This document discusses gastroesophageal reflux disease (GERD). GERD occurs when stomach contents backflow into the esophagus past the lower esophageal sphincter. Factors that can contribute to reflux include a low pressure LES, spontaneous LES relaxation, hiatal hernia, and gastric distension. Symptoms range from heartburn and regurgitation to respiratory complications. Diagnosis involves endoscopy, pH monitoring, esophageal manometry, and imaging. Treatment includes lifestyle modifications, proton pump inhibitors, and in some cases surgery such as Nissen fundoplication or other anti-reflux procedures. Complications of surgery include gas bloat and dysphagia.
Hiatal hernia
Synonyms Hiatus hernia
Hiatalhernia.gif
A drawing of a hiatal hernia
Specialty Gastroenterology, general surgery
Symptoms Taste of acid in the back of the mouth, heartburn, trouble swallowing[1]
Complications Iron deficiency anemia, volvulus, bowel obstruction[1]
Types Sliding, paraesophageal[1]
Risk factors Obesity, older age, major trauma[1]
Diagnostic method Endoscopy, medical imaging, manometry[1]
Treatment Raising the head of the bed, weight loss, medications, surgery[1]
Medication H2 blockers, proton pump inhibitors[1]
Frequency 10–80% (US)[1]
[edit on Wikidata]
A hiatal hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest.
Hiatal hernia
Synonyms Hiatus hernia
Hiatalhernia.gif
A drawing of a hiatal hernia
Specialty Gastroenterology, general surgery
Symptoms Taste of acid in the back of the mouth, heartburn, trouble swallowing[1]
Complications Iron deficiency anemia, volvulus, bowel obstruction[1]
Types Sliding, paraesophageal[1]
Risk factors Obesity, older age, major trauma[1]
Diagnostic method Endoscopy, medical imaging, manometry[1]
Treatment Raising the head of the bed, weight loss, medications, surgery[1]
Medication H2 blockers, proton pump inhibitors[1]
Frequency 10–80% (US)[1]
[edit on Wikidata]
A hiatal hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest.
This presentation is about peptic ulcer disease , including:Pathomorphology,etiology,symptoms,complications,diagnosis and pharmacotherapy,asurgical intervention and prevention...
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
esophageal varices are the second most common cause of upper GI bleed after PUD.These are actually the dilated veins which occur secondary to increase in the pressure in the portal circulation called as Portal Hypertension..
This presentation is about peptic ulcer disease , including:Pathomorphology,etiology,symptoms,complications,diagnosis and pharmacotherapy,asurgical intervention and prevention...
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
esophageal varices are the second most common cause of upper GI bleed after PUD.These are actually the dilated veins which occur secondary to increase in the pressure in the portal circulation called as Portal Hypertension..
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.
Gastroesophageal reflux disease (GERD) is defined as the failure of the antireflux barrier, allowing abnormal reflux of gastric contents into the esophagus. It is a condition which develops when the reflux of stomach contents causes troublesome symptoms and complications.
Gastroesophageal reflux disease in children.Indian Society of Pediatric Gast...Vijitha A S
Gastroesophageal reflux disease in children.Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN) 2022 update
DR VIJITHA A S
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
Gastrointestinal Diseases
Group 5:
Leticia Bernal Leon
Daydig Rodriguez
Maria Rodriguez
Karina Silveira
Instructor:
Dr. Alain Llanes Rojas, DNP, APRN, FNP-BC
Miami Regional University
Diagnosis, Symptoms & Illness Management
MSN5600
Gastroesophageal Reflux
Gastroesophageal reflux that does not cause symptoms is known as physiologic reflux. In nonerosive reflux disease (NERD), individuals have symptoms of reflux disease but no visible or minimal esophageal mucosal injury
Gastroesophageal reflux disease (GERD) is the reflux of acid and pepsin or bile salts from the stomach to the esophagus that causes esophagitis. The severity of the esophagitis depends on the composition of the gastric contents and esophageal mucosa exposure time.
Definition & Classification
Gastroesophageal Reflux
Causes
GERD can be caused by abnormalities or alterations in
1. Lower esophageal sphincter function
2. Esophageal motility
3. Gastric motility or emptying
Esophageal function studies include the following:
Determination of the lower esophageal sphincter (LES) pressure (manometry)
Graphic recording of esophageal swallowing waves, or swallowing pattern (manometry)
Detection of reflux of gastric acid back into the esophagus (acid reflux)
Detection of the ability of the esophagus to clear acid (acid clearing)
An attempt to reproduce symptoms of heartburn (Bernstein test)
Gastroesophageal Reflux
Risk Factors
Obesity
Hiatal hernia
Use of drugs or chemicals that relax the LES (anticholinergics, nitrates, calcium channel blockers, nicotine)
Cigarette smoke.
Trigger Factors
Coughing
Vomiting
Straining at stool
Asthma
Chronic cough
Sinusitis.
Gastroesophageal Reflux
Common Symptoms
Heartburn that occurs 30 to 60 minutes after meals and when the patient bends over or lies down.
Regurgitation of sour or bitter gastric contents
Belching, and fullness of the stomach
Upper abdominal pain within 1 hour of eating.
Atypical Symptoms
chronic cough
asthma attacks
chronic laryngitis
sinusitis
discomfort during swallowing.
Noncardiac chest pain.
Dysphagia
Gastroesophageal Reflux
Clinical manifestations are related to mucosal injury from acid regurgitation and the frequency and duration of reflux events.
The symptoms worsen if the individual lies down or if intraabdominal pressure increases because of coughing, vomiting, or straining at stool.
Uncomplicated GERD that is responsive to first-line therapy does not require an endoscopy.
Patients who do not respond to therapy and those with suspected complications should undergo an endoscopic examination
Management & Evaluation
Differential diagnosis
Gastritis
Peptic ulcer
Gastric cancer
Cholelithiasis
Angina pectoris.
Gastroesophageal Reflux
Diagnosis of GERD is based on the history and clinical manifestations.
An upper endoscopy with biopsy is the standard diagnostic procedure for GERD. It confirms the diagnosis and documents the type and extent of tissue damage.
Esophageal endoscopy: shows hyperemia ...
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Gastro esophageal reflux?
Backflow of gastric and/or duodenal contents into
the esophagus and past the lower esophageal
sphincter (LES), without associated belching or
vomiting
Reflux may cause symptoms or pathologic changes
3. Pathophysiology
LES – a physiological entity not a distinct
anatomical structure
Located just cephalad to the GEJ
Identifiable as a zone of high pressure during
manometric evaluation
4. Factors contributing to high
pressure zone
Intrinsic musculature of distal esophagus
Sling fibres of cardia
Diaphragm
Transmitted pressure of abdominal cavity
5.
6. GASTRO ESOPHAGEAL REFLUX
OCCURS WHEN
Pressure of high pressure zone is too low to prevent
gastric contents from entering the esophagus
Sphincter of normal pressure undergoes spontaneous
relaxation, not associated with peristaltic wave in the
body of esophagus
Shortening of High pressure zone
Cephalad displacement
Gastric distension
14. Manometry
To rule out primary motility disorders
Station pull through and Rapid pull through measurement
Normal pressure for station pull through measurement - 12-30 mm
Hg
Added information like total length of LES, intra abdominal length,
location of sphincter relative to nares
Assessment of effectiveness of peristalsis
Peristaltic activity
Amplitude
15. Ineffective esophageal motility is defined as less
than 70% peristalsis or distal esophageal
amplitudes lower than 30mm of Hg
Often associated with significant GERD
16. pH monitoring
24 hr pH test- gold standard for diagnosing and
quantifying acid reflux
Assess
total number of reflux episodes ( pH <4)
Number of episodes >5 min
Extent of reflux in upright position
Extent of reflux in supine position
DeMeester score
Impedence pH testing
Can distinguish between a true reflux event and
intake of acid beverage
18. Esophagography
True value of the study is to determine the external
anatomy of esophagus and stomach
To rule out peptic esophageal strictures, diverticula,
tumors, hernias
20. Medical and Lifestyle modifications
Weight loss
Head end elevation of bed
Avoidance of meal 2-3 hrs before bed time
Avoidance of chocolate, caffeine, alcohol, spicy/acidic
foods
8 week course of PPI ‘s
21. Proton pump inhibitors
Act by irreversibly binding to proton pumps in parietal cells of
stomach – stops acid production
Effect occurs after 4 days of therapy and action lingers for the life of
parietal cell
Patient needs to be off therapy for atleast a week before evaluation
with pH monitoring
90% can expect full mucosal healing
Later step down of dosage
Side effects- head ache, flatulence, abd pain, constipation/
diarrhea
? Chronic acid suppression – risk of gastric cancer
22. Reasons for failure on PPI
Volume reflux
Hermit life style
Psychological distress
Poor compliance
Misdiagnosis
23. Surgical
Surgery is cost effective after 8 -10 years of medical
therapy
NISSEN FUNDOPLICATION
PARTIAL FUNDOPLICATION
28. Endoscopic procedures
Plicating gastric mucosa just below cardia to
accentuate
Angle of His
Radiofrequency ablation of sphincter
Injection of submucosal polymers to lower esophagus
30. Special Considerations
Stricture
Day case dilatation
PPI
Short esophagus
Collis gastroplasty
Collis Nissen
operation
Barrett esophagus
