Gastroesophageal reflux Gastroesophageal reflux disease [GERD] disease [GERD]

Underlying causesUnderlying causes Incompetent lower esophageal sphincterIncompetent lower esophageal sphincter ObesityObesity Hiatial herniaHiatial hernia Pregnancy Pregnancy Decreased motilityDecreased motility Delayed gastric emptyingDelayed gastric emptying

Signs and SymptomsSigns and SymptomsPostprandial epigastric [chest] burning worse in Postprandial epigastric [chest] burning worse in

supine position, cough, hoarse voice, regurgitation supine position, cough, hoarse voice, regurgitation

It is a clinical diagnosisIt is a clinical diagnosis

GERDGERD

TreatmentTreatmentFirst line- lifestyle modificationsFirst line- lifestyle modifications

Weight lossWeight loss Avoidance of instigating foods such as caffeine, fatty foodsAvoidance of instigating foods such as caffeine, fatty foods Avoid eating right before going to sleepAvoid eating right before going to sleep

Second lineSecond line H2 blockers--CimetidineH2 blockers--Cimetidine

Third lineThird line If H2 blockers fail, try Proton Pump Inhibits--OmeprazoleIf H2 blockers fail, try Proton Pump Inhibits--Omeprazole

Last ResortLast Resort Nissen fundoplicationNissen fundoplication

Pelvic Inflammatory Disease Pelvic Inflammatory Disease

An infectious and inflammatory disorder of the upper An infectious and inflammatory disorder of the upper female genital tract, including:female genital tract, including: UterusUterus Fallopian tubesFallopian tubes Adjacent pelvic structures. Adjacent pelvic structures. Infection and inflammation may spread to the abdomenInfection and inflammation may spread to the abdomen

The diagnosis of acute pelvic inflammatory disease The diagnosis of acute pelvic inflammatory disease (PID) is primarily based on historical (PID) is primarily based on historical and clinical and clinical findingfinding

Pelvic Inflammatory Pelvic Inflammatory DiseaseDisease

Centers for Disease Control and Prevention (CDC) has Centers for Disease Control and Prevention (CDC) has established minimal criteria for the diagnosis of PID.established minimal criteria for the diagnosis of PID.

According to these criteria, empiric treatment of PID is According to these criteria, empiric treatment of PID is indicated when a patient who is at risk for sexually indicated when a patient who is at risk for sexually transmitted disease has pelvic or lower abdominal pain, transmitted disease has pelvic or lower abdominal pain, no identifiable cause for her illness other than PID, and, no identifiable cause for her illness other than PID, and, on pelvic examination, 1 or more of the following on pelvic examination, 1 or more of the following minimal criteriaminimal criteria Cervical motion tendernessCervical motion tenderness Uterine tendernessUterine tenderness Adnexal tendernessAdnexal tenderness

Gastritis Gastritis

Inflammation of the gastric mucosa Inflammation of the gastric mucosa

Types of Gastritis Types of Gastritis Type AType A

Most likely found in the fundusMost likely found in the fundus Associated with autoimmune causes, achlorhydria, Associated with autoimmune causes, achlorhydria,

pernicious anemia.pernicious anemia.

Type BType B Most likely found in the antrum of the stomach Most likely found in the antrum of the stomach Most common cause is nonsteroidal anti-infalmatory drug Most common cause is nonsteroidal anti-infalmatory drug

[NSAID] use [NSAID] use Can be caused by H. pylori infectionCan be caused by H. pylori infection Associated with risk for peptic ulcer disease and gastric Associated with risk for peptic ulcer disease and gastric

cancer cancer

Gastric Mucosa and Gastric Mucosa and Stomach Stomach

Gastritis Gastritis

Signs and Symptoms Signs and Symptoms May be asymptomatic May be asymptomatic Epigastric painEpigastric painWeight lossWeight lossNausea Nausea VomitingVomitingHematemesis Hematemesis Coffee ground EmesisCoffee ground Emesis

Gastritis Gastritis

How is it Diagnosed?How is it Diagnosed? EndoscopyEndoscopy

Treatment depends on EtiologyTreatment depends on Etiology If H. pylori If H. pylori

Triple therapy: PPI, 2 antibiotics [Clarithromycin + Triple therapy: PPI, 2 antibiotics [Clarithromycin + Amoxicillin/Metronidazole], and Bismuth [Pepto Bistmol] Amoxicillin/Metronidazole], and Bismuth [Pepto Bistmol]

If caused by NSAID useIf caused by NSAID use Discontinue NSAID useDiscontinue NSAID use Start sucralfate, PPI, or H2 blockerStart sucralfate, PPI, or H2 blocker

If caused by post-procedure, hospitalization stressIf caused by post-procedure, hospitalization stress IV H2 BlockerIV H2 Blocker

If caused by pernicious anemiaIf caused by pernicious anemia Vitamin B12 treatmentVitamin B12 treatment

Colitis Colitis

Inflammation of the inner lining of the colon. Inflammation of the inner lining of the colon.

It may cause abdominal pain, bloating, and diarrhea It may cause abdominal pain, bloating, and diarrhea with or without blood.with or without blood.

May be due toMay be due to Loss of blood supply to the colonLoss of blood supply to the colon

Ischemic Ischemic Inflammatory Bowel DiseaseInflammatory Bowel Disease

Ulcerative ColitisUlcerative Colitis Chrohn’s DiseaseChrohn’s Disease

Invasion of the colon wall with lymphocytic white blood Invasion of the colon wall with lymphocytic white blood cells or collagencells or collagen

Peptic Ulcer Disease Peptic Ulcer Disease

A lesion in the lining (mucosa) of the digestive tract caused by A lesion in the lining (mucosa) of the digestive tract caused by the digestive action of pepsin and stomach acidthe digestive action of pepsin and stomach acid Duodenal Ulcer—twice as commonDuodenal Ulcer—twice as common

Due to increased acid productionDue to increased acid production Signs and symptomsSigns and symptoms

Burning epigastric pain that is usually 2-3 hours postprandiallyBurning epigastric pain that is usually 2-3 hours postprandially Relieved by food or antacidsRelieved by food or antacids Pain may radiate to the backPain may radiate to the back Pain awakens patient at nightPain awakens patient at night Nausea and sometimes vomitinNausea and sometimes vomitin Hematemesis/Melena if patient has a GI bleedHematemesis/Melena if patient has a GI bleed

Gastric UlcerGastric Ulcer Due to decreased mucosal protection Due to decreased mucosal protection Signs and SymptomsSigns and Symptoms

Same as duodenal ulcers except pain is greater with meals, patients Same as duodenal ulcers except pain is greater with meals, patients often lose weightoften lose weight

Peptic Ulcer DiseasePeptic Ulcer Disease

Tests for suspected peptic UlcerTests for suspected peptic UlcerCBC to make sure patient is not anemicCBC to make sure patient is not anemicUpper GI endoscopy or upper GI seriesUpper GI endoscopy or upper GI seriesH pylori screeningH pylori screening

If Gastric ulcerIf Gastric ulcerMust rule out malignancy by doing biopsy Must rule out malignancy by doing biopsy

of ulcerated region during endoscopy of ulcerated region during endoscopy

Peptic Ulcer DiseasePeptic Ulcer Disease

2 most common causes of Peptic Ulcer Disease2 most common causes of Peptic Ulcer DiseaseH pylori infection H pylori infection Frequent NSAID useFrequent NSAID use

Risk factors for peptic ulcerRisk factors for peptic ulcerSmoking, significant alcohol use, frequent NSAID Smoking, significant alcohol use, frequent NSAID

use, significant physiologic stress [surgery, use, significant physiologic stress [surgery, trauma, and burns]trauma, and burns]

Hypersecretory states Hypersecretory states Zollinger-Ellison syndromZollinger-Ellison syndrom Multiple Endocrine Neoplasia Type I [MEN 1] Multiple Endocrine Neoplasia Type I [MEN 1] Antral G-cell hyperplasia Antral G-cell hyperplasia

Peptic Ulcer Disease Peptic Ulcer Disease

Treatment of Peptic ulcersTreatment of Peptic ulcers Avoidance of instigating factors—smoking and NSAIDsAvoidance of instigating factors—smoking and NSAIDs H2 blockers or PPIsH2 blockers or PPIs Mucosal protectors such as bismuth Mucosal protectors such as bismuth Antibiotics if H pylori infection Antibiotics if H pylori infection TRIPLE therapy TRIPLE therapy

Complications of Peptic Ulcer DiseaseComplications of Peptic Ulcer Disease HemorrhageHemorrhage ObstructionObstruction PerforationPerforation

Perofrated Dudodgenal Ulcer—severe epigastric pain that radiates to Perofrated Dudodgenal Ulcer—severe epigastric pain that radiates to the back the back

If suspected must do Abdominal series of Upper GI series with If suspected must do Abdominal series of Upper GI series with contrast [NO BARIUM] contrast [NO BARIUM] Free air under diaphragm would be seen Free air under diaphragm would be seen

Penetration causing Acute Pancreatitis Penetration causing Acute Pancreatitis

Helicobacter pylori Helicobacter pylori infectioninfection Infection occurs when a type of bacteria called Infection occurs when a type of bacteria called

Helicobacter pylori (H. pylori) infects your stomach,Helicobacter pylori (H. pylori) infects your stomach,H pylori causes:H pylori causes:

90% of duodenal ulcers90% of duodenal ulcers 70% of gastric ulcers70% of gastric ulcers

Signs or symptoms do occur with H. pylori infection, Signs or symptoms do occur with H. pylori infection, they may include:they may include: An ache or burning pain in your abdomenAn ache or burning pain in your abdomen NauseaNausea VomitingVomiting Frequent burpingFrequent burping BloatingBloating Weight lossWeight loss

Helicobacter pylori Helicobacter pylori infectioninfection

Tests and Diagnosis Tests and Diagnosis Stool H pylori antigenStool H pylori antigen Urea breath testUrea breath test Serum Immunoglobulin testSerum Immunoglobulin test H pylori blood test—does not indicated ACTIVE INFECTION. H pylori blood test—does not indicated ACTIVE INFECTION.

Will be + even if the patient was infected in the past and is Will be + even if the patient was infected in the past and is not currently infected.not currently infected.

LOW sensitivityLOW sensitivity

EndoscopyEndoscopy