SOEPEL – 5 GASTRO-OESOPHAGEAL REFLUX DISSESE

AHMAD MHD ALDHLAWIY

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CONTENTS …

SOEPEL

DEFINITION

LOCATION

CLINICAL FEATURES

CAUSES

INVESTIGATION

MANEGEMENT

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SOEPEL …

Subject:

A 35 year old patient admitted to the hospital cause of excessive vomiting.

History:

the patient complain with abdominal pain, excessive vomiting, and loss of weight.

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SOEPEL …

Pain analysis:

1. Site: epigastric.

2. Onset: episodic.

3. Character: burning.

4. Associated factors: --

5. Time/duration: 4 months.

6. Exaggerated factors: after eating.

7. relieving factors: medication.

8. Severity: moderate

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SOEPEL …

Object: General examination & Abdominal examination.

Evaluation (DD): achalasia, hiatal hernia.

Plan: Endoscopy.

Elaboration: change lifestyle.

Learning goals: GERD.

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DEFINITION …

highly variable chronic condition that is characterized by periodic episodes of gastroesophageal reflux usually accompanied by heartburn and that may result in histopathologic changes in the esophagus.

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LOCATION …

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CLINICAL FEATURES …

HEART BURN: It is a major feuters, aggrevated by bending, stopping or laying down which promote acid exposure. The complain of pain well be during drinking hot liquid or alcohol.

REGURGITATION: Food and acid into the mouth occurs particular on bending or layig flat.

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CAUSES …

Obesity. Pregnancy. Certain medications, such as asthma medications, calcium channel blockers, and many antihistamines, pain killers, sedatives, and antidepressants.

Smoking, or inhaling secondhand smoke.

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INVESTIGATION …

Assess oesophagitis and hiatal hernia by endoscopy:If there is oesophagitis or Barrett’s oesophagus, reflux is confirmed.

Document reflux by intraluminal monitoring:

24-hour intraluminal pH monitoring or impedance combined with manometry is helpful if there is no response to PPI and should always be performed to confirm reflux before surgery.

INVESTIGATION …

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MANAGEMENT …

Change Lifestyle:

losing weight, if needed

wearing loose-fitting clothing around the stomach area.

remaining upright for 3 hours after meals.

raising the head of the bed 6 to 8 inches by securing wood blocks under the bedposts––just using extra pillows will not help.

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MANAGEMENT … Medication:

Alginate-containing antacids: (10 mL three times daily), if it contain magnesium antacid it will cause to diarrehea, or if it contain aluminum it will cause to concitipation.

The dopamine antagonist prokinetic agents : they enhance peristalsis and speed gastric emptying.

H2-receptor antagonists: used for acid suppression if antacids fail as they can often be obtained over the counter.

Proton pump inhibitors: inhibit gastric hydrogen/potassium-ATPase. PPIs reduce gastric acid secretion by up to 90% and are the drugs of choice for allbut mild cases.

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MANAGEMENT …

Surgery: Fundoplication.

Endoscopic  techniques.

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REFERENCES …

Kumar and clark’s 8th edition. Oxforf clinical medicine.