Gastroenterology

Chronic reflux of stomach contents into esophagus

Multifactorial Px:

• Lower esophageal sphincter dysfunction

• impaired esophageal motility

• increased gastric acid exposure

Classical symptoms:

• postprandial retrosternal burning

• regurgitation (acid content reaches mouth or throat)

Others: dysphagia, chest pain, globus sensation, extraesophageal symptoms

Cx + upper endoscopy

Predominant symptoms: postprandial fullness, early satiety, bloating, epigastric pain

Occasional: nausea, vomiting, hearburn

• rome criteria

• upper endoscopy

• labs

• H. pylori test + treat

  • stool antigen or urea breath test

  • clarithromycin + amoxicillin + PPI

• PPI

• Lifestyle and dietary changes (low FODMAP diet)

inflammation of the gastric mucosa associated with injury

• infections: H pylori usually

• immune mediated: autoimmune gastritis

• other: NSAIDS, alcohol, bile reflux,

OLGA/OLGIM Stating

OLGA: gastric histological atrophy

OLGIM: intestinal metaplasia

higher state = higher risk of gastric cancer

• PPI

• Eradicate H pylori

  • clarithromycin + amoxicillin + PPI

Stop NSAIDS, alcohol etc…

mucosal defect in the stomach or duodenum that penetrates through the mucosa muscularis

H pylori

nsaids or aspirin

stress

smoking or alcohol

Mostly asymptomatic

epigastric pain

• gastric ulcer: pain is worse with food

• duodenal ulcer: pain happens 2-5H after meal

chronic functional gastrointestinal disease

recurrent abdominal pain + altered bowel habits

• CBC

• Fecal calprotectin + lactoferrin (excluse IBD)

• infectious causes

• Alarm features? colonoscopy and biopsy

Progressive inflammatory disease of the pancreas

• permanent structural damage

• impaired exocrine and endocrine functions

• chronic abdominal pain and potential conplications

Abdominal pain: after meals. may become constant over time

Exocrine insuficiency: steatorrhea, weightloss, bloating…

Endocrine insufficiency: pancreatogenic diabetes (type 3c)

Non modifiable foctors: female, age>40yo, family history

Modifiable:

obesity or rapid weight loss

high fat low fiber diet

DM, metabolic syndrome

dyslipidemia

pregnancy

• asymptomatic

• billirary colic (RUQ pain post postprandial, intense dull and constant pain, may radiate to right scapula, vomiting nausea diaphoresis

• WHO analgesic ladder + low fat diet

• Cholelithiasis: stone in gall bladder

• Choledocholithiasis: stone in common bile duct

• Cholecystitis: inflammation of gallbladder

• Cholangitis: inflammation of the common bile duct

long-standing inflammation of gallbladder

• repeated episodes of acute or subacute cholecystitis

• persistent mechanical irritation from gallstones

• intermittent obstruction of cystic duct or bile ducts

asymptomatic

recurrent biliary colic

bloating nausea malasportion

Fat soluble vitamin deficiencies (ADEK)

Anamnesis (recurrent biliary colic)

Labs: elevated ALP, GGT, ALT, AST; CRP, leukoctyes

Imaging:

• US: procelain gallblader, fibrosis, shrunken, thick walls

• Do CT/MRI to rule out other Ex of pain

• MRCP or ERCP to evaluate ducts

Elective laparoscopic cholecystectomy

Conservative treatment if surgery is CI:

• IV ampicillin-sulbactam