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Nausea and vomiting

Functional 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?

  1. chronic esophagitis àerosive changes
  2. strictures àDYSPHAGIA
  3. Barret’s esopgagus

a. dysplasia

b. adenocarcinoma

 

Question: what is chronic gastritis?

It is a prolonged inflammation of the stomach

Question: what is the classification of gastritis?

  1. According to etiology

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?

  1. According to clinical form

i. Acute

ii. chronic

  1. According to special features

i. Granulomatous

ii. eosinophilous

  1. According to etiology

i. Autoimmune

ii. Bacteria (H. pylori)

iii. Chemical ( bile reflux, NSAIDs)

iv. Reactive

v. idiopathic

  1. According to localization

i. Antral

ii. Fundal

iii. Pangastritis

iv. Duodenitis

  1. According to endoscopic findings

i. Superficial

ii. Erosive

iii. Hemorrhagic

iv. Atrophic and

v. Hyperplasic

  1. According to histology

i. Superficial

ii. Without atrophy of glands

iii. With atrophy of glands

iv. Atrophic

v. Intestinal metaplasia

  1. According to secretion

i. normal

ii. Increased

iii. decreased

  1. According to periods

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?

Gastric ulcer Duodenal ulcer
  1. Pain starts during eating or 30 mins after eating
  2. Coffee color vomitus
  3. Most common cause is NSAIDs use, bile reflux and H. pylori
  4. It may be malignant
  5. Less common than duodenal ulcer
Pain starts 2-3hours after eating , and usually at night
  1. Melena stools
  2. Risk factors are smoking , NSAIDs, COPD, cirrhosis
  3. It mostly occurs in the first part of duodenum, 50% are on anterior wall
  4. More common 4 times than gastric ulcers

 

Question: what is the plan of investigation of PUD?


  1. Total blood count
  2. Biochemical analysis

3. Urinalysis, Diastase of urine

  1. Coprogram

5. Hidden blood in feces

  1. ECG
  2. Endoscopy+biopsy+ Histology

8. Diagnosis of HP infection

  1. X-ray
  2. USD

11. pH-metry


Question: what is the treatment of PUD?

  1. antibiotics (clarithromycin, amoxycillin)
  2. antisecretory drugs:

- proton pump inhibitors

- h2 receptor antagonists

- antacids (almagel, maalox)

  1. gastrocytoprotectors
  2. drugs, which improve motor function of stomach (cerucal, motilium, eglonil); spasmolytics

Date: 2015-12-11; view: 562


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