). It discusses the pathophysiology, symptoms, clinical spectrum, investigations including pH monitoring and endoscopy, medical management using PPIs and lifestyle modifications, and various treatment options including endoscopic, surgical, and minimally invasive approaches. The surgical management section covers laparoscopic anti-reflux procedures like Nissen fundoplication and partial fundoplications, magnetic sphincter augmentation, EndoStim, Collis gastroplasty, and Roux-en-Y reconstruction.
Evaluation and management of patients with Dyspepsia.pptxgarvitnanecha
Evaluation and management of patients with Dyspepsia.
Dyspeptic symptoms.
Causes of dyspepsia
Approach to adult with Dyspepsia.
Newer advancement about diagnosing dyspepsia causes.
GERD and peptic ulcer and many more organic diseases.
Functional Dyspepsia and organic dyspepsia
This document provides information on dysphagia (difficulty swallowing). It begins by defining dysphagia and describing the swallowing mechanism. The clinical presentation of dysphagia is then outlined. Dysphagia can be graded on a scale of 1 to 6 based on severity. The document discusses the main causes/etiologies of dysphagia as being neurological, mechanical/obstructive issues. Evaluation involves history, examination, imaging like barium swallow and endoscopy. Management depends on the underlying cause and may include lifestyle changes, medications, endoscopic procedures like dilation, stenting, or surgery.
This document discusses Achalasia, a primary motor disorder of the esophagus characterized by failure of the lower esophageal sphincter to relax during swallowing and loss of peristalsis in the esophageal body. It covers the pathophysiology, classification, clinical presentation, diagnostic tests including manometry, and treatment options for Achalasia such as botulinum toxin injection, pneumatic dilation, Heller's myotomy, and POEM. It also discusses other esophageal motility disorders like DES, jackhammer esophagus, hypertensive LES, and IEM and their associated symptoms, diagnostic findings, and treatment approaches.
1) Gastroesophageal reflux disease (GERD) occurs when stomach contents back up into the esophagus or beyond, causing troublesome symptoms or complications.
2) Diagnosis is confirmed by endoscopic findings of erosive esophagitis or positive pH monitoring, showing abnormal acid exposure in the esophagus.
3) Treatment involves lifestyle changes and medication. Surgery is considered for patients with severe, refractory GERD or complications like strictures. The most common anti-reflux surgery is laparoscopic Nissen fundoplication, which has high success rates but risks dysphagia.
Approach, indications and surgical management of gerd 2Shambhavi Sharma
GERD is diagnosed clinically or with endoscopy and pH monitoring. Surgical options include laparoscopic Nissen fundoplication, which is the gold standard for treating failed medical management, complications, or large hiatal hernias. Complications include dysphagia, which can be reduced using a partial fundoplication or short wrap. Newer minimally invasive options include the LINX device and endoscopic fundoplication but long-term data is still emerging. Revisional surgery is an option for failed initial antireflux procedures.
This document discusses gastroesophageal reflux disease (GERD). It defines GERD as a chronic condition caused by prolonged reflux of gastric contents into the esophagus, potentially causing esophagitis. It describes the anatomy and physiology related to GERD, including the lower esophageal sphincter. Risk factors include hiatal hernia, obesity, smoking, diet, medications and certain diseases. Diagnosis involves history, physical exam, barium swallow, endoscopy and pH monitoring. Treatment includes lifestyle changes, antacids, H2 blockers, PPIs, surgery and endoscopic procedures. Complications can include esophagitis, stricture, Barrett's esophagus and adenocarc
This document provides information about gastroesophageal reflux disease (GERD), including its definition, pathophysiology, clinical manifestations, diagnostic evaluation, treatment, and complications. It defines GERD as a condition that develops when stomach contents reflux into the esophagus, causing troublesome symptoms or complications. The pathophysiology section describes the lower esophageal sphincter and how physiological and pathological reflux differ. Common symptoms, diagnostic tests, lifestyle modifications, medications, and surgical treatments are also summarized.
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
Evaluation and management of patients with Dyspepsia.pptxgarvitnanecha
Evaluation and management of patients with Dyspepsia.
Dyspeptic symptoms.
Causes of dyspepsia
Approach to adult with Dyspepsia.
Newer advancement about diagnosing dyspepsia causes.
GERD and peptic ulcer and many more organic diseases.
Functional Dyspepsia and organic dyspepsia
This document provides information on dysphagia (difficulty swallowing). It begins by defining dysphagia and describing the swallowing mechanism. The clinical presentation of dysphagia is then outlined. Dysphagia can be graded on a scale of 1 to 6 based on severity. The document discusses the main causes/etiologies of dysphagia as being neurological, mechanical/obstructive issues. Evaluation involves history, examination, imaging like barium swallow and endoscopy. Management depends on the underlying cause and may include lifestyle changes, medications, endoscopic procedures like dilation, stenting, or surgery.
This document discusses Achalasia, a primary motor disorder of the esophagus characterized by failure of the lower esophageal sphincter to relax during swallowing and loss of peristalsis in the esophageal body. It covers the pathophysiology, classification, clinical presentation, diagnostic tests including manometry, and treatment options for Achalasia such as botulinum toxin injection, pneumatic dilation, Heller's myotomy, and POEM. It also discusses other esophageal motility disorders like DES, jackhammer esophagus, hypertensive LES, and IEM and their associated symptoms, diagnostic findings, and treatment approaches.
1) Gastroesophageal reflux disease (GERD) occurs when stomach contents back up into the esophagus or beyond, causing troublesome symptoms or complications.
2) Diagnosis is confirmed by endoscopic findings of erosive esophagitis or positive pH monitoring, showing abnormal acid exposure in the esophagus.
3) Treatment involves lifestyle changes and medication. Surgery is considered for patients with severe, refractory GERD or complications like strictures. The most common anti-reflux surgery is laparoscopic Nissen fundoplication, which has high success rates but risks dysphagia.
Approach, indications and surgical management of gerd 2Shambhavi Sharma
GERD is diagnosed clinically or with endoscopy and pH monitoring. Surgical options include laparoscopic Nissen fundoplication, which is the gold standard for treating failed medical management, complications, or large hiatal hernias. Complications include dysphagia, which can be reduced using a partial fundoplication or short wrap. Newer minimally invasive options include the LINX device and endoscopic fundoplication but long-term data is still emerging. Revisional surgery is an option for failed initial antireflux procedures.
This document discusses gastroesophageal reflux disease (GERD). It defines GERD as a chronic condition caused by prolonged reflux of gastric contents into the esophagus, potentially causing esophagitis. It describes the anatomy and physiology related to GERD, including the lower esophageal sphincter. Risk factors include hiatal hernia, obesity, smoking, diet, medications and certain diseases. Diagnosis involves history, physical exam, barium swallow, endoscopy and pH monitoring. Treatment includes lifestyle changes, antacids, H2 blockers, PPIs, surgery and endoscopic procedures. Complications can include esophagitis, stricture, Barrett's esophagus and adenocarc
This document provides information about gastroesophageal reflux disease (GERD), including its definition, pathophysiology, clinical manifestations, diagnostic evaluation, treatment, and complications. It defines GERD as a condition that develops when stomach contents reflux into the esophagus, causing troublesome symptoms or complications. The pathophysiology section describes the lower esophageal sphincter and how physiological and pathological reflux differ. Common symptoms, diagnostic tests, lifestyle modifications, medications, and surgical treatments are also summarized.
Dysphagia is an important problem in surgical patients. I have discussed Introduction, Zenker's diverticulum, GERD, Achalasia Cardia and Carcinoma Esophagus. If you watch all these videos together, i assure you that you will become confident in managing a case of dysphagia.
Gastroesophageal reflux and Hiatal HerniaViswa Kumar
The document discusses GERD/hiatus hernia. It provides information on:
1) The factors involved in GERD pathogenesis including the antireflux barrier, aggressive factors like gastric acid, and mechanisms of reflux.
2) Diagnostic tests for GERD like endoscopy, pH monitoring, and barium swallow which assess esophageal damage, acid exposure, and function.
3) Treatment approaches including lifestyle changes, medications like PPIs, H2 blockers, and prokinetics, and surgical options like Nissen fundoplication.
4) Complications of long-term GERD including Barrett's esophagus, strictures, and adenoc
An acute abdomen refers to severe abdominal pain lasting less than 5 days that may require urgent surgical intervention. The document discusses several potential life-threatening causes of acute abdomen including ruptured abdominal aortic aneurysm, perforated viscus, bowel ischemia, ruptured ectopic pregnancy, and testicular torsion. It provides details on the clinical presentation, diagnostic findings, and management of each condition. Common non-life threatening causes like acute appendicitis and acute cholecystitis are also reviewed.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
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.
The document provides tips for using a PowerPoint presentation on gastroesophageal reflux disease (GERD). It suggests:
1. Using blank slides to elicit what students already know about each topic before presenting new information
2. Repeating this process of blank slide then information slide three times for active learning
3. The presentation can be used for self-study as well by reviewing the notes and bibliography
The presentation covers learning objectives and sections on introduction/history, etiology, pathophysiology, clinical features, investigations, management, and multiple choice questions. It provides detailed information on each topic in an engaging format designed for teaching.
GERD ~It is most common common benign conditions of stomach and esophagusJayaPrakash78548
GERD ~Gastroesophageal reflux (GER) occurs when intragastric pressure is greater than the high-pressure zone of the distal esophagus. This can develop under two conditions
1.)the LES resting pressure is too low (i.e., hypotensive LES).
2.the LES with normal resting pressure inappropriately relaxes in the absence of peristaltic contraction of the esophagus (i.e., spontaneous LES relaxation)
~ Not all GER is pathologic—in fact, it is a normal physiologic process that occurs even in the setting of a normal LES.
~Heartburn, regurgitation, and water brash are the three typical esophageal symptoms of GERD.
~Heartburn and regurgitation are the most common presenting symptoms. Heartburn is specific to GERD and described as an epigastric or retrosternal caustic or stinging sensation.
~it does not radiate to the back and is not described as a pressure sensation
~ Regurgitation of gastric contents to the oropharynx and mouth can produce a sour taste that patients will describe as either acid or bile. This phenomenon is referred to as water brash.
•Esophageal impedance monitoring identifies episodes of nonacid reflux
•Impedance catheters use electrodes placed at 1-cm intervals to detect changes in the resistance to flow of an electrical current (i.e., impedance)
•Impedance increases in the presence of air and decreases in the presence of a liquid bolus
•pH-impedance catheters can determine the direction of movement of esophageal acid exposures
~frequent drinking of water
~posture of sitting lean forward with their lungs inflated to vital capacity
~ This maneuver flattens the diaphragm, narrows the anteroposterior diameter of the hiatus, and increases the LES pressure to counteract GER.
~yellowing of teeth
~injected oropharyngeal mucosa
Both peptic strictures and LA class C and D esophagitis can be considered pathognomonic for GERD
patients found to have LA class A and B esophagitis should undergo pH testing to confirm abnormal distal esophageal acid exposure.
Endoscopic evaluation should also include an assessment of the GEJ flap valve
In hiatus hernia craniocaudal and lateral dimensions are measured
•immediate side effects of ppi are rare but long term usage causes side effects
•long term side effects of ppi are
1)loss of bone density
2)risk of fracture, dementia, myocardial infarction
3)micronutrient (magnesium, iron, B-12) deficiencies
4)Clostridioides difficile infection
5)kidney disease
• judicious prescription of PPIs for well-established indications is prudent.
•operative technique (LARS)
1)short gastric vessel ligation and mobilisation of gastric fundus
2)left crus dissection by incision at phrenoesophageal ligament
3)right crura dissection
4) The esophagus is mobilized in the posterior mediastinum to obtain a minimum of 3 cm of intra abdominal esophagus
5)fundoplocation is done
If an anterior fundoplication is to be performed (e.g., Thal or Dor), there is no need to disea
A 77-year-old female presented with progressive dysphagia and chest pain and was found to have a large paraesophageal hernia; she underwent a laparoscopic paraesophageal hernial repair with gastropexy and had an uneventful postoperative course with resolution of her symptoms. Paraesophageal hernias are rare types of hiatal hernias that can cause symptoms from GERD to obstruction and require surgical repair to prevent complications like strangulation.
The document discusses various pancreatic disorders including acute pancreatitis, chronic pancreatitis, and pancreatic cancer. It provides details on the epidemiology, anatomy, physiology, etiology, pathophysiology, clinical manifestations, diagnostic studies, medical and surgical management, nursing management, and complications of each disorder. Acute pancreatitis results from inflammation of the pancreas caused by auto-digestion by pancreatic enzymes. Chronic pancreatitis is a progressive inflammatory disease often caused by alcoholism. Pancreatic cancer develops from the uncontrolled growth of pancreatic cells.
This document provides an overview of a 22 hour course on gastrointestinal and biliary tract disorders. It covers the anatomy and physiology of the gastrointestinal tract, common manifestations of gastrointestinal disorders, assessment of patients with gastrointestinal issues, and diseases and conditions of the gastrointestinal tract and biliary system including their management. Specific topics discussed include the esophagus, stomach, liver, gallbladder, pancreas, and large intestine. Diseases like achalasia, gastroesophageal reflux disease, and cancer of the esophagus are described in detail.
The document discusses hiatal hernia, which occurs when part of the stomach bulges through an opening in the diaphragm. It outlines the causes, symptoms, diagnosis through imaging and endoscopy, differential diagnosis, and treatment options including medication, surgery to repair the diaphragm and prevent reflux, and post-operative care. The prognosis is generally good if the hernia is repaired and complications like aspiration pneumonia are managed.
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentation of gastroesophageal reflux disease. it also discusses the medical and surgical management of gastroesophageal reflux disease.. what makes this presentation unique is that it explains the short and long term effects of antireflux surgery and patient's satisfaction with this surgery with references.
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentaion of gastroesophageal reflux disease. It also discusses the medical and surgical management of gastroesophageal reflux disease. What makes this presentaion unique is that it also explains the short and long term effects of antireflux surgery and patient's satisfaction with surgery with references.
- Anti-reflux surgery (ARS) is an option for treating severe gastroesophageal reflux disease (GERD) when symptoms are not adequately controlled by medications.
- Key factors for successful ARS include confirming the GERD diagnosis, properly selecting patients, comprehensive pre-operative evaluation, and tailoring the surgical technique to each individual.
- Common surgical options are laparoscopic Nissen fundoplication and magnetic sphincter augmentation. Complications can include dysphagia, gas bloat, and recurrence, so patient expectations must be managed. ARS provides long-term symptom control for most appropriately selected patients when performed by an experienced surgeon.
- Anti-reflux surgery (ARS) is an option for treating severe gastroesophageal reflux disease (GERD) when symptoms are not adequately controlled by medications.
- Key factors for successful ARS include confirming the GERD diagnosis, properly selecting patients, comprehensive pre-operative evaluation, and tailoring the surgical technique to each individual.
- Common surgical options are laparoscopic Nissen fundoplication and magnetic sphincter augmentation. Complications can include dysphagia, gas bloat, and recurrence, so patient expectations must be managed. ARS provides long-term symptom control for most appropriately selected patients when performed by an experienced surgeon.
This document provides an overview of gastrointestinal disorders, including anatomy and physiology of the GI tract, physical assessment techniques, common GI conditions like peptic ulcer disease, and nursing interventions. It describes the functions of the GI organs and accessories like the liver and pancreas. Diagnostic tests and procedures like endoscopy are outlined. Complications of tube feedings and acute GI bleeding from sources like stress ulcers are reviewed.
1) Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus in excessive amounts, causing symptoms or mucosal injury.
2) Common symptoms include heartburn and regurgitation. Complications include esophagitis, strictures, and Barrett's esophagus.
3) Diagnosis is usually made clinically based on symptoms. Testing with endoscopy, pH monitoring, or impedance monitoring may be used to confirm diagnosis or assess for complications.
4) Treatment involves lifestyle modifications and medication like antacids, H2 blockers, or proton pump inhibitors. Reflux surgery may be considered for severe cases.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Gastroesophageal reflux and Hiatal HerniaViswa Kumar
The document discusses GERD/hiatus hernia. It provides information on:
1) The factors involved in GERD pathogenesis including the antireflux barrier, aggressive factors like gastric acid, and mechanisms of reflux.
2) Diagnostic tests for GERD like endoscopy, pH monitoring, and barium swallow which assess esophageal damage, acid exposure, and function.
3) Treatment approaches including lifestyle changes, medications like PPIs, H2 blockers, and prokinetics, and surgical options like Nissen fundoplication.
4) Complications of long-term GERD including Barrett's esophagus, strictures, and adenoc
An acute abdomen refers to severe abdominal pain lasting less than 5 days that may require urgent surgical intervention. The document discusses several potential life-threatening causes of acute abdomen including ruptured abdominal aortic aneurysm, perforated viscus, bowel ischemia, ruptured ectopic pregnancy, and testicular torsion. It provides details on the clinical presentation, diagnostic findings, and management of each condition. Common non-life threatening causes like acute appendicitis and acute cholecystitis are also reviewed.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
This document defines and describes Gastroesophageal Reflux Disease (GERD) and several related conditions. It covers the definition, causes, symptoms, investigations and treatment of GERD. It also discusses complications like Barrett's esophagus and esophageal cancer. Other esophageal conditions covered include dysphagia, esophageal diverticula, peptic strictures, esophageal webs/rings and infectious esophagitis.
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.
The document provides tips for using a PowerPoint presentation on gastroesophageal reflux disease (GERD). It suggests:
1. Using blank slides to elicit what students already know about each topic before presenting new information
2. Repeating this process of blank slide then information slide three times for active learning
3. The presentation can be used for self-study as well by reviewing the notes and bibliography
The presentation covers learning objectives and sections on introduction/history, etiology, pathophysiology, clinical features, investigations, management, and multiple choice questions. It provides detailed information on each topic in an engaging format designed for teaching.
GERD ~It is most common common benign conditions of stomach and esophagusJayaPrakash78548
GERD ~Gastroesophageal reflux (GER) occurs when intragastric pressure is greater than the high-pressure zone of the distal esophagus. This can develop under two conditions
1.)the LES resting pressure is too low (i.e., hypotensive LES).
2.the LES with normal resting pressure inappropriately relaxes in the absence of peristaltic contraction of the esophagus (i.e., spontaneous LES relaxation)
~ Not all GER is pathologic—in fact, it is a normal physiologic process that occurs even in the setting of a normal LES.
~Heartburn, regurgitation, and water brash are the three typical esophageal symptoms of GERD.
~Heartburn and regurgitation are the most common presenting symptoms. Heartburn is specific to GERD and described as an epigastric or retrosternal caustic or stinging sensation.
~it does not radiate to the back and is not described as a pressure sensation
~ Regurgitation of gastric contents to the oropharynx and mouth can produce a sour taste that patients will describe as either acid or bile. This phenomenon is referred to as water brash.
•Esophageal impedance monitoring identifies episodes of nonacid reflux
•Impedance catheters use electrodes placed at 1-cm intervals to detect changes in the resistance to flow of an electrical current (i.e., impedance)
•Impedance increases in the presence of air and decreases in the presence of a liquid bolus
•pH-impedance catheters can determine the direction of movement of esophageal acid exposures
~frequent drinking of water
~posture of sitting lean forward with their lungs inflated to vital capacity
~ This maneuver flattens the diaphragm, narrows the anteroposterior diameter of the hiatus, and increases the LES pressure to counteract GER.
~yellowing of teeth
~injected oropharyngeal mucosa
Both peptic strictures and LA class C and D esophagitis can be considered pathognomonic for GERD
patients found to have LA class A and B esophagitis should undergo pH testing to confirm abnormal distal esophageal acid exposure.
Endoscopic evaluation should also include an assessment of the GEJ flap valve
In hiatus hernia craniocaudal and lateral dimensions are measured
•immediate side effects of ppi are rare but long term usage causes side effects
•long term side effects of ppi are
1)loss of bone density
2)risk of fracture, dementia, myocardial infarction
3)micronutrient (magnesium, iron, B-12) deficiencies
4)Clostridioides difficile infection
5)kidney disease
• judicious prescription of PPIs for well-established indications is prudent.
•operative technique (LARS)
1)short gastric vessel ligation and mobilisation of gastric fundus
2)left crus dissection by incision at phrenoesophageal ligament
3)right crura dissection
4) The esophagus is mobilized in the posterior mediastinum to obtain a minimum of 3 cm of intra abdominal esophagus
5)fundoplocation is done
If an anterior fundoplication is to be performed (e.g., Thal or Dor), there is no need to disea
A 77-year-old female presented with progressive dysphagia and chest pain and was found to have a large paraesophageal hernia; she underwent a laparoscopic paraesophageal hernial repair with gastropexy and had an uneventful postoperative course with resolution of her symptoms. Paraesophageal hernias are rare types of hiatal hernias that can cause symptoms from GERD to obstruction and require surgical repair to prevent complications like strangulation.
The document discusses various pancreatic disorders including acute pancreatitis, chronic pancreatitis, and pancreatic cancer. It provides details on the epidemiology, anatomy, physiology, etiology, pathophysiology, clinical manifestations, diagnostic studies, medical and surgical management, nursing management, and complications of each disorder. Acute pancreatitis results from inflammation of the pancreas caused by auto-digestion by pancreatic enzymes. Chronic pancreatitis is a progressive inflammatory disease often caused by alcoholism. Pancreatic cancer develops from the uncontrolled growth of pancreatic cells.
This document provides an overview of a 22 hour course on gastrointestinal and biliary tract disorders. It covers the anatomy and physiology of the gastrointestinal tract, common manifestations of gastrointestinal disorders, assessment of patients with gastrointestinal issues, and diseases and conditions of the gastrointestinal tract and biliary system including their management. Specific topics discussed include the esophagus, stomach, liver, gallbladder, pancreas, and large intestine. Diseases like achalasia, gastroesophageal reflux disease, and cancer of the esophagus are described in detail.
The document discusses hiatal hernia, which occurs when part of the stomach bulges through an opening in the diaphragm. It outlines the causes, symptoms, diagnosis through imaging and endoscopy, differential diagnosis, and treatment options including medication, surgery to repair the diaphragm and prevent reflux, and post-operative care. The prognosis is generally good if the hernia is repaired and complications like aspiration pneumonia are managed.
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentation of gastroesophageal reflux disease. it also discusses the medical and surgical management of gastroesophageal reflux disease.. what makes this presentation unique is that it explains the short and long term effects of antireflux surgery and patient's satisfaction with this surgery with references.
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentaion of gastroesophageal reflux disease. It also discusses the medical and surgical management of gastroesophageal reflux disease. What makes this presentaion unique is that it also explains the short and long term effects of antireflux surgery and patient's satisfaction with surgery with references.
- Anti-reflux surgery (ARS) is an option for treating severe gastroesophageal reflux disease (GERD) when symptoms are not adequately controlled by medications.
- Key factors for successful ARS include confirming the GERD diagnosis, properly selecting patients, comprehensive pre-operative evaluation, and tailoring the surgical technique to each individual.
- Common surgical options are laparoscopic Nissen fundoplication and magnetic sphincter augmentation. Complications can include dysphagia, gas bloat, and recurrence, so patient expectations must be managed. ARS provides long-term symptom control for most appropriately selected patients when performed by an experienced surgeon.
- Anti-reflux surgery (ARS) is an option for treating severe gastroesophageal reflux disease (GERD) when symptoms are not adequately controlled by medications.
- Key factors for successful ARS include confirming the GERD diagnosis, properly selecting patients, comprehensive pre-operative evaluation, and tailoring the surgical technique to each individual.
- Common surgical options are laparoscopic Nissen fundoplication and magnetic sphincter augmentation. Complications can include dysphagia, gas bloat, and recurrence, so patient expectations must be managed. ARS provides long-term symptom control for most appropriately selected patients when performed by an experienced surgeon.
This document provides an overview of gastrointestinal disorders, including anatomy and physiology of the GI tract, physical assessment techniques, common GI conditions like peptic ulcer disease, and nursing interventions. It describes the functions of the GI organs and accessories like the liver and pancreas. Diagnostic tests and procedures like endoscopy are outlined. Complications of tube feedings and acute GI bleeding from sources like stress ulcers are reviewed.
1) Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus in excessive amounts, causing symptoms or mucosal injury.
2) Common symptoms include heartburn and regurgitation. Complications include esophagitis, strictures, and Barrett's esophagus.
3) Diagnosis is usually made clinically based on symptoms. Testing with endoscopy, pH monitoring, or impedance monitoring may be used to confirm diagnosis or assess for complications.
4) Treatment involves lifestyle modifications and medication like antacids, H2 blockers, or proton pump inhibitors. Reflux surgery may be considered for severe cases.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
2. CONTENTS
1. INTRODUCTION
2. PATHOPHYSIOLOGY
3. SYMPTOMS
4. CLINICAL SPECTRUM OF DISEASE
5. INVESTIGATIONS
6. HOW TO APPROACH
7. LIFESTYLE MODIFICATIONS
8. MEDICAL MANAGEMENT
9. ENDOSCOPIC MANAGEMENT
10. SURGICAL MANAGEMENT
3. INTRODUCTI
ON
The American College of Gastroenterology (ACG) guidelines define “symptoms or
complications resulting from the reflux of gastric contents into the esophagus or
beyond, into the oral cavity (including larynx) or lung.”
8. AMBULATORY PH MONITORING
• Gold standard test.
• Data :
1. total number of reflux episode (Ph<4)
2. Longest episode of reflux
3. No. of episode lasting longer than 5min
4. % of time spent in reflux in the upright and
supine position
DEMEESTER SCORE is calculated
Abnormal when >= 14.7
9. PH IMPEDANCE CATHETAR
• Monitor non acid reflux as well as acid reflux
• performed with thin flexible catheter
• Electrodes placed at 1 cm intervals
• Impedance increase in air and decrease in liquid
bolus
• Differentiate retrograde (gastroesophageal reflux)
and antegrade (swallow) event.
• Drawback: automated analytic software is very
sensitive and therefore overestimate non acid reflux
episode (hence manually reviewed which is time
consuming )
DUAL PH
PROBE
11. Esophageal manometry
• Assess
1. function of esophageal body and
LES (pressure wave)
2. Measures LES resting pressure
3. Esophageal motility (peristalsis)
4. measurements of gastric, pyloric
and small bowel contractility
12. ESOPHAGOGASTRODUOD
ENOSCOPY
• Evaluate GERD considered for LARS
• Examine mucosal injury d/t GER i.e
ulcerations, peptic stricture, and barrett
esophagus
• Peptic stricture and LA C and D esophagitis
– pathognomonic for GERD as ambulatory
Ph is unnecessary in these patients
• Assess GEJ flap valve (by retroflexing
endoscope 180 degree in stomach)
BARIUM ESOPHAGRAM
Anatomy of esophagus and stomach
(preop evaluation)
Imp to diagnose hiatal hernia and PEH
Episode of GER
Identify additional condition :
Esophageal diverticula, tumors, peptic
strictures, achalasia, dysmotility
13.
14. Heartburn and regurgitation without alarm
symptoms
Impairs quality of life
Emperical t/t- PPIs for 8week OD before
meal
15.
16.
17.
18.
19. Medical management
First line treatment:PPIs (Adequate dose for 8 weeks)
A policy of ‘step-down’ medical treatment is advocated after the initial 8 weeks of treatment
1. Decrease dose ( symptoms free)
2. Cessation of PPI
Inadequate treatment
1. Another PPI
2. Increased Dosage
3. Twice-a-day
4. Addition Of An H2-receptor Antagonist
20. Antacid–alginate preparations target the acid pockets and form a polysaccharide barrier at the proximal
stomach.
Potassium-competitive acid blockers (P-CABs)- VONOPRAZAN rapid, competitive, reversible inhibition of
proton pumps.
Baclofen, a gamma-aminobutyricacid-B agonist refractory GERD by reducing the rate of TLESR
22. INDICATIONS
Typical symptoms
Low grade Erosive esophagitis A/B
Endoscopy s/o normal acid reflux
<3cm hiatal hernia
Partial response to PPI
Poor compliance and desire to discontinue
medicine
Not interested in medical and surgical therapy
CONTRAINDICATIONS
Sliding hernia >3cm
Morbidly obese
Scleroderma
h/o esophageal and gastric surgery
Esophageal motor disorders
Stricture, Esophageal varices
Barrett's esophagus
Pregnant/lactating women
ENDOSCOPIC TREATMENT
23. Endoluminal therapy
The original endoluminal therapies have been broadly categorized to four different
types;
1. Fixation
2. ablation
3. injection
4. mucosal excision and suturing.
26. DEVICE(RADIOFREQUENCY
ABLATION)
Radiofrequency energy is delivered to
the muscularis propria
INDICATED : Early reflux disease
Mechanism of action: NEUROLYSIS OR
TISSUE NECROSIS
Causing
• Local inflammation
• Collagen deposition
• Muscular thickening of LES
RESULT : fewer TLOSRs
SIDE EFFECT: chest pain and
gastroparesis
29. Indications for Surgical
management
Patient’s choice and <18yrs
Long term management in patient with objective evidence of GERD
Severe reflux esophagitis (C and D)
motility disorders
Large hiatal hernia >2cm
Troublesome and extraesophageal symptoms
Persistent abnormal acid reflux and reflux hypersensitivity are likely to
benefit
Complications- barrett’s esophagus
Morbid obesity
30. PREDICTORS OF SURGICAL OUTCOME
GOOD
Typical symptoms
PPI responders
Hiatus hernia
Complications present
(reflux esophagitis,
non dysplastic
barrett’s esophagus
POOR
Normal pre operative
pH
functional heartburn
EOO
Connective tissue
disease
Extreme obesity
SIDE EFFECTS
• Dysphagia
• Gas bloat
• Abdominal discomfort
• Failed antireflux
surgery
OPERATIVE
COMPLICATIONS
• Peumothorax
• Gastric And
Esophageal
Injuries
• Splenic And Liver
Injuries And
Bleeding
32. Partial fundoplication
POSTERIOR FUNDOPLICATION ANTERIOR FUNDOPLICATION
TOUPET DOR/THAL BELSEY MARK IV
FUNDOPLICATION
INDICATED
1. MOTILITY DISORDERS,
2. EPIPHRENIC
DIVERTICULA,
3. GIANT HIATAL HERNIA
WITH PLEURAL
ADHESIONS,
4. GASTRIC LENGTHENING
NOT REQUIRED,
5. ESOPHAGEAL
PERFORATION
• Patient with esophageal
dysmotility who have
undergone LARS : partial
fundoplication to dec
postop dysphagia
• Toupet – m/c
Dor/thal –Used after
esophageal
(Heller) myotomy
33. Magnetic sphincter
augmentation
• Laparoscopically
• LES resting pressure
• Better control of regurgitation
• Used in hiatal hernia >3cm
• m/c s/e- dysphagia d/t extrinsic
compression of device or fibrotic band
formation around distal esophagus
• Device erosion is feared complication –
chest pain and dysphagia, endoscopy
confirms it
• If erode – removed by endoscopic
approach f/b delayed lap removal of
remainder
34. EndoStim
Electrical Stimulation Therapy
Target weak lower esophageal
sphincter (LES) to restore function via
implantable pulse generator(IPG) and
bipolar lead placed laparoscopically
Showed significant and sustained
improvement in GERD symptoms,
esophageal pH and reduce in PPIs
usage
Currently not approved
35. COLLIS GASTROPLASTY
Esophageal lengthening procedure in patient undergoing fundoplication
Involve stapling fundus of stomach(WEDGE FUNDECTOMY), create
neoesophagus around which fundus can be wrapped
Both transthoracic and transabdominal approach
Cont on PPIs post op for short term d/t acid secreting gastric mucosa above
the wrap.
36. Roux en y reconstruction
Indications:
1. Bile Or Gastric Reflux
2. Morbid Obesity
3. Diabetes
4. Esophageal Dysmotility
5. Revisional Surgery (Scarring + And Questionable Vagus Condition
Near Esophagojejunostomy Allow Passage Of All Gastric And Biliary Content Far Downstram
Esophagus
Quatify distal esophageal acid exposure (24hr) with thin catheter passed into esophagus with nares
To monitor 48 hrs – wireless ph monitor
intervals to detect changes in resistance to flow of an electrical current (impedance
Gather data from 32 channel flexible catheter
Pressure sensing device at 1 cm intervals
Conducted in 15 minutes
During this time patient perform 10 swallows
Image showing sliding hiatus hernia
Refractory – symptoms even after double dose of PPI given for 8 weeks
Ablative- stretta
Injections- Enteryx , gatekeeper, durasphere
Fixation- endoluminal gastroplication, endoscopic full thickness gastroplication system (NDO plicator), esophyx (transoral incisionless fundoplication)
Mucosal excison and suturing – safesticth medical gastroplasty system
esophyx
Mimic classic fundoplication by Reconstruct GEFV in omega shaped
Restore its function as a reflux barrier,
For patient with LES incompetence( HILL GRADE 2) without HH
MOA : Recreate dynamic of angle of his
SIDE EFFECTS : AET and reflux episode are not improved and PPI usage increase with time
Used during the (endoluminal fundoplication technique )TIF® procedure to create a 3 cm, 270° esophagogastric fundoplication.
utilizes proprietary tissue manipulating technology to deploy 20+ SerosaFuse fasteners that evenly distribute force across the entire circumference of the wrap.
A GERDx™ arms are opened. B Tissue retractor is advanced to serosa. C, D Gastric wall is retracted into the GERDx™ arms. E A pre-tied transmural pledgeted suture is deployed. F Full-thickness plication is restructuring the GE junction
The distal end of the device was then retroflexed to the anterior gastric cardia approximately 1 cm below the gastroesophageal (GE) junction.
Originally to create a full-thickness intussusception at the gastroesophageal junction by a transoral sewing technique.
Later modified to create endoscopic plications below and at the “Z” line.
conscious sedation,40 to 60 min procedure
BENEFITS:
improvement of the gastroesophageal flap valve grade.
reduced the relaxation rate of the LES
improving the reflux symptoms
decreased esophageal acid sensitivity.
the transoral stapler was advanced into the stomach through an overtube (17 mm ID/19.5 mm OD) and retroflexed under direct video guidance.
After identifying a stapling location, the stapler was gently pulled back to place
the staple cartridge in the esophagus approximately 3 cm proximal to the gastroesophageal junction (Fig. 1C).
The operator then used the articulation knob to bend the device tip to press the fundus against the esophagus.
Next, the screws were deployed.
As the tissues were compressed, and direct visualization was no longer possible,
the ultrasonic range finder automatically engaged to display the tissue thickness
. When the tissue thickness was 1.4–1.6 mm, the operator fired the stapler. Each firing delivers a quintuplet pattern of five standard 4.8 mm surgical staples simultaneously. The screws were retracted back into the tip of the device, and the stapler removed for reloading. The procedure was repeated to add additional quintuplets of staples
Tissue temp are measure using thermocouple incorporated INTO active electrodes
for approximately 60 s to a target temperature of 65-85 degrees Fahrenheit
Gastroscope inserted to measure distance till z line and withdrawn
Cathetar inserted and placed 1cm proximal to z line
ARMS, scarring of the artificial ulcer created by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at the gastric cardia tightens the enlarged cardiac opening.
Anti-reflux mucosectomy (ARMS) rebuild the flap valve at the gastric cardia and technically challenging due to scarring from the previous treatment
Endoscopic Mucosal Resection, Or EMR, Uses A Specially Designed Endoscope Or Colonoscope To Remove Suspect Tissue Or Polyps From Your Esophagus. The Tissue Or Polyp Is First Injected With A Solution That Raises A Blister, To Remove The Tissue Without Damaging The Rest Of The esophagus. The Solution Also Helps Decrease Bleeding.
Suction Is Then Used To Further Lift The Growth Up And Away From Surrounding Tissue. A Thin Wire Loop Is Slipped Over The Tissue, And An Electric Current Is Passed Through The Wire. This Cuts The Growth And Helps To Seal The Wound. Once The Growth Is Free, It's Scooped Up In A Small Wire Basket And Removed From The Digestive Tract For Analysis In The Lab.
It involves resection of gastric mucosa at the GEJ, including approximately 2 cm of gastric mucosa and 1 cm of esophageal mucosa=> results in scarring with shrinking and remodeling of the GEJ and creation of a flap valve, which causes an improvement of the Hill grade
Endoscopic follow-up of anti-reflux mucosal ablation (ARMA). a Pre-ARMA. Endoscopy in retroflexion demonstrated significant hernia (Flap valve grade III) but no sliding component. b Immediately post-ARMA. Endoscopy in retroflexion showed butterfly-shaped artificial ulcer. c Appearance at 1 month post-ARMA. Mucosal flap valve was re-shaped (Flap valve grade I). d Before ARMA. Los Angeles grade A esophagitis is seen. e After ARMA. Erosive esophagitis resolved.
6 hr pre ARMA fasting
Under GA
Supine or left lateral decubitus
Stomach insufflated with CO2 Marking done using triangle-tip knife j connected to elctrocautery(spray,coagulation mode
Mucosal ablation around cardia (butterfly shape) leaving c/l normal cardiac mucosa to avoid stenosis
Saline with indigo carmine dye was injected into the submucosal layer (25g needle)
Submucosal cushion reduces thermal injury and perforation during ablation
Adequate depth- reaching submucal layer
PPIs FOR 1 MONTH POST PROCEDURE
Ethylene vinyl alcohol copolymer with tantalum dissolved in dimethyl sulfide
The procedure is considered satisfactory if 6 to 8 mL of Enteryx is delivered to the muscularis propria circumferentially without a submucosal or transmural injection. After the injection is complete at one site, the needle remains in place for 20 s allowing the material to stabilize and solidify. This maneuver prevents leakage of the prosthesis into the esophageal lumen. Patients are usually discharged 2 to 4 h after recovery
Gatekeeper reflux repair system was a dehydrated hydrogel prosthesis
Implanted into submucosa of cardia/LES
. Within24 h, the hydrogel implants were fully expanded, creatingpillow-like mounds in the esophageal wall or cardia sub-mucosa, which bulged into the lumen, thus creating apotential mechanical antireflux barrier.
Composed of pyrolite carbon coated graphite beads containing Zirconium oxide susoended in water based absorbable polysaccharide carrier gel
Size of beads : 90microm to 212microm to prevent migration
Injected in submucosa within 1 cm of Z line
The procedure is considered complete when the esophageal walls are approximated at the GEJ.
Patients can be discharged within 60 minutes.
POLYMETHYLMETHACRYLATE,PMMA
Implanted submucosally (1-2 cm proximally to SCJ )
Volume – 32ml
S/E: transient and gas bloat syndrome if excessive treatment with 39ml volume
Not antigenic and donot cause any systemic complications
Highly viscous
Sigmoidoscope with large biopsy channel (large capacity catheter ) used for implantation.
Surgeon- between patient’s legs and operate through two cephalad port
Assistant- patient’s left and operate through two caudad port
Access – veress needle at palmer point at left upper quadrant of abdomen
Nathanson liver retractor- small epigastric incision not require trocar
Low lithotomy position with steep reverse tredelenburg- to improve esophageal hiatus view
Belsey : Transthoracic approach
Via left posterolateral thoracotomy
Return high pressure zone of cardia(4-5cm distal esophagus) to its normal anatomical position below diaphragm.
Incomplete 240 degree anterior fundal wrap
Associated crural plication to narrow the esophageal hiatus and provide extra support of the LES
Post :On both side of esophagus – most cephalad suture incorporate fundus, crus and esophagus
Remaining suture anchor – fundus to either crura or esophagus
Ant :donot disrupt posterior attachment of esophagus and fundus folded over anterior aspect of esophagus
anchored to hiatus and esophagus
Postop, antiemetics are given to avoid retching or emesis.
If tension on closure, reduce CO2 insufflation will reduce the cephalad displacement of the diaphragm to allows tension-free closure.
360-degree wraps when reflux causes respiratory compromise, e.g lung transplant population
Dysphagia is a major cause of reoperation in Nissen
Dor fundoplication m/c used in- esophageal myotomy
As postoperative patients, partial wraps are preferred in patients with a history of preoperative dysphagia or poor peristalsis on manometry
Complete. Even in complete wraps, there should be space for the passage of an instrument between the stomach and esophagus to reduce postoperative dysphagia and gas bloat.
The wrap can be individualized to the patient’s symptoms. Variations on this classic procedure exist that allow an operation to be individualized to the patient’s needs
These findings highlight the critical importance of appropriate patient selection and medical therapy prior to entertaining antireflux surgery
series of biocompatible titanium beads with magnetic cores hermetically sealed inside placed around distal esophagus
Linx create mechanical barrier
Propogated bolus > separate beads> open GEJ > allow bolus to pass into stomach > beads return to original position > augment LES resting pressure
Regurgiattion – d/t ineffective mechanical barrier to reflux
Hb d/t acidic gastric contents contacting esophageal mucosa
Ppi improves heartburn as it neautralise acidic exposure in esophageal mucosa
Don’t alter anatomy or mechanical constraint
Tiny electrical impulses delivered to LES without causing any sensation
IPG similar to pacdmaker implanted under the skin of abdomen
Lead connect IPG to esophagus
Through minimally invasive procedure
40min