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Nausea and vomitingFunctional and organic diseases of esophagus and stomach in children Question: what is gastroesophageal reflux disease (GERD)? It is the backward movement of gastric content across the lower esophageal sphincter (LES) into the esophagus. Question: what are the risk factors of GERD? ü prolonged gastric emptying (persistent constipation) ü obesity ü pregnancy ü hiatal hernia ü trauma ü transient LES relaxation - nocturnal, postprandial question: what is the pathophysiology of GERD? 1. Dysfunction of the lower esophageal sphincter 2. Reflux of gastric content into esophagus leads to esophagitis and other postinflammatory conditions of intestinal and respiratory mucosa Question: name the signs and symptoms of GERD? 1. Heartburns: retrosternal burning pain, may start in abdomen and extend up into the neck 2. regurgitation - appearance of refluxed liquid in the oral cavity Globus syndrome 4. respiratory symptoms –atypical symptoms connected to asthma, hoarseness, hiccough nausea and vomiting Question: what is the criterion of diagnosis of GERD? 1. History 2. Endoscopy (esophagogastroscopy) 3. 24 hours pH monitoring of esophagus 4. Barium meal swallow 5. X-ray 6. Manometry of LES Question: what is the principle of treatment of GERD? ü proton pump inhibitors (omeprazol) ü H2 antagonists (ranitidine) ü Antacids (aluminium hydroxide) ü Positioning measures are particularly important for infants, who cannot control their positions independently ü surgical and endocsopic procedures Question: what is the complication of GERD?
a. dysplasia b. adenocarcinoma
Question: what is chronic gastritis? It is a prolonged inflammation of the stomach Question: what is the classification of gastritis?
i. Autoimmune gastritis/ type A gastritis ii. Bacterial gastritis (H. pylori)/type B gastritis iii. Chemical gastritis (bile reflux, NSAIDs)/type C
Question: what is gastroduodenitis? It is the inflammation of the stomach and the duodenum Question: what is the classification of gastroduodenitis?
i. Acute ii. chronic
i. Granulomatous ii. eosinophilous
i. Autoimmune ii. Bacteria (H. pylori) iii. Chemical ( bile reflux, NSAIDs) iv. Reactive v. idiopathic
i. Antral ii. Fundal iii. Pangastritis iv. Duodenitis
i. Superficial ii. Erosive iii. Hemorrhagic iv. Atrophic and v. Hyperplasic
i. Superficial ii. Without atrophy of glands iii. With atrophy of glands iv. Atrophic v. Intestinal metaplasia
i. normal ii. Increased iii. decreased
i. Exacerbation ii. Nonful clinical remission iii. Full clinical remission iv. Clinical, endoscopic morphological remission v. Mild vi. Moderate vii. Severe Question: what is peptic ulcer disease (PUD)? It is the ulceration of the GIT lining especially the stomach and duodenum
Question: what is the etiology of PUD? 1. Helicobacter pylori 2. NSAIDs (aspirin, ibuprofen, etc.) 3. Heredity 4. Smoking 5. Association with other diseases or known factors (COPD, cor pulmonale, cirrhosis, chronic renal failure) 6. Stress 7. Alcohol abuse Question: what is the pathogenesis of PUD? An ulcer forms when there is an imbalance between - Aggressive factors (e.g. hydrochloric acid and pepsin) and - Defense factors (mucus, good blood supply, tight-junctions of mucosa)
1. Helicobacter pylori infection 2. Colonization of gastric mucous 3. Urease àammonia àneutralization of acid à Rebound acid production. 4. Protease – Mucous break down. 5. Weak mucosal resistance 6. Acid & Pepsin digestion of mucosa 7. Chronic Ulceration Question: what is the classification of PUD? I. according to phase of disease: -Acute -Uncomplete remission -Remission II. according to course of disease: -mild -moderate - Severe. III. according to localization: -stomach -duodenum -stomach + duodenum -gastroenteroanostomosis IV. according to Association with Helicobacter pylori: - H. pylori – associated - H. pylori – not associated V. Complications -Hemorrhage -Perforation -Penetration -Pyloristenosis -Malignancy Question: name the signs and symptoms of PUD 1. The typical pain-food-relief syndrome. 2. Chronic abdominal pain, especially when the stomach is empty, during the night or early morning. 3. Recurrent vomiting after meals. 4. Chronic anemia with occult blood in the stools 5. Heartburns 6. Constipation or diarrhea Question: what is the difference between gastric and duodenal ulcers?
Question: what is the plan of investigation of PUD?
3. Urinalysis, Diastase of urine
5. Hidden blood in feces
8. Diagnosis of HP infection
11. pH-metry Question: what is the treatment of PUD?
- proton pump inhibitors - h2 receptor antagonists - antacids (almagel, maalox)
Date: 2015-12-11; view: 1205
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