Heartburn

Heartburn

1. Abdullah 55 years old Male, Complaining of Chest discomfort for several months, difficulty Swallowing, Weight loss, and diagnosed with Barret’s Esophagus

2. Anatomy

   • Esophagus
   • Stomach

3. Swallowing

   • Definition: the entire act of 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.
   • phases:
     • 1-Voluntary phase
     • 2-Pharyngeal phase
     • 3-esophageal phase

4. Gastric Acid Secretion

5. Differential Diagnosis of dysphagia

   • Oropharyngeal dysphagia
     • Neurological disorders
       • Cerebrovascular accident
       • Parkinson’s disease
       • Degerenrative diseases
       • Postinfectious
       • Peripheral neuropathy
     • Muscular disorders
       • Polymyositis
       • Dermatomyositis
       • Muscular dystrophy
       • Cricopharyngeal achalasia
     • Motor-end-plate disorders
       • Myasthenia gravis
     • Obstructive Lesions
       • Tumors
       • eosinophilic esophagitis
       • Zenker’s diverticulum
     • Congenital Anomalies
       • Cerebral palsy
       • Cleft lip and palate
   • Esophageal Dysphagia
     • Neuromuscular disorders
       • Scleroderma
       • Achalasia
       • Spastic motor disorders
     • Obstructive Lesions
       • Vascular compression
       • Esophageal webs
       • Schatzki’s ring
     • Mediastinal Masses
       • Lymphadenophathy
       • Substernal thyroid
     • GERD
       • Causes
         • LES decreased tone
         • Hiatal Hernia
         • abnormal peristalysis
         • Abnormally slow emptying of stomach
         • fatty foods, spicy foods, chocolate, caffeine, onions, tomato, sauce, carbonated beverages, mint, large meals and alcohol
         • Medications
           • sedatives
           • tranquilizers
           • calcium channel blockers
       • DIAGNOSIS
         • Upper endoscopy
         • Ambulatory acid (pH) probe test
         • Esophageal manometry
         • X-ray
       • Risk Factors
         • Obesity
         • Asthma
         • Diabetes
         • Peptic Ulcer
         • Connective tissue disorders
         • Zollinger-Ellison Syndrome
         • Bad diet
         • Cigarette smoking
         • Aging
         • Alcohol
         • Increased histamine release
         • Increased gastric infections
       • signs and symptoms
         • heartburn
         • Chest pain
         • Difficulty swallowing
         • Regurgitation of food or sour liquid
         • Sensation of a lump in your throat
       • Complications
         • bleeding
         • strictures
         • perforation
         • barret esophagus
           • Definition: metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.
           • Diagnosis
             • endoscopy
             • histological examination of biopsies
       • Management
         • Lifestyle modifications
           • Elevation of bed head
           • Weight loss
           • Avoid
             • Smoking
             • Alcohol
             • Fatty meal, chocolate, onion, tea, coffee
             • Spicy foods, citrus & tomato products
             • Drugs that decrease LES pressure
           • Small frequent meals
           • No eating 3 hrs before sleeping
         • Medical Treatment
           • H2 Receptor antagonists
           • Proton Pump inhibitors
           • Misoprostol
           • Sucralfate
           • Antacids
           • anti-muscarinic

6. Helicobacter Pylori

   • Gram-negative, microaerophilic bacterium
   • it causes
     • gastritis
     • peptic ulcers
     • stomach cancer
   • Signs and Symptoms
     • An ache or burning pain in your abdomen
     • Abdominal pain
     • Nausea
     • Loss of appetite
     • Frequent burping
     • Bloating
     • Unintentional weight loss
   • Risk Factors
     • Living in crowded conditions
     • Living without a reliable supply of clean water
     • Living in a developing country
     • Living with someone who has an H. pylori infection
   • Diagnosis
     • Blood and stool tests
     • Urea breath test
     • Upper gastrointestinal endoscopy
     • Upper GI tests
     • CT Scan
   • Treatment
     • Triple Therapy
       • Two antibiotics and a proton pump inhibitor

7. Neoplasms of the Esophagus

   • SSC
   • Adenocarcenoma
     • Intestinal type
     • Diffuse type
   • Gastric polyps
   • Gastric lymphoma

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