Diffuse Esophageal Spasm

-(dysphagia + intermittent chest pain) / the pain can simulate that of MI

-Diagnosis :

.barium studies may show a “corkscrew”

-Treatment :

.calcium-channel blockers (nifedipine,nitrates)

Esophaitis

-Infection or inflammation of the esophagus

-M.C. infection is from Candida albicans

Gastroesophageal Reflix Disease GERD

-Is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus

-Associated with smoking,alcohol,hiatus hernia,pregnancy,obesity,surgery in achalasia,drugs(tricyclis)

-GERD is usually caused by :

.changes in the barrier between the stomach and the esophagus

.abnormal relaxation of the lower esophageal sphincter

-Symptoms & Signs :

.dyspepsia

.epigastric pain

.ulcer disease

.pancreatitis

.gastritis

.sore throat

.hoarseness

.heartborn

.odynophagia

.GERD associated with pain in the substernal area

-Diagnosis :

.pH monitor

-Treatment :

.PPIs (proton-pimp inhibitors)

.omeprazole,osemeprazole,lansoprazole will all reliably increase th PH of gastric contents

.H2 blockers (should only be ysed in Pt has very mild,intermittent symptoms)

-Complications of gastroesophageal reflux :

.anemia (iron def.)

.aspiration

.barrett's esophagus

.motility disturbances

.benihn stricture

.oesoph. Carcinoma

Barrett Esophagus

-Is a complication of long standing reflux disease.After several years of GERD.the epithelium of the lower esophagus undergoes histologic change from a normal squamous epithelium to a columnar epithelium

-Symptoms & Signs :

.heartburn

.trouble swallowing (dysphagia)

.vomiting blood (hematemesis)

.pain under the sternum where the esophagus meets the stomach

.unintentional weight loss because eating is painful

-Diagnosis :

.endoscopy (Pt with barrett syndrome should have a repeat endoscopy every 2-3yrs to see whether dysplasia or esophageal cancer)

.Esophagectomy is warranted if high grade dysplasia is found

-Treatment :

.PPIs

.Operative therapy prevents further progression of the disease

Plummer–Vinson syndrome

-Is a rare disease characterized by difficulty in swallowing, iron deficiency anemia, and esophageal webs

-Treatment :

.with iron supplementation

.mechanical widening of the esophagus

-Symptoms & Signs :

.dysphagia (difficulty in swallowing)

.pain

.weakness

.odynophagia (painful swallowing)

.atrophic glossitis

.angular stomatitis

.post-cricoid web

.iron def.

Gastiritis

-Inflammation,erosion or damage of the gastritic lining that has not developed into an ulcer

-Gastrin is produced primarily in the Pylorus

-Types :

*type A

.gastritis from atrophy of the gastric mucosa and is associated with autoimmune processes,such as Vit B12 deficiency

.also linked to diminished gastric acid production and achlorhydria,and it is lead to gastric cancer

+Alchlorhydria (production of hydrochloric acid in gastric secretions of the stomach and other digestive organs is absent or low)

+Hypochlorhydria is caused by :

.carcinoma of stomach

.pregnancy

.pernicious anemia

.atrophic gastritis

*type B

.M.C type of gastritis.It is also associated with increased gastric acid production

-Causes :

.H.pylori

.alcohol

.NSAIDs

-Symtoms & Signs :

.nausea

.vomiting (if present, may be clear, green or yellow, blood-streaked, or completely bloody, depending on the severity of the stomach inflammation)

.belching (if present, usually does not relieve the pain much)

.bloating

.early satiety

.loss of appetite

.unexplained weight loss

.bleeding (hematemesis or melena)

-Diagnosis :

.Presence of H. pylori

.endoscopy (BEST)

.blood cell count

.stool sample (to look for blood in stole)

-Treatment :

.PPIs

.H2 blockers

.antibiotics

Date: 2016-04-22; view: 527