Heartburn

Heartburn

Abdullah 55 years old
Felt in the chest and the reason is a problem in the GIT system
1. Anatomy of upper GI
  1. Esophagus
  2. Gastroesophageal junction
  3. Stomach
2. Hitology
  1. Esophagus
  2. Gastroesophageal junction
  3. Stomach
    1. Fundus/Body
    2. Pylorus
Swallowing
1. deglutition from placement of food in the mouth through the oral and pharyngeal stages of the swallow until the material enters the esophagus through the cricopharyngeal juncture
Gastric Acid Secretion Mechanisms
2. 3 receptors
  1. Muscarinic receptors (ACh)
  2. Gastrin
  3. H2 receptors (Histamine)
3. H+/K+ ATPase or "proton pump"
Causes of dysplasia
1. Mutations in a developing fetus' DNA
3. Differential Diganosis
  1. Neurological Disorder
    1. Cerebrovascular accident
      1. Parkinson's Disease
        Brain stem tumors
        Degenerative diseases
        Peripheral neuropathy
  2. Motor-end-plate-disorder
    1. Myasenthia gravis
  3. Muscular disorder
    1. Polymyositis
      1. Dermatomyositis
        Muscular dystrophy
        Cricopharyngeal achalasia
  4. Obstructive lesions
    1. Tumors
      1. Inflammatory masses
        Trauma/surgical resection
        Zenker's diverticulum
        Esophageal web
        Extrinsic structural lesions
        Anterior mediastinal lesions
        Cervical spondylosis
    2. Mediastinal masses
      1. Lymphadenopathy
        Substernal thyroid
  5. Congenital Anomalies
    1. Cerebral palsy
      1. Cleft lip palate
GERD Gastroesophageal Reflux Disease
1. S&S
  1. Chest pain
  2. Difficulty swallowing
  3. Regurgitation
  4. Chronic cough
  5. Laryngitis
  6. Disrupted sleep
2. Risk factors
  1. Obesity
  2. Pregnancy
  3. Smoking
  4. certain medications
3. Diagnosis
  1. Upper endoscopy
  2. Ambulatory acid (pH) probe test
  3. X-ray
  4. Esophageal manometry
4. Complications
  1. Esophagitis Might develop to:
    1. Strictures
      1. Barrett's esophagus
5. Lifestyle modifications:
  1. Elevation of bed head
  2. Weight loss
  3. Avoid :
    1. Smoking
    2. Alcohol
    3. Fatty meal
    4. Chocolate
    5. Spicy food
  4. Small frequent meals
  5. No eating 3 hrs before sleeping
6. Management
  1. H2 receptor antagonist
  2. PPI
  3. Misoprostol
  4. Sucralfate
  5. Antacis
H.Pylori
1. H. Pylori attacks the lining of the stomach >> acid can get through the lining >>ulcer formation
2. S&S
  1. ache or burning pain
  2. Nausea
  3. Loss of appetite
  4. Bloating
  5. Frequent burping
3. Risk Factors
  1. Living in crowded conditions
  2. Living without a reliable supply of clean water
  3. Living in a developing country
  4. Living with someone who has an H. pylori infection
4. Diagnosis
  1. Invasive
    1. Histology
    2. Upper gastrointestinal endoscopy
  2. Non-invasive
    1. Urea breath test
    2. Stool antigen test
5. Treatment
6. Complications
  1. Ulcers
    1. Chronic gastritis
      1. Gastric Adenocarcinoma

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