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Gastroesophageal reflux

disease [GERD]
Underlying causes
Incompetent lower esophageal sphincter
Obesity
Hiatial hernia
Pregnancy
Decreased motility
Delayed gastric emptying

Signs and Symptoms


Postprandial epigastric [chest] burning worse in
supine position, cough, hoarse voice, regurgitation
It is a clinical diagnosis

GERD
Treatment
First line- lifestyle modifications
Weight loss
Avoidance of instigating foods such as caffeine, fatty foods
Avoid eating right before going to sleep

Second line
H2 blockers--Cimetidine

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

Last Resort
Nissen fundoplication

Pelvic Inflammatory Disease


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

The diagnosis of acute pelvic inflammatory disease


(PID) is primarily based on historical and clinical
finding

Pelvic Inflammatory
Disease
Centers for Disease Control and Prevention (CDC) has
established minimal criteria for the diagnosis of PID.
According to these criteria, empiric treatment of PID is
indicated when a patient who is at risk for sexually
transmitted disease has pelvic or lower abdominal pain,
no identifiable cause for her illness other than PID, and,
on pelvic examination, 1 or more of the following
minimal criteria
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness

Gastritis
Inflammation of the gastric mucosa
Types of Gastritis
Type A
Most likely found in the fundus
Associated with autoimmune causes, achlorhydria,
pernicious anemia.

Type B
Most likely found in the antrum of the stomach
Most common cause is nonsteroidal anti-infalmatory drug
[NSAID] use
Can be caused by H. pylori infection
Associated with risk for peptic ulcer disease and gastric
cancer

Gastric Mucosa and


Stomach

Gastritis
Signs and Symptoms
May be asymptomatic
Epigastric pain
Weight loss
Nausea
Vomiting
Hematemesis
Coffee ground Emesis

Gastritis
How is it Diagnosed?
Endoscopy
Treatment depends on Etiology
If H. pylori
Triple therapy: PPI, 2 antibiotics [Clarithromycin +
Amoxicillin/Metronidazole], and Bismuth [Pepto Bistmol]

If caused by NSAID use


Discontinue NSAID use
Start sucralfate, PPI, or H2 blocker

If caused by post-procedure, hospitalization stress


IV H2 Blocker

If caused by pernicious anemia


Vitamin B12 treatment

Colitis
Inflammation of the inner lining of the colon.
It may cause abdominal pain, bloating, and diarrhea
with or without blood.
May be due to
Loss of blood supply to the colon
Ischemic

Inflammatory Bowel Disease


Ulcerative Colitis
Chrohns Disease

Invasion of the colon wall with lymphocytic white blood


cells or collagen

Peptic Ulcer Disease

A lesion in the lining (mucosa) of the digestive tract caused by


the digestive action of pepsin and stomach acid
Duodenal Ulcertwice as common
Due to increased acid production
Signs and symptoms

Burning epigastric pain that is usually 2-3 hours postprandially


Relieved by food or antacids
Pain may radiate to the back
Pain awakens patient at night
Nausea and sometimes vomitin
Hematemesis/Melena if patient has a GI bleed

Gastric Ulcer
Due to decreased mucosal protection
Signs and Symptoms
Same as duodenal ulcers except pain is greater with meals, patients

Peptic Ulcer Disease


Tests for suspected peptic Ulcer
CBC to make sure patient is not anemic
Upper GI endoscopy or upper GI series
H pylori screening
If Gastric ulcer
Must rule out malignancy by doing biopsy
of ulcerated region during endoscopy

Peptic Ulcer Disease


2 most common causes of Peptic Ulcer Disease
H pylori infection
Frequent NSAID use
Risk factors for peptic ulcer
Smoking, significant alcohol use, frequent NSAID
use, significant physiologic stress [surgery,
trauma, and burns]
Hypersecretory states
Zollinger-Ellison syndrom
Multiple Endocrine Neoplasia Type I [MEN 1]
Antral G-cell hyperplasia

Peptic Ulcer Disease


Treatment of Peptic ulcers
Avoidance of instigating factorssmoking and NSAIDs
H2 blockers or PPIs
Mucosal protectors such as bismuth
Antibiotics if H pylori infection
TRIPLE therapy
Complications of Peptic Ulcer Disease
Hemorrhage
Obstruction
Perforation
Perofrated Dudodgenal Ulcersevere epigastric pain that radiates to
the back
If suspected must do Abdominal series of Upper GI series with contrast
[NO BARIUM]
Free air under diaphragm would be seen

Penetration causing Acute Pancreatitis

Helicobacter pylori infection


Infection occurs when a type of bacteria called
Helicobacter pylori (H. pylori) infects your stomach,
H pylori causes:
90% of duodenal ulcers
70% of gastric ulcers

Signs or symptoms do occur with H. pylori infection,


they may include:
An ache or burning pain in your abdomen
Nausea
Vomiting
Frequent burping
Bloating
Weight loss

Helicobacter pylori infection


Tests and Diagnosis
Stool H pylori antigen
Urea breath test
Serum Immunoglobulin test
H pylori blood testdoes not indicated ACTIVE INFECTION.
Will be + even if the patient was infected in the past and is not
currently infected.
LOW sensitivity

Endoscopy