Orientation

Friday, 20 January 2023 2:51 PM

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GERD
Saturday, 21 January 2023 10:44 AM

Ingestion problem

Upper GI - mouth to stomach

Lower GI - intestines

- GERD
○ Known as heartburn
○ Backflow of gastric and/or duodenal contents into the esophagus and
past the lower esophageal sphincter (LES), w/out belching or vomiting
○ Reflux may cause symptoms or pathologic changes
▪ Pain

Inflammation cardinal sign

○ Rubor "redness"
○ Tumour "swelling"
○ Calor "heat, body extremities"
○ Dolor "pain & loss of function"

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- Mucus - protects stomach
○ Repetitive reflux causes irritation to the esophageal lining.
- Irritated - constrict - wbc -
- Thin out intima = third shift = extracellular - edema
- Edema - prostaglandin

• Inflammation -
• -itis means inflammation

- PATHOPYSIOLOGY

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- Full stomach - pressure is greater to than to close sphincter

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- Food
- Alcohol'
- These agents causes relax the muscles.

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- Esophageal stricture - stricture means like putting straw in flame

○ Is not contracting or moving
○ No motility
- Eso. Ulcer
○ Fistula - tunnelling or pagbutang sa surrounding tissues
- Barrett's esophagus
○ Columnar epithelium grows in the gastroesophageal junction

- Irritation causes minor bleeding.

- Reflux - causes irritation - causes inflammation - thinning intima - third
shifting - low grade bleeding

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- Dyspepsia - hindi natunawan.
- Dysphagia - difficulty swallowing

- Reflux -acid - dental enamel loss

- Odynophagia - pain in swallowing.

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- Pyrosis - GERD

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- Mix/dilute hydrochloric acid and saline

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- Colas - carbon dioxide

- Tomato products has content that is irritants, also has acids.
- Smoke - constrict blood vessels
- Alcohol - relaxes muscles
○ Irritants to the stomach lining
○ Decreases the LES pressure
- Milk will be converted to lactic acid causes increase to acid

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○ KREMIL S

○ PPI can destroy kidneys

○ Once a day to prevent adverse effects

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- High fiber - constipation

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Hiatal Hernia
Friday, 27 January 2023 2:54 PM

- Ingestion problem
○ Mouth to the stomach

- Normal anatomy - below the diaphragm

- Hiatal hernia - protruding stomach above the diaphragm

- Risk factor of GERD

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- Smoking causes reflux

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Attacks the symptoms of GERD

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- Attacks the symptoms of GERD
- Antacids - magnesium

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Achalasia
Friday, 27 January 2023 3:43 PM

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- No movement or peristalsis means achalasia

- Dysphagia - difficulty on swallowing.

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- *RAT-TAIL APPEARANCE

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○ COMPLICATION IS GERD

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- Pooling of fluids - pneumonia

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Nausea and Vomiting
Saturday, 28 January 2023 10:52 AM

- Substances that can harm the body itself can result to vomit

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- Primary - obstruction
- Secondary - mentioned above

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- VOMITING

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- AFFECTORS - carry stimulation

- EFFECTORS - carry the message

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- Medulla oblongata

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- Vertigo - betahistine

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- Ipecac - induced VOMITING REFLEX

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- Uremia - presence of urine toxics

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- ANTIEMETICS

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Acute GI Bleeding
Saturday, 28 January 2023 1:16 PM

- First part of the small intestine - duodenum

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- Cracks/lacerations in anal

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- Kasama ba sa first - diluted ang sumunod

- Or sumunod na suka - already diluted

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- ASPIRIN AND NSAID - irritate the stomach

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- Occult blood

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- Varices - dilated blood vessels

○ Could led to bleeding
○ Weakened vessels/veins
○ Pressure inserted/imposed to the weak vessels tend to massive
bleeding
○ Management: shunting

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- Active bleeding and unknown cause - admit to ICU

- 2 L via nasal cannula

○ 5 L maximum for nurses to use
○ Check every 2 to 3 mins.

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- Omeprazole - nephrotoxic

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- Somatostatin - vasoconstriction
○ Decrease bleeding

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- Tranexamic acid - prevent coagulation of blood

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- Hemodynamic instability
○ HR - fast
○ BP - low

- Anastomosis - tube use to connect

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