Summary about bowel GERD including Hx, examinations, ddx & Tx

1. Gastroesophageal flux
DiseaseRessoph. causing irritation to the masae
Etiology:-
->
Gastroesophageal Junction Dysfunction - ↑ Frequency of
transient
LES Relaxations
"
TLESR,"(Caffeine And Nitroglycerin)
LanatomiC Abnormalities of
of Junction Chiatal hernia And tumors)
- >
Impaired Esoph. Acid Clearance -
Normally, Acid Reflex is neutralized by
salivary bi-carbonate and back to
Lstomach via Esoph.
O
peristalsis
↓
pearance,canbedisrupted
by reduced Salination (smokings
andare
S
Risk factors-
is
*
smoking, caffeine And
Alcohol
A
1 - 6 LES tone 1- 6 LES tone
x
stress -- A
gastric Acid 2- ↑ gastric Acid
x
obesity ↑ Abdominal Pressures
* Pregnancy ↑ Abdominal Pressure
-I
-
Lo LES fone 4 Progesterone And 4 Estrogen
*Angle of
his 6: normal 50-60
X
Sclero-derma
x
sliding hiatal hernia
*
Asthma B2 Agonists
Clinical features:
*
Typical symptoms - Retrosternal Pain (heartburn)
↓
Regurgitation
- _
° Dysphagia
L water brash, excessive salivations
*
Atypical symptoms
-
Pressure sensation in the chest
↓
Belching
-
DYSPCPSia "Discomfort"
L Nause a
-
↳
Aspiration Pheumonia
*
Extra-Esoph. symptoms - chronic non-productive cough
I Hoarseness Husky voice"
- Dental Erosion

2. Aggravating factors: -
~ Ling Down shortly After meals
* certain foods/beverages
Red flags
8 Anemia And/or GS Bleeding"
hematemesis, hematochezia
"
0 weight loss
o vomiting *
Male
·Presence of 71 Risk for Barrett esoph.
*rees, soy
~ obe se
* SYMP1oms>5Y
*
European Decent
Diagnosis:-
- There is no gold standard test
for the Dx of
GERD.
- If Patient with chest pain -> ECG + Cardiac Enzyme "troPonin" ->
Normal
- Patient with suspecte GERD Without
Red flags or high Risk of
Barrett Esoph. Start with once-Daily
PPI
for 8
*
If
relief
symptoms of
GERD -
can stop PPI
* If Persist
symptoms or Recur After stop PPI
or Red flags or High Risk for Barrett
ESOPL. ->
E6D
A
esoau. Monitoring
*
If Erosive will see by
↳ measure so. PH over
24-48 h using telemetry
capsule catheter
- PH ->
Abnormal "Nor-crosise Reflux Disease"
I
X
treat by PPI
for 8 W
- With Normal EGD And PH treat
by Low Dose PPI
or H2 Antagonists
-I

3. ↑
reatment :-
*
Initial with lifestyle changes And Acid suppression therapy ppy, Hz Antagonist.
*
Surgical therapy"
is not Routinely indicated"(fundoplication() 18: Dor fundo.
!27 Toupet
fundo.
360 complete fund.
"Nissen fundoplication"
complication..
B arrett Esophages "Intestinal metaplasia of
the ESOPL. mucosa
IDA -
mucosal erosion and ulceration - Chronic Bleeding-
Anemia
Esophageal stricture
=
SoPhageal Ring "Schatzki Rings"
Aspiration pneumonia
Reflux
laryngitis Hoarsenesss)
*
St
-