Heartburn

Anatomy & Histology of Esophagus
1. extends from pharynx to stomach
2. has 3 portions: cervical/thoracic/abdominal
3. blood supply
  1. arterial: abdominal part supplied by left gastric and left inferior phrenic arteries
  2. venous: abdominal part drained by left gastric of potral system, inferior venacava and hemiazygos
4. lymphatics
  1. abdominal part by celiac group of lymph nodes
5. innervation
  1. sympathetic
    1. greater, lesser, and least splanchnic nerves and celiac plexus
  2. parasympathetic
    1. vagus and recurrent laryngeal nerves
6. histology
Anatomy & Histology of Stomach
1. lies mostly in epigastric region and partly in left hypochondriac region
2. has a fungus, body, antrum, and pylorus
3. blood supply
  1. arterial: celiac trunk and branches
  2. venous: corresponds to arteries and drain into portal vein
4. lymphatics
  1. celiac nodes and left supraclavicular nodes
5. innervation
  1. sympathetic
    1. greater and lesser splanchnic nerves, celiac, and hepatic plexuses
  2. parasympathetic
    1. anterior and posterior vagal trunks
6. histology
Stages Of Swallowing
1. oral phase
  1. voluntary and initiates swallowing process
2. pharyngeal phase
  1. involuntary passage of food through pharynx into oesophagus
3. oesophageal phase
  1. involuntary passage of food from oesophagus into stomach
Functional Disorders Of Oesophagus
1. achalasia
  1. oesophageal motility disorder due to inability of LES to relax
  2. may be primary or secondary
2. zenker's diverticulum
  1. out pouching of mucosa through the muscular layer of oesophagus
  2. may result in halitosis and regurgitation
3. oesophagitis
  1. chemicals
    1. lye/ alcohol
  2. infectious
    1. HSV/ CMV/ candida albicans
GERD
1. signs & symptoms
  1. typical
    1. heartburn/ regurgitation
  2. atypical
    1. dysphagia/ odynophagia/ burping/ chest pain
2. risk factors
  1. obesity
  2. alcohol
  3. smoking
  4. medications
  5. food
  6. hiatal hernia
3. disease that involves the reflux of acidic stomach juices or foods from stomach into oesophagus
4. management
  1. lifestyle modifications
  2. mild GERD
    1. low dose H2RA
    2. if symptoms persist, high dose H2RA
  3. severe GERD
    1. standard dose PPIs
    2. if symptoms persist, high dose PPIs
      1. if symptoms only controlled by high dose PPI -> may be referred to Nissen's Fundiplication
Barrett's Esophagus
1. complication of chronic GERD
2. characterised by intestinal metaplasia
3. risk factors
  1. gender/ age/ history/ race
  2. GERD
  3. increasing intraabdominal pressure
  4. obesity
4. signs & symptoms
  1. progressive heartburn
  2. hoarseness of voice
  3. chest pain
  4. black, tarry blood stools
  5. dysphagia
  6. weight loss
5. management
  1. pharmacological
    1. antacids
    2. H2RA
    3. proton pump inhibitors
    4. promotility agents
    5. aspirin/ NSAIDs
  2. non-pharmacological
    1. endoscopic surveillance
    2. endoscopic ablative therapy
    3. esophagectomy
    4. endoscopic mucosal resection

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Heartburn

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	Created by hana ahmed almost 3 years ago