Gastro-oesophageal reflux disease is caused by abnormal reflux of gastric contents into the oesophagus, affecting approximately 30% of the population. It develops when the oesophageal mucosa is exposed to gastric contents for prolonged periods, resulting in symptoms like heartburn and regurgitation. Key factors include abnormalities of the lower oesophageal sphincter that permit reflux, such as reduced tone or inappropriate relaxation, as well as hiatus hernia. Complications may include oesophagitis, Barrett's oesophagus which is a pre-malignant condition, benign strictures, and iron-deficiency anaemia. Investigation involves endoscopy to diagnose and exclude complications, while management focuses
Achalasia is a rare disorder of the esophagus that results from damaged nerves that control food movement. It causes difficulty swallowing and food getting stuck. The document discusses the causes, symptoms, tests used to diagnose (endoscopy, manometry), and treatments of achalasia. Treatments include medications to relax muscles, botox injections, balloon dilation procedures, and surgeries like Heller myotomy to cut the lower esophageal sphincter muscle.
The document discusses gallstones, including their pathogenesis, types (cholesterol, pigment, mixed), and complications such as cholecystitis, cholangitis, pancreatitis, and intestinal obstruction. It describes acute and chronic cholecystitis, noting that acute cholecystitis is usually associated with gallstones and presents with symptoms of pain, fever, jaundice. Treatment involves conservative measures followed by cholecystectomy. Chronic cholecystitis can be secondary or primary, presenting with vague symptoms, and is treated definitively with cholecystectomy.
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
Esophagitis is inflammation of the esophagus that can have various causes like acid reflux, infections, medications, radiation, and more. Common symptoms include dysphagia, heartburn, and painful swallowing. Diagnosis involves endoscopy and biopsy. Treatment depends on the underlying cause but may include lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and surgery in some cases. Complications can include strictures and Barrett's esophagus.
Malabsorption syndrome is a clinical term that encompasses defects occurring during the digestion and absorption of food nutrients by the gastrointestinal tract. It is characterized by defective absorption of fats, vitamins, proteins, carbohydrates, electrolytes, and water. Malabsorption can be caused by issues with intraluminal digestion, terminal digestion, transepithelial transport, or lymphatic transport. Common causes include celiac disease, tropical sprue, chronic pancreatitis, cystic fibrosis, and inflammatory bowel disease. Symptoms include chronic diarrhea, steatorrhea, weight loss, fatigue, and nutritional deficiencies. Diagnosis involves tests for steatorrhea, Schilling tests, D-xylose tests, imaging
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
Achalasia is a rare disorder of the esophagus that results from damaged nerves that control food movement. It causes difficulty swallowing and food getting stuck. The document discusses the causes, symptoms, tests used to diagnose (endoscopy, manometry), and treatments of achalasia. Treatments include medications to relax muscles, botox injections, balloon dilation procedures, and surgeries like Heller myotomy to cut the lower esophageal sphincter muscle.
The document discusses gallstones, including their pathogenesis, types (cholesterol, pigment, mixed), and complications such as cholecystitis, cholangitis, pancreatitis, and intestinal obstruction. It describes acute and chronic cholecystitis, noting that acute cholecystitis is usually associated with gallstones and presents with symptoms of pain, fever, jaundice. Treatment involves conservative measures followed by cholecystectomy. Chronic cholecystitis can be secondary or primary, presenting with vague symptoms, and is treated definitively with cholecystectomy.
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
Esophagitis is inflammation of the esophagus that can have various causes like acid reflux, infections, medications, radiation, and more. Common symptoms include dysphagia, heartburn, and painful swallowing. Diagnosis involves endoscopy and biopsy. Treatment depends on the underlying cause but may include lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and surgery in some cases. Complications can include strictures and Barrett's esophagus.
Malabsorption syndrome is a clinical term that encompasses defects occurring during the digestion and absorption of food nutrients by the gastrointestinal tract. It is characterized by defective absorption of fats, vitamins, proteins, carbohydrates, electrolytes, and water. Malabsorption can be caused by issues with intraluminal digestion, terminal digestion, transepithelial transport, or lymphatic transport. Common causes include celiac disease, tropical sprue, chronic pancreatitis, cystic fibrosis, and inflammatory bowel disease. Symptoms include chronic diarrhea, steatorrhea, weight loss, fatigue, and nutritional deficiencies. Diagnosis involves tests for steatorrhea, Schilling tests, D-xylose tests, imaging
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
Diverticular disease refers to the bulging pouches that can develop in the gastrointestinal wall when the lining pushes through weak spots in the surrounding muscle. The most common site is the sigmoid colon, but diverticula can develop anywhere along the GI tract. There are two forms: diverticulosis, which are non-inflamed pouches, and diverticulitis, which is inflammation of the pouches. Diverticula are caused by increased pressure within the colon lumen from constipation or low-fiber diets, which can weaken the colon walls. While diverticulosis is often asymptomatic, it may cause left lower abdominal pain relieved by bowel movements or gas, alternating constipation and diarrhea, and difficult def
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.
- TSH is produced by the adenohypophysis and regulates thyroid function by stimulating iodine uptake, colloid endocytosis, and thyroid gland growth. The majority of circulating thyroid hormone is T4, with T3 making up a small percentage.
- Iodine deficiency is the most common cause of goiter and hypothyroidism worldwide. It can lead to miscarriages, stillbirths, neurological issues, and impaired intellectual function in both fetuses and newborns through adults.
- Goiters are classified based on their etiology, morphology, and size. The most common types are diffuse nontoxic goiter and multinodular goiter, which can sometimes become toxic
Peptic ulcer disease causes and treatmentAbu Bakar
Peptic ulcer disease is defined as a discontinuity in the gastric or duodenal mucosa exposed to acid and pepsin secretion. Common causes include H. pylori infection, NSAID use, and stress. H. pylori infection is associated with 95% of duodenal ulcers and 80% of gastric ulcers. NSAID use inhibits prostaglandins, which protect the gastric mucosa. Treatment involves antibiotics to eradicate H. pylori, PPIs to reduce acid secretion, and medications to protect the gastric lining such as sucralfate. Triple therapy with a PPI and two antibiotics is the standard treatment to eradicate H. pylori.
This document discusses intussusception, which is the telescoping of one segment of bowel into an adjacent segment. It provides definitions, etiology, types and pathology, signs and symptoms, differential diagnosis, workup, and treatment options for intussusception. The main points are that intussusception is usually idiopathic or caused by respiratory viruses in infants and young children, presenting with abdominal pain, vomiting, and bloody stools. Diagnosis involves imaging like ultrasound or barium enema. Treatment options include non-surgical reduction techniques like hydrostatic or pneumatic reduction or surgical reduction through manual manipulation or resection.
GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Peptic ulcer disease is caused by factors like NSAIDs, H. pylori bacteria, smoking, and stress that can damage the lining of the stomach or small intestine. Common symptoms include abdominal pain, vomiting, weight loss, and bleeding. Diagnosis involves an endoscopy with biopsy. Treatment involves eliminating risk factors, prescribing proton pump inhibitors or antibiotics to kill H. pylori, and sometimes surgery if complications arise. Surgical procedures like vagotomy and drainage or Billroth I reconstruction can reduce acid secretion but lead to side effects like dumping syndrome or diarrhea.
Malabsorption refers to disorders that disrupt digestion and nutrient absorption in the small intestine. This can lead to malnutrition and various anemias from deficiencies. Diagnosis involves tests like fecal fat analysis, D-xylose absorption tests, and vitamin B12 absorption (Schilling) tests. Treatment focuses on correcting nutritional deficiencies through supplements and treating any underlying diseases through measures like gluten-free diets for celiac disease or antibiotics for bacterial overgrowth.
Diverticulosis occurs when pouches called diverticula develop in the walls of the large intestine. While the cause is unknown, risk factors include not eating enough fiber, straining during bowel movements, and constipation. Most people with diverticulosis do not experience symptoms until it turns into diverticulitis, causing pain, bloating, fever, and other issues. Diverticulosis is often diagnosed during a routine colonoscopy or x-ray for another issue, and may also involve blood tests or CT scans. Treatment focuses on increasing fiber intake, staying hydrated, and eating fruits/vegetables to prevent symptoms and diverticulitis.
This document describes different types of gastritis, including erythematous/exudative gastritis, erosive gastritis, atrophic gastritis, stress-induced gastritis, rugal hyperplastic gastritis, bacterial gastritis caused by H. pylori, viral gastritis, fungal gastritis, chemotoxic gastritis, and distinct forms like Crohn's disease. It provides details on endoscopic findings and characteristics of each type of gastritis.
Hiatal hernia is a condition where the stomach and other intra-abdominal contents protrude through the esophageal hiatus of the diaphragm. Risk factors include obesity, increased abdominal pressure, and previous hiatal hernia surgery. Symptoms may include heartburn, dysphagia, chest pain, or respiratory issues. Diagnosis is typically made through upper gastrointestinal imaging. Treatment depends on symptoms and hernia type but may involve lifestyle changes, medication, or surgery to repair the diaphragmatic defect and prevent acid reflux. Complications can include obstruction, bleeding, stomach twisting, and Barrett's esophagus.
There are two main types of hiatal hernia: sliding and paraesophageal. A sliding hernia occurs when the stomach and lower esophagus slide up into the chest cavity through the diaphragm. A paraesophageal hernia involves part of the stomach squeezing through the diaphragmatic opening and landing next to the esophagus. Hiatal hernias often do not cause symptoms but can sometimes lead to heartburn. Treatment involves lifestyle changes and medication to reduce acid production if heartburn is present. Surgery to repair the diaphragmatic opening may be needed in some cases.
Diffuse toxic goiter, also known as endemic goiter, is an autoimmune disease characterized by overproduction of thyroid hormones causing damage to organs like the nervous and cardiovascular systems. It is caused by iodine deficiency in the environment, especially in soil and water. People in iodine-deficient areas can develop an enlarged thyroid gland with a reduction in its function over time, along with symptoms like difficulty swallowing and changes to heart function. Treatment options include thyroid drugs, surgery to remove part of the thyroid gland, and preventing future cases by providing iodized salt and foods to populations.
This document discusses achalasia, a rare disorder where the lower esophagus fails to relax and allow food to pass into the stomach. It defines achalasia, lists its causes as damage to nerves in the esophagus, and discusses its clinical manifestations such as difficulty swallowing and food returning to the mouth. The document outlines the diagnosis, medical management including balloon dilation and Botox injections, and nursing care for patients with achalasia which focuses on positioning during eating and monitoring for complications.
This document discusses gallstone disease (cholelithiasis). It describes gallstones as abnormal masses formed in the gallbladder or bile ducts that are a common cause of abdominal pain and dyspepsia. It identifies factors that increase risk of gallstones like gender, age, obesity, pregnancy, and rapid weight loss. It discusses the types of gallstones, pathogenesis, definitions of related conditions, clinical manifestations, complications, and risk factors in more detail over several pages.
This document discusses acute pancreatitis, defining it as a reversible inflammation of the pancreas that ranges from mild to severe. It can be caused by gallstones, alcohol use, metabolic issues, infections, drugs, trauma, and other factors. Symptoms include severe abdominal pain that may radiate to the back. Investigations include blood tests of amylase, lipase, and other enzymes. Treatment focuses on supportive care, pain management, and identifying/treating any complications like infections. The mortality rate ranges from 1% for mild cases to 15-20% overall.
The document discusses biliary dyskinesia in children, which is a disturbance in the coordination of contractions in the biliary ducts that can cause pain in the upper right quadrant of the abdomen. It notes that biliary dyskinesia has various potential causes including neuro-circulatory dysfunction, viral hepatitis, genetic factors, and gastrointestinal issues. The document also covers pathogenesis, diagnosis, and potential treatment options which can include laparoscopic cholecystectomy, proton pump inhibitors, osteopathic treatment, and magnesium and enzyme supplements.
This document discusses predisposing factors, pathogenesis, types, clinical features, complications, investigations, differential diagnosis, and management of gallstones. The main types are cholesterol stones, mixed stones, and pigment stones. Risk factors include obesity, female sex hormones, age, pregnancy, certain drugs, and diabetes. Gallstones can cause symptoms like biliary colic or be asymptomatic. Complications involve inflammation of the gallbladder or bile ducts. Treatment options are medical therapy with ursodeoxycholic acid for small cholesterol stones or laparoscopic cholecystectomy.
Dyspepsia refers to any symptoms thought to originate from the upper gastrointestinal tract. There are several potential mechanisms that can cause dyspepsia, including gastroesophageal acid reflux, gastric motor dysfunction, and visceral afferent hypersensitivity. Gastroesophageal acid reflux can be caused by reduced lower esophageal sphincter tone, frequent transient lower esophageal sphincter relaxations, overeating, aerophagia, impaired esophageal body motility, reduced salivary secretion, and hiatal hernias. Gastric motor dysfunction may involve delayed gastric emptying or impaired gastric fundus relaxation after eating. Visceral afferent hypersensitivity is proposed to disturb gastric sensory function in functional
This document provides an outline on gastritis, including its definition, causes, signs and symptoms, diagnostic tests, medical and nursing management, prevention, and complications. Gastritis is defined as inflammation of the stomach lining and can be acute or chronic. Common causes include NSAID use, H. pylori infection, alcohol, and stress. Symptoms may include nausea, abdominal pain, and bleeding. Tests used for diagnosis include endoscopy, blood tests, stool tests, and biopsy. Treatment focuses on reducing acid and treating underlying causes, such as antibiotics for H. pylori. Nursing care includes relieving pain, maintaining nutrition and hydration, administering medications correctly, and educating on lifestyle changes and symptom monitoring
1) Gastroesophageal reflux disease (GORD) is caused by abnormal relaxation of the lower esophageal sphincter that allows stomach contents to flow back into the esophagus.
2) The main symptoms are heartburn and regurgitation which can be aggravated by certain foods, drinks, smoking, and obesity.
3) Treatment involves lifestyle modifications, antacids, H2 blockers, proton pump inhibitors, endoscopic procedures, and sometimes surgery.
4) Complications of long-term reflux include peptic strictures, Barrett's esophagus, and rarely esophageal cancer. Barrett's esophagus involves replacement of normal esophageal lining with an abnormal columnar epithelium
This document discusses gastroesophageal reflux disease (GORD). It defines key terms like hiatal hernia and Barrett's esophagus. It covers the epidemiology, pathophysiology, risk factors, diagnosis and treatment of GORD. Regarding treatment, it discusses lifestyle modifications, medical options like PPIs, and surgical interventions. It emphasizes that PPIs are the most effective medical treatment for healing esophagitis and relieving symptoms of GORD. Investigation with endoscopy, pH monitoring, and manometry is recommended for patients who fail to respond to initial treatment or have concerning symptoms.
Diverticular disease refers to the bulging pouches that can develop in the gastrointestinal wall when the lining pushes through weak spots in the surrounding muscle. The most common site is the sigmoid colon, but diverticula can develop anywhere along the GI tract. There are two forms: diverticulosis, which are non-inflamed pouches, and diverticulitis, which is inflammation of the pouches. Diverticula are caused by increased pressure within the colon lumen from constipation or low-fiber diets, which can weaken the colon walls. While diverticulosis is often asymptomatic, it may cause left lower abdominal pain relieved by bowel movements or gas, alternating constipation and diarrhea, and difficult def
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.
- TSH is produced by the adenohypophysis and regulates thyroid function by stimulating iodine uptake, colloid endocytosis, and thyroid gland growth. The majority of circulating thyroid hormone is T4, with T3 making up a small percentage.
- Iodine deficiency is the most common cause of goiter and hypothyroidism worldwide. It can lead to miscarriages, stillbirths, neurological issues, and impaired intellectual function in both fetuses and newborns through adults.
- Goiters are classified based on their etiology, morphology, and size. The most common types are diffuse nontoxic goiter and multinodular goiter, which can sometimes become toxic
Peptic ulcer disease causes and treatmentAbu Bakar
Peptic ulcer disease is defined as a discontinuity in the gastric or duodenal mucosa exposed to acid and pepsin secretion. Common causes include H. pylori infection, NSAID use, and stress. H. pylori infection is associated with 95% of duodenal ulcers and 80% of gastric ulcers. NSAID use inhibits prostaglandins, which protect the gastric mucosa. Treatment involves antibiotics to eradicate H. pylori, PPIs to reduce acid secretion, and medications to protect the gastric lining such as sucralfate. Triple therapy with a PPI and two antibiotics is the standard treatment to eradicate H. pylori.
This document discusses intussusception, which is the telescoping of one segment of bowel into an adjacent segment. It provides definitions, etiology, types and pathology, signs and symptoms, differential diagnosis, workup, and treatment options for intussusception. The main points are that intussusception is usually idiopathic or caused by respiratory viruses in infants and young children, presenting with abdominal pain, vomiting, and bloody stools. Diagnosis involves imaging like ultrasound or barium enema. Treatment options include non-surgical reduction techniques like hydrostatic or pneumatic reduction or surgical reduction through manual manipulation or resection.
GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Peptic ulcer disease is caused by factors like NSAIDs, H. pylori bacteria, smoking, and stress that can damage the lining of the stomach or small intestine. Common symptoms include abdominal pain, vomiting, weight loss, and bleeding. Diagnosis involves an endoscopy with biopsy. Treatment involves eliminating risk factors, prescribing proton pump inhibitors or antibiotics to kill H. pylori, and sometimes surgery if complications arise. Surgical procedures like vagotomy and drainage or Billroth I reconstruction can reduce acid secretion but lead to side effects like dumping syndrome or diarrhea.
Malabsorption refers to disorders that disrupt digestion and nutrient absorption in the small intestine. This can lead to malnutrition and various anemias from deficiencies. Diagnosis involves tests like fecal fat analysis, D-xylose absorption tests, and vitamin B12 absorption (Schilling) tests. Treatment focuses on correcting nutritional deficiencies through supplements and treating any underlying diseases through measures like gluten-free diets for celiac disease or antibiotics for bacterial overgrowth.
Diverticulosis occurs when pouches called diverticula develop in the walls of the large intestine. While the cause is unknown, risk factors include not eating enough fiber, straining during bowel movements, and constipation. Most people with diverticulosis do not experience symptoms until it turns into diverticulitis, causing pain, bloating, fever, and other issues. Diverticulosis is often diagnosed during a routine colonoscopy or x-ray for another issue, and may also involve blood tests or CT scans. Treatment focuses on increasing fiber intake, staying hydrated, and eating fruits/vegetables to prevent symptoms and diverticulitis.
This document describes different types of gastritis, including erythematous/exudative gastritis, erosive gastritis, atrophic gastritis, stress-induced gastritis, rugal hyperplastic gastritis, bacterial gastritis caused by H. pylori, viral gastritis, fungal gastritis, chemotoxic gastritis, and distinct forms like Crohn's disease. It provides details on endoscopic findings and characteristics of each type of gastritis.
Hiatal hernia is a condition where the stomach and other intra-abdominal contents protrude through the esophageal hiatus of the diaphragm. Risk factors include obesity, increased abdominal pressure, and previous hiatal hernia surgery. Symptoms may include heartburn, dysphagia, chest pain, or respiratory issues. Diagnosis is typically made through upper gastrointestinal imaging. Treatment depends on symptoms and hernia type but may involve lifestyle changes, medication, or surgery to repair the diaphragmatic defect and prevent acid reflux. Complications can include obstruction, bleeding, stomach twisting, and Barrett's esophagus.
There are two main types of hiatal hernia: sliding and paraesophageal. A sliding hernia occurs when the stomach and lower esophagus slide up into the chest cavity through the diaphragm. A paraesophageal hernia involves part of the stomach squeezing through the diaphragmatic opening and landing next to the esophagus. Hiatal hernias often do not cause symptoms but can sometimes lead to heartburn. Treatment involves lifestyle changes and medication to reduce acid production if heartburn is present. Surgery to repair the diaphragmatic opening may be needed in some cases.
Diffuse toxic goiter, also known as endemic goiter, is an autoimmune disease characterized by overproduction of thyroid hormones causing damage to organs like the nervous and cardiovascular systems. It is caused by iodine deficiency in the environment, especially in soil and water. People in iodine-deficient areas can develop an enlarged thyroid gland with a reduction in its function over time, along with symptoms like difficulty swallowing and changes to heart function. Treatment options include thyroid drugs, surgery to remove part of the thyroid gland, and preventing future cases by providing iodized salt and foods to populations.
This document discusses achalasia, a rare disorder where the lower esophagus fails to relax and allow food to pass into the stomach. It defines achalasia, lists its causes as damage to nerves in the esophagus, and discusses its clinical manifestations such as difficulty swallowing and food returning to the mouth. The document outlines the diagnosis, medical management including balloon dilation and Botox injections, and nursing care for patients with achalasia which focuses on positioning during eating and monitoring for complications.
This document discusses gallstone disease (cholelithiasis). It describes gallstones as abnormal masses formed in the gallbladder or bile ducts that are a common cause of abdominal pain and dyspepsia. It identifies factors that increase risk of gallstones like gender, age, obesity, pregnancy, and rapid weight loss. It discusses the types of gallstones, pathogenesis, definitions of related conditions, clinical manifestations, complications, and risk factors in more detail over several pages.
This document discusses acute pancreatitis, defining it as a reversible inflammation of the pancreas that ranges from mild to severe. It can be caused by gallstones, alcohol use, metabolic issues, infections, drugs, trauma, and other factors. Symptoms include severe abdominal pain that may radiate to the back. Investigations include blood tests of amylase, lipase, and other enzymes. Treatment focuses on supportive care, pain management, and identifying/treating any complications like infections. The mortality rate ranges from 1% for mild cases to 15-20% overall.
The document discusses biliary dyskinesia in children, which is a disturbance in the coordination of contractions in the biliary ducts that can cause pain in the upper right quadrant of the abdomen. It notes that biliary dyskinesia has various potential causes including neuro-circulatory dysfunction, viral hepatitis, genetic factors, and gastrointestinal issues. The document also covers pathogenesis, diagnosis, and potential treatment options which can include laparoscopic cholecystectomy, proton pump inhibitors, osteopathic treatment, and magnesium and enzyme supplements.
This document discusses predisposing factors, pathogenesis, types, clinical features, complications, investigations, differential diagnosis, and management of gallstones. The main types are cholesterol stones, mixed stones, and pigment stones. Risk factors include obesity, female sex hormones, age, pregnancy, certain drugs, and diabetes. Gallstones can cause symptoms like biliary colic or be asymptomatic. Complications involve inflammation of the gallbladder or bile ducts. Treatment options are medical therapy with ursodeoxycholic acid for small cholesterol stones or laparoscopic cholecystectomy.
Dyspepsia refers to any symptoms thought to originate from the upper gastrointestinal tract. There are several potential mechanisms that can cause dyspepsia, including gastroesophageal acid reflux, gastric motor dysfunction, and visceral afferent hypersensitivity. Gastroesophageal acid reflux can be caused by reduced lower esophageal sphincter tone, frequent transient lower esophageal sphincter relaxations, overeating, aerophagia, impaired esophageal body motility, reduced salivary secretion, and hiatal hernias. Gastric motor dysfunction may involve delayed gastric emptying or impaired gastric fundus relaxation after eating. Visceral afferent hypersensitivity is proposed to disturb gastric sensory function in functional
This document provides an outline on gastritis, including its definition, causes, signs and symptoms, diagnostic tests, medical and nursing management, prevention, and complications. Gastritis is defined as inflammation of the stomach lining and can be acute or chronic. Common causes include NSAID use, H. pylori infection, alcohol, and stress. Symptoms may include nausea, abdominal pain, and bleeding. Tests used for diagnosis include endoscopy, blood tests, stool tests, and biopsy. Treatment focuses on reducing acid and treating underlying causes, such as antibiotics for H. pylori. Nursing care includes relieving pain, maintaining nutrition and hydration, administering medications correctly, and educating on lifestyle changes and symptom monitoring
1) Gastroesophageal reflux disease (GORD) is caused by abnormal relaxation of the lower esophageal sphincter that allows stomach contents to flow back into the esophagus.
2) The main symptoms are heartburn and regurgitation which can be aggravated by certain foods, drinks, smoking, and obesity.
3) Treatment involves lifestyle modifications, antacids, H2 blockers, proton pump inhibitors, endoscopic procedures, and sometimes surgery.
4) Complications of long-term reflux include peptic strictures, Barrett's esophagus, and rarely esophageal cancer. Barrett's esophagus involves replacement of normal esophageal lining with an abnormal columnar epithelium
This document discusses gastroesophageal reflux disease (GORD). It defines key terms like hiatal hernia and Barrett's esophagus. It covers the epidemiology, pathophysiology, risk factors, diagnosis and treatment of GORD. Regarding treatment, it discusses lifestyle modifications, medical options like PPIs, and surgical interventions. It emphasizes that PPIs are the most effective medical treatment for healing esophagitis and relieving symptoms of GORD. Investigation with endoscopy, pH monitoring, and manometry is recommended for patients who fail to respond to initial treatment or have concerning symptoms.
GERD is caused by backflow of gastric contents into the esophagus due to lower esophageal sphincter dysfunction. It commonly causes heartburn and can lead to complications like esophagitis and Barrett's esophagus. Treatment involves lifestyle modifications, medications like antacids, H2 blockers, and PPIs. Surgery to reinforce the LES may be needed in severe cases. Nursing focuses on pain management, dietary changes, medication administration, and education on GERD and its treatment.
This document discusses gastroesophageal reflux disease (GERD). It begins by defining GERD as a condition caused by stomach contents refluxing into the esophagus and causing troublesome symptoms or complications. It then discusses the pathophysiology of GERD, noting that the lower esophageal sphincter normally acts as a barrier but can become disrupted, allowing acid to reflux from the stomach into the esophagus. The document outlines the clinical manifestations of GERD including heartburn, regurgitation, and extraesophageal symptoms. It also discusses diagnostic evaluations for GERD including endoscopy, pH monitoring, and manometry. The document concludes by covering treatment options for GERD including lifestyle modifications
This document discusses gastroesophageal reflux disease (GERD). It defines GERD as a condition where the abnormal reflux of gastric contents into the esophagus causes symptoms or mucosal damage. It discusses the epidemiology, pathophysiology involving breakdown of the lower esophageal sphincter barrier, clinical manifestations including typical and atypical symptoms as well as complications. It outlines the diagnostic evaluation including clinical diagnosis, endoscopy, and pH monitoring. It also details treatment approaches including lifestyle modifications, antacids, H2 receptor antagonists, proton pump inhibitors, and in some cases surgery or endoscopic interventions.
Typhoid fever is caused by the bacterium Salmonella typhi. It remains a major public health problem, infecting over 21 million people annually and causing over 200,000 deaths per year globally. The disease is transmitted through contaminated food or water. Clinical features include a sustained high fever over several weeks and complications can include intestinal bleeding or perforation. Diagnosis is made through blood or stool cultures. Treatment involves antibiotics. Prevention relies on vaccination, improved sanitation and hygiene practices like handwashing to control the spread from infected cases and carriers.
Gastroesophageal reflux disease (GERD) occurs when gastric contents reflux into the esophagus in excessive amounts, potentially causing injury. It results from lower esophageal sphincter dysfunction or impaired esophageal clearance. Symptoms include heartburn and regurgitation. Diagnosis involves endoscopy, manometry, and pH monitoring. Treatment consists of lifestyle modifications, antacids, H2 blockers, proton pump inhibitors, prokinetics, and surgery for severe cases. In infants, GERD is common and usually resolves by age 1 with conservative measures like thickened feedings and upright positioning.
GERD is one of the most common gastrointestinal disorders, affecting up to 15% of individuals. It results from backflow of stomach contents into the esophagus, which is normally prevented by the lower esophageal sphincter and other anatomical protections. Symptoms include heartburn and acid regurgitation. Risk factors include hiatal hernia, excess stomach acid production, delayed gastric emptying, and decreased mucosal resistance. Complications include esophagitis, ulcers, Barrett's esophagus, and even esophageal cancer if left untreated. Treatment involves lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and sometimes surgery for complications like strictures.
Laparoscopic trans hiatal esophagectomy for early cancer-finalforegutsurgeon
The document discusses early stage esophageal cancer (T1a and T1b), which has a low risk of lymph node metastasis, especially for T1a cancers. Endoscopic mucosal resection can be used for staging and treatment of T1a cancers. Laparoscopic transhiatal esophagectomy is recommended for incomplete endoscopic resection, as it has lower morbidity compared to transthoracic esophagectomy. Vagus-sparing and Merindino operations are also discussed as minimally invasive options.
GERD is caused by reflux of stomach contents into the esophagus. It can be due to transient lower esophageal sphincter relaxations, reduced LES tone, hiatal hernia, or impaired esophageal clearance. Risk factors include obesity, smoking, pregnancy, and connective tissue disorders. Symptoms include heartburn, regurgitation, and chest pain. Diagnosis involves endoscopy or 24-hour pH monitoring. Treatment begins with lifestyle changes and antacids. Proton pump inhibitors are prescribed for moderate to severe cases or those not responding to other treatments. Surgery or endoscopic procedures may be used for cases not controlled by medication.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD as abnormal reflux of gastric contents into the esophagus causing troublesome symptoms or complications, with more than 2 heartburn episodes per week. Approximately 20% of adults experience frequent GERD symptoms. The document discusses the pathogenesis, risk factors, diagnosis and diagnostic tests, and treatment options for GERD including pharmacologic therapies, surgery, and endoscopic treatments. It provides details on classifications of esophagitis, guidelines for endoscopy and pH monitoring in GERD diagnosis and management.
Parotid gland anatomy and pathophysiology of parotitis are described. Parotitis is inflammation of the parotid gland most commonly caused by viral or bacterial infection when saliva production is decreased. Symptoms include pain, swelling, and pus draining from the parotid duct. Diagnosis involves medical history, physical exam, and imaging tests. Treatment ranges from conservative measures like antibiotics, heat therapy and increased fluids to surgery in severe cases. Complications are rare if treated properly.
La gastritis es una inflamación de la mucosa gástrica que puede ser aguda o crónica. La gastritis aguda se debe a factores como AINEs, alcohol o H. pylori e incluye síntomas como dolor abdominal y vómito. La gastritis crónica se clasifica en atrófica (tipo A, autoinmune) o no atrófica (tipo B, asociada a H. pylori) y puede progresar a atrofia gástrica. El tratamiento incluye antibióticos para erradicar H. pylori y f
Updated national guidelines for pediatric tuberculosis in indiaSachin Sony
This document discusses tuberculosis (TB) in children, including epidemiology, diagnosis, treatment recommendations, and prevention strategies. It provides statistics on pediatric TB globally and in India. It summarizes guidelines for diagnosing TB in children based on symptoms, tests, and imaging. Treatment recommendations include regimens, dosages based on weight, and considerations for special cases like TB meningitis. It also covers strategies to improve diagnosis and treatment adherence, including replacing injections with oral medications when possible.
The document provides information on homeopathy materia medica capsules, including indicators, aggravating and ameliorating factors, and relationships for over 30 homeopathic remedies such as Aconite, Arsenicum Album, Belladonna, Bryonia, and more. Each remedy is summarized with its key uses and characteristics. The document serves as a reference for homeopaths to understand different remedies and select the most appropriate one based on a patient's symptoms.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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2. AnatomyAnatomy
The oesophagus is a muscular tube 25 cmThe oesophagus is a muscular tube 25 cm
long which extends from the cricoidlong which extends from the cricoid
cartilage to the cardiac orifice of thecartilage to the cardiac orifice of the
stomach.stomach.
It has an upper and a lower sphincter.It has an upper and a lower sphincter.
A peristaltic swallowing wave propels theA peristaltic swallowing wave propels the
food bolus into the stomach.food bolus into the stomach.
3. PathophysiologyPathophysiology
Occasional episodes of gastro-oesophagealOccasional episodes of gastro-oesophageal
reflux are common in health.reflux are common in health.
Reflux is followed by oesophageal peristalticReflux is followed by oesophageal peristaltic
waves which efficiently clear the gullet, alkalinewaves which efficiently clear the gullet, alkaline
saliva neutralises residual acid, and symptomssaliva neutralises residual acid, and symptoms
do not occur.do not occur.
Gastro-oesophageal reflux disease developsGastro-oesophageal reflux disease develops
when the oesophageal mucosa is exposed towhen the oesophageal mucosa is exposed to
gastric contents for prolonged periods of time,gastric contents for prolonged periods of time,
resulting in symptoms and, in a proportion ofresulting in symptoms and, in a proportion of
cases, oesophagitis.cases, oesophagitis.
4. EtiologyEtiology
1. abnormal of the lower oesophageal sphincter:1. abnormal of the lower oesophageal sphincter:
A. reduced tone:A. reduced tone:
dietary factors (coffee, tea),dietary factors (coffee, tea),
smoking,smoking,
alcohol,alcohol,
pregnancy, obesity (resulting in increased intra-abdominalpregnancy, obesity (resulting in increased intra-abdominal
pressure);pressure);
preparations (Papaverin, Nitrats, Teophyllin, etc.)preparations (Papaverin, Nitrats, Teophyllin, etc.)
B. inappropriate relaxation:B. inappropriate relaxation:
hiatus hernia;hiatus hernia;
dietary factors (fried, fatty food, macaroni; these food result indietary factors (fried, fatty food, macaroni; these food result in
delayed gastric emptying, increased intra-gastric acidity)delayed gastric emptying, increased intra-gastric acidity)
2. defective oesophageal clearance;2. defective oesophageal clearance;
5. Factors associated with the developmentFactors associated with the development
of gastro-oesophageal reflux diseaseof gastro-oesophageal reflux disease ..
6. Abnormalities of the lowerAbnormalities of the lower
oesophageal sphincter:oesophageal sphincter:
In health, the lower oesophageal sphincter isIn health, the lower oesophageal sphincter is
tonically contracted, relaxing only duringtonically contracted, relaxing only during
swallowing.swallowing.
Some patients with gastro-oesophageal refluxSome patients with gastro-oesophageal reflux
disease have reduced lower oesophagealdisease have reduced lower oesophageal
sphincter tone, permitting reflux when intra-sphincter tone, permitting reflux when intra-
abdominal pressure rises.abdominal pressure rises.
In others, basal sphincter tone is normal butIn others, basal sphincter tone is normal but
reflux occurs in response to frequent episodes ofreflux occurs in response to frequent episodes of
inappropriate sphincter relaxation.inappropriate sphincter relaxation.
7. Hiatus hernia:Hiatus hernia:
Hiatus hernia causes reflux because theHiatus hernia causes reflux because the
pressure gradient between the abdominal andpressure gradient between the abdominal and
thoracic cavities, which normally pinches thethoracic cavities, which normally pinches the
hiatus, is lost. In addition, the oblique anglehiatus, is lost. In addition, the oblique angle
between the cardia and oesophagus disappears.between the cardia and oesophagus disappears.
Many patients who have large hiatus herniasMany patients who have large hiatus hernias
develop reflux symptoms, but the relationshipdevelop reflux symptoms, but the relationship
between the presence of a hernia and symptomsbetween the presence of a hernia and symptoms
is poor.is poor.
Hiatus hernia is very common in individuals whoHiatus hernia is very common in individuals who
have no symptoms, and some symptomatichave no symptoms, and some symptomatic
patients have only a very small or no hernia.patients have only a very small or no hernia.
8. Important features of hiatusImportant features of hiatus
herniahernia
Occurs in 30% of the population over theOccurs in 30% of the population over the
age of 50 years;age of 50 years;
Often asymptomatic;Often asymptomatic;
Heartburn and regurgitation can occur;Heartburn and regurgitation can occur;
Gastric volvulus may complicate largeGastric volvulus may complicate large
para-oesophageal hernias.para-oesophageal hernias.
10. Delayed oesophagealDelayed oesophageal
clearance:clearance:
Defective oesophageal peristaltic activityDefective oesophageal peristaltic activity
is commonly found in patients who haveis commonly found in patients who have
oesophagitis.oesophagitis.
It is a primary abnormality, since it persistsIt is a primary abnormality, since it persists
after oesophagitis has been healed byafter oesophagitis has been healed by
acid-suppressing drug therapy.acid-suppressing drug therapy.
Poor oesophageal clearance leads toPoor oesophageal clearance leads to
increased acid exposure time.increased acid exposure time.
11. Gastric contents:Gastric contents: Gastric acid isGastric acid is
the most important oesophagealthe most important oesophageal
irritant and there is a closeirritant and there is a close
relationship between acid exposurerelationship between acid exposure
time and symptoms.time and symptoms.
Defective gastric emptying:Defective gastric emptying:
Gastric emptying is delayed inGastric emptying is delayed in
patients with gastro-oesophagealpatients with gastro-oesophageal
reflux disease.reflux disease.
12. Increased intra-abdominal pressure:Increased intra-abdominal pressure:
Pregnancy and obesity are establishedPregnancy and obesity are established
predisposing causes. Weight loss maypredisposing causes. Weight loss may
improve symptoms.improve symptoms.
Dietary and environmental factors:Dietary and environmental factors:
Dietary fat, chocolate, alcohol and coffeeDietary fat, chocolate, alcohol and coffee
relax the lower oesophageal sphincter andrelax the lower oesophageal sphincter and
may provoke symptoms. There is littlemay provoke symptoms. There is little
evidence to incriminate smoking orevidence to incriminate smoking or
NSAIDs as causes of gastro-oesophagealNSAIDs as causes of gastro-oesophageal
reflux disease.reflux disease.
13. Clinical featuresClinical features
The major symptoms areThe major symptoms are heartburnheartburn andand
regurgitationregurgitation, often provoked by bending,, often provoked by bending,
straining or lying down.straining or lying down.
'Waterbrash', which is salivation due to reflex'Waterbrash', which is salivation due to reflex
salivary gland stimulation as acid enters thesalivary gland stimulation as acid enters the
gullet, is often present.gullet, is often present.
A history of weight gain is common.A history of weight gain is common.
Some patients are woken at night by choking asSome patients are woken at night by choking as
refluxed fluid irritates the larynx.refluxed fluid irritates the larynx.
Others develop dysphagia.Others develop dysphagia.
A few present with atypical chest pain whichA few present with atypical chest pain which
may be severe, can mimic angina and ismay be severe, can mimic angina and is
probably due to reflux-induced oesophagealprobably due to reflux-induced oesophageal
spasm.spasm.
14. ComplicationsComplications
1. Oesophagitis1. Oesophagitis
A range of endoscopic findings, from mildA range of endoscopic findings, from mild
redness to severe, bleeding ulcerationredness to severe, bleeding ulceration
with stricture formation, is recognised.with stricture formation, is recognised.
There is a poor correlation betweenThere is a poor correlation between
symptoms and histological andsymptoms and histological and
endoscopic findings.endoscopic findings.
A normal endoscopy and normalA normal endoscopy and normal
oesophageal histology are perfectlyoesophageal histology are perfectly
compatible with significant gastro-compatible with significant gastro-
oesophageal reflux disease.oesophageal reflux disease.
15. Reflux oesophagitisReflux oesophagitis . The gullet is inflamed and. The gullet is inflamed and
ulcerated (small arrows) and there is early stricturing (largeulcerated (small arrows) and there is early stricturing (large
arrow).arrow).
16. 2. Barrett's oesophagus2. Barrett's oesophagus
Barrett's oesophagus ('columnar linedBarrett's oesophagus ('columnar lined
oesophagus'-CLO) is a pre-malignant glandularoesophagus'-CLO) is a pre-malignant glandular
metaplasia of the lower oesophagus, in whichmetaplasia of the lower oesophagus, in which
the normal squamous lining is replaced bythe normal squamous lining is replaced by
columnar mucosa composed of a cellular mosaiccolumnar mucosa composed of a cellular mosaic
containing areas of intestinal metaplasia.containing areas of intestinal metaplasia.
It occurs as an adaptive response to chronicIt occurs as an adaptive response to chronic
gastro-oesophageal reflux and is found in 10%gastro-oesophageal reflux and is found in 10%
of patients undergoing gastroscopy for refluxof patients undergoing gastroscopy for reflux
symptoms.symptoms.
17. CLO principally occurs in Western CaucasianCLO principally occurs in Western Caucasian
males and is rare in other racial groups.males and is rare in other racial groups.
It is the major risk factor for oesophagealIt is the major risk factor for oesophageal
adenocarcinoma, with a lifetime cancer risk ofadenocarcinoma, with a lifetime cancer risk of
around 10%.around 10%.
The prevalence is increasing, and it is moreThe prevalence is increasing, and it is more
common in men (especially white) and thosecommon in men (especially white) and those
over 50 years of age.over 50 years of age.
It is weakly associated with smoking but notIt is weakly associated with smoking but not
alcohol.alcohol.
Recent studies suggest that cancer risk isRecent studies suggest that cancer risk is
related to the severity and duration of refluxrelated to the severity and duration of reflux
rather than the presence of CLO per se but thisrather than the presence of CLO per se but this
remains to be proven.remains to be proven.
DiagnosisDiagnosis requires multiple systematicrequires multiple systematic
biopsies to maximise the chance of detectingbiopsies to maximise the chance of detecting
intestinal metaplasia and/or dysplasia.intestinal metaplasia and/or dysplasia.
18. ManagementManagement
Neither potent acid suppression nor antirefluxNeither potent acid suppression nor antireflux
surgery will stop progression or inducesurgery will stop progression or induce
regression of CLO, and treatment is onlyregression of CLO, and treatment is only
indicated for symptoms of reflux or complicationsindicated for symptoms of reflux or complications
such as stricture.such as stricture.
Endoscopic ablation therapy or photodynamicEndoscopic ablation therapy or photodynamic
therapy can induce regression but 'buriedtherapy can induce regression but 'buried
islands' of glandular mucosa may persistislands' of glandular mucosa may persist
underneath the squamous epithelium andunderneath the squamous epithelium and
cancer risk is not eliminated.cancer risk is not eliminated.
At present these therapies remain experimentalAt present these therapies remain experimental
but show promise; they are used in patients withbut show promise; they are used in patients with
high-grade dysplasia (HGD) or early malignancyhigh-grade dysplasia (HGD) or early malignancy
that is not suitable for surgery.that is not suitable for surgery.
19. Barrett's oesophagusBarrett's oesophagus . Pink columnar mucosa extends up. Pink columnar mucosa extends up
the gullet. Small islands of squamous mucosa remain (arrow).the gullet. Small islands of squamous mucosa remain (arrow).
20. AnaemiaAnaemia
Iron deficiency anaemia occurs as aIron deficiency anaemia occurs as a
consequence of chronic, insidious blood lossconsequence of chronic, insidious blood loss
from long-standing oesophagitis.from long-standing oesophagitis.
Almost all such patients have a large hiatusAlmost all such patients have a large hiatus
hernia.hernia.
Nevertheless, hiatus hernia is very common andNevertheless, hiatus hernia is very common and
other causes of blood loss, particularly colorectalother causes of blood loss, particularly colorectal
cancer, must be considered in anaemic patients,cancer, must be considered in anaemic patients,
even when endoscopy reveals oesophagitis andeven when endoscopy reveals oesophagitis and
a hiatus hernia.a hiatus hernia.
21. Benign oesophageal strictureBenign oesophageal stricture
Fibrous strictures develop as a consequence ofFibrous strictures develop as a consequence of
long-standing oesophagitis.long-standing oesophagitis.
Most patients are elderly and have poorMost patients are elderly and have poor
oesophageal peristaltic activity.oesophageal peristaltic activity.
They present with dysphagia which is worse forThey present with dysphagia which is worse for
solids than for liquids.solids than for liquids.
Bolus obstruction following ingestion of meat canBolus obstruction following ingestion of meat can
lead to absolute dysphagia.lead to absolute dysphagia.
A history of heartburn is common but notA history of heartburn is common but not
invariable; many elderly patients presenting withinvariable; many elderly patients presenting with
strictures have no preceding heartburn.strictures have no preceding heartburn.
22. DiagnosisDiagnosis ofof
benign oesophageal stricturebenign oesophageal stricture
Endoscopy and biopsies of the strictureEndoscopy and biopsies of the stricture
are taken to exclude malignancy.are taken to exclude malignancy.
Endoscopic balloon dilatation orEndoscopic balloon dilatation or
bouginage is undertaken.bouginage is undertaken.
23. ManagementManagement ofof
benign oesophageal stricturebenign oesophageal stricture
Subsequently, long-term therapy with aSubsequently, long-term therapy with a
proton pump inhibitor drug at full doseproton pump inhibitor drug at full dose
should be started to reduce the risk ofshould be started to reduce the risk of
recurrent oesophagitis and stricturerecurrent oesophagitis and stricture
formation.formation.
The patient should be advised to chewThe patient should be advised to chew
food thoroughly, and it is important tofood thoroughly, and it is important to
ensure adequate dentition.ensure adequate dentition.
24. InvestigationsInvestigations
Investigation is advisable if patients present in middle orInvestigation is advisable if patients present in middle or
late age, if symptoms are atypical or if a complication islate age, if symptoms are atypical or if a complication is
suspected.suspected.
Endoscopy is the investigation of choiceEndoscopy is the investigation of choice . This is. This is
performed to exclude other upper gastrointestinalperformed to exclude other upper gastrointestinal
diseases which can mimic gastro-oesophageal reflux,diseases which can mimic gastro-oesophageal reflux,
and to identify complications. A normal endoscopy in aand to identify complications. A normal endoscopy in a
patient with compatible symptoms should not precludepatient with compatible symptoms should not preclude
treatment for gastro-oesophageal reflux disease.treatment for gastro-oesophageal reflux disease.
When, despite endoscopy, the diagnosis is unclear or ifWhen, despite endoscopy, the diagnosis is unclear or if
surgical intervention is under consideration,surgical intervention is under consideration, 24-hour24-hour
pH monitoringpH monitoring is indicated. A pH of less than 4 foris indicated. A pH of less than 4 for
more than 6-7% of the study time is diagnostic of refluxmore than 6-7% of the study time is diagnostic of reflux
disease.disease.
25. ManagementManagement
Lifestyle advice, including:Lifestyle advice, including:
weight loss,weight loss,
avoidance of dietary items which theavoidance of dietary items which the
patient finds worsen symptoms,patient finds worsen symptoms,
elevation of the bed head in those whoelevation of the bed head in those who
experience nocturnal symptoms,experience nocturnal symptoms,
avoidance of late meals,avoidance of late meals,
giving up smoking.giving up smoking.
26. AntacidsAntacids
Antacids widely available for self-Antacids widely available for self-
medication and are used for relief of minormedication and are used for relief of minor
dyspeptic symptoms.dyspeptic symptoms.
Magnesium Trisilicate Mixture 10 – 20 mlMagnesium Trisilicate Mixture 10 – 20 ml
3 – 4 times daily before meals;3 – 4 times daily before meals;
Aluminium Hydroxide 300 mg5 ml LiquidAluminium Hydroxide 300 mg5 ml Liquid
300 – 600 mg as needed between meals300 – 600 mg as needed between meals
and at bedtime or as directed byand at bedtime or as directed by
physician.physician.
27. The majority are based on combinations ofThe majority are based on combinations of
calcium, aluminium and magnesium salts,calcium, aluminium and magnesium salts,
all of which have individual side-effects.all of which have individual side-effects.
Calcium compounds cause constipation,Calcium compounds cause constipation,
Magnesium-containing agents causeMagnesium-containing agents cause
diarrhoea,diarrhoea,
Aluminium compounds block absorption ofAluminium compounds block absorption of
digoxin, tetracycline and dietarydigoxin, tetracycline and dietary
phosphates.phosphates.
Most have a high sodium content and canMost have a high sodium content and can
exacerbate congestive heart failure.exacerbate congestive heart failure.
28. Histamine H2-receptorHistamine H2-receptor
antagonist drugsantagonist drugs ..
Cimetidine 800 mg at bedtime; treatment should beCimetidine 800 mg at bedtime; treatment should be
continued for at least 4 – 8 weeks; maintenance: 400mgcontinued for at least 4 – 8 weeks; maintenance: 400mg
at bedtime;at bedtime;
Ranitidine (Zantac) 150 mg twice a day or 300 mg atRanitidine (Zantac) 150 mg twice a day or 300 mg at
night for 4 – 8 weeks; maintenance: 150 – 300 mg atnight for 4 – 8 weeks; maintenance: 150 – 300 mg at
night;night;
Dyspeptic symptoms remit promptly, usually within daysDyspeptic symptoms remit promptly, usually within days
of starting treatment.of starting treatment.
They are moderately effective for the management ofThey are moderately effective for the management of
reflux disease.reflux disease.
H2-receptor antagonist drugs help symptoms withoutH2-receptor antagonist drugs help symptoms without
healing oesophagitis.healing oesophagitis.
They are well tolerated, and the timing of medication andThey are well tolerated, and the timing of medication and
dosage should be tailored to individual need.dosage should be tailored to individual need.
29. H+/K+ ATPase ('protonH+/K+ ATPase ('proton
pump') inhibitorspump') inhibitors ..
Omeprazole (Losec) 20 – 80 mg once daily or twice dailyOmeprazole (Losec) 20 – 80 mg once daily or twice daily
up to 8 – 12 weeks;up to 8 – 12 weeks;
Lansoprazole (Prevacid) 30 mg once daily or twice dailyLansoprazole (Prevacid) 30 mg once daily or twice daily
for 4 – 8 weeks;for 4 – 8 weeks;
They are the most powerful inhibitors of gastric secretionThey are the most powerful inhibitors of gastric secretion
yet discovered, with maximal inhibition occurring 3-6yet discovered, with maximal inhibition occurring 3-6
hours after an oral dose. They have an excellent safetyhours after an oral dose. They have an excellent safety
profile.profile.
Proton pump inhibitors (omeprazole and lansoprazole)Proton pump inhibitors (omeprazole and lansoprazole)
are also much more effective than H2-antagonists forare also much more effective than H2-antagonists for
healing and maintenance of reflux oesophagitis.healing and maintenance of reflux oesophagitis.
Proton pump inhibitors are the treatment of choice forProton pump inhibitors are the treatment of choice for
severe symptoms and for complicated reflux disease.severe symptoms and for complicated reflux disease.
Recurrence of symptoms is common when therapy isRecurrence of symptoms is common when therapy is
stopped and some patients require life-long treatment atstopped and some patients require life-long treatment at
the lowest acceptable dose.the lowest acceptable dose.
31. Anti-reflux surgeryAnti-reflux surgery
Patients who fail to respond to medical therapy,Patients who fail to respond to medical therapy,
those who are unwilling to take long-term proton pumpthose who are unwilling to take long-term proton pump
inhibitors,inhibitors,
those whose major symptom is severe regurgitationthose whose major symptom is severe regurgitation
should be considered forshould be considered for anti-reflux surgery.anti-reflux surgery.
This can be undertaken by an open operation but isThis can be undertaken by an open operation but is
increasingly being carried out laparoscopically.increasingly being carried out laparoscopically.
Although heartburn and regurgitation are alleviated inAlthough heartburn and regurgitation are alleviated in
most patients, a proportion develop complications suchmost patients, a proportion develop complications such
as inability to vomit and abdominal bloating ('gas-bloatas inability to vomit and abdominal bloating ('gas-bloat
syndrome').syndrome').
32. Issues in older people gastro-Issues in older people gastro-
oesophageal reflux diseaseoesophageal reflux disease
The prevalence of gastro-oesophageal refluxThe prevalence of gastro-oesophageal reflux
disease is higher in older people anddisease is higher in older people and
complications are more common.complications are more common.
The severity of symptoms does not correlateThe severity of symptoms does not correlate
with the degree of mucosal inflammation in oldwith the degree of mucosal inflammation in old
age.age.
Late complications such as peptic strictures orLate complications such as peptic strictures or
bleeding from oesophagitis are more common inbleeding from oesophagitis are more common in
older people.older people.
Aspiration from occult gastro-oesophageal refluxAspiration from occult gastro-oesophageal reflux
disease should be considered in older patientsdisease should be considered in older patients
with recurrent pneumonia.with recurrent pneumonia.
33. GASTRITISGASTRITIS
Gastritis is a histological diagnosis,Gastritis is a histological diagnosis,
although it can sometimes be recognisedalthough it can sometimes be recognised
at endoscopy.at endoscopy.
35. Acute gastritisAcute gastritis
Acute gastritis is often erosive and haemorrhagic.Acute gastritis is often erosive and haemorrhagic.
Neutrophils are the predominant inflammatory cell in theNeutrophils are the predominant inflammatory cell in the
superficial epithelium.superficial epithelium.
Acute gastritis often produces no symptoms but mayAcute gastritis often produces no symptoms but may
cause dyspepsia, anorexia, nausea or vomiting,cause dyspepsia, anorexia, nausea or vomiting,
haematemesis or melaena.haematemesis or melaena.
Many cases resolve quickly and do not meritMany cases resolve quickly and do not merit
investigation; in others, endoscopy and biopsy may beinvestigation; in others, endoscopy and biopsy may be
necessary to exclude peptic ulcer or cancer.necessary to exclude peptic ulcer or cancer.
Treatment should be directed to the underlying cause.Treatment should be directed to the underlying cause.
Short-term symptomatic therapy with antacids, acidShort-term symptomatic therapy with antacids, acid
suppression (e.g. H2-receptor antagonists) orsuppression (e.g. H2-receptor antagonists) or
antiemetics (e.g. metoclopramide 10 mg 3 times a day)antiemetics (e.g. metoclopramide 10 mg 3 times a day)
may be necessary.may be necessary.
36. Chronic gastritis due toChronic gastritis due to
Helicobacter pylory infectionHelicobacter pylory infection
The predominant inflammatory cells areThe predominant inflammatory cells are
lymphocytes and plasma cells.lymphocytes and plasma cells.
Correlation between symptoms and endoscopicCorrelation between symptoms and endoscopic
or pathological findings is poor.or pathological findings is poor.
Most patients are asymptomatic and do notMost patients are asymptomatic and do not
require any treatment.require any treatment.
Patients with dyspepsia and H. pylori-associatedPatients with dyspepsia and H. pylori-associated
gastritis may benefit from H. pylori eradication.gastritis may benefit from H. pylori eradication.
37. Autoimmune chronic gastritisAutoimmune chronic gastritis
This involves the body of the stomach, spares the antrumThis involves the body of the stomach, spares the antrum
and results from autoimmune activity against parietal cells.and results from autoimmune activity against parietal cells.
The histological features are diffuse chronic inflammation,The histological features are diffuse chronic inflammation,
atrophy and loss of fundic glands, intestinal metaplasia andatrophy and loss of fundic glands, intestinal metaplasia and
sometimes hyperplasia of enterochromaffin-like (ECL)sometimes hyperplasia of enterochromaffin-like (ECL)
cells.cells.
Circulating antibodies to parietal cell and intrinsic factorCirculating antibodies to parietal cell and intrinsic factor
may be present.may be present.
In some patients the degree of gastric atrophy is severe,In some patients the degree of gastric atrophy is severe,
and loss of intrinsic factor secretion leads to perniciousand loss of intrinsic factor secretion leads to pernicious
anaemia.anaemia.
The gastritis itself is usually asymptomatic but someThe gastritis itself is usually asymptomatic but some
patients have evidence of other organ-specificpatients have evidence of other organ-specific
autoimmunity, particularly thyroid disease.autoimmunity, particularly thyroid disease.
There is a fourfold increase in the risk of gastric cancerThere is a fourfold increase in the risk of gastric cancer
development.development.
38. Menetrie`s diseaseMenetrie`s disease
In this rare condition the gastric pits are elongated andIn this rare condition the gastric pits are elongated and
tortuous, with replacement of the parietal and chief cellstortuous, with replacement of the parietal and chief cells
by mucus-secreting cells. As a result, the mucosal foldsby mucus-secreting cells. As a result, the mucosal folds
of the body and fundus are greatly enlarged.of the body and fundus are greatly enlarged.
Most patients are hypochlorhydric.Most patients are hypochlorhydric.
Whilst some patients have upper gastro-intestinalWhilst some patients have upper gastro-intestinal
symptoms, the majority present in middle or old age withsymptoms, the majority present in middle or old age with
protein-losing enteropathy due to exudation from theprotein-losing enteropathy due to exudation from the
gastric mucosa.gastric mucosa.
Barium meal shows enlarged, nodular and coarse foldsBarium meal shows enlarged, nodular and coarse folds
which are also seen at endoscopy.which are also seen at endoscopy.
Treatment with anti-secretory drugs may reduce proteinTreatment with anti-secretory drugs may reduce protein
loss but unresponsive patients require partialloss but unresponsive patients require partial
gastrectomy.gastrectomy.