Heart Burn

Phases of swallowing
1. Oral phase
  1. Voluntary
  2. Initiated by tongue forces a bolus of food back toward the pharynx
  3. Activation initiates involuntary swallowing reflex in the medulla
2. Pharyngeal phase
  1. Reflexive
  2. Soft palate pulled upward,
    1. Epiglottis moves to cover the opening to the larynx;
      1. Larynx moves upward against the epiglottis
        Upper esophageal sphincter relaxes
        Peristaltic wave of contraction initiated in pharynx
3. Esophageal phase
  1. Controlled by swallowing reflex and enteric nervous system
    1. Primary peristaltic wave: Swallowing reflex travels down the esophagus
    2. Secondary peristaltic wave: Food not cleared initiates; mediated by the enteric nervous system; begins at the site of distention
Causes of dysphagia
1. Oropharyngeal dysphagia
  1. Neurological disease
2. Oesophageal dysphagia
  1. Strictures
    1. Benign
    2. Malignant
  2. Oesophagitis
  3. Dysmotility
Normal Histology of the esophagus
Causes of Chest discomfort
H. pylori
1. Curved gram negative rod
2. virulence factors
3. diagosis
  1. Invasive tests
    1. Histology
    2. Culture
    3. Rapid Urease Test
    4. Molecular
  2. non- Invasive tests
    1. Serology – antibody detection by ELISA
    2. Urea Breath Test
    3. Stool Antigen Test
4. Treatment
Gastroesophageal reflux disease
1. occurs when stomach acid frequently flows back into the esophagus. This acid reflux can irritate the lining of the esophagus.
2. Pathophysiology
  1. LES abnormalities
    1. Hypotensive LES
    2. Inadequate response to increased intraabdominal pressure
    3. TLESR (transient lower esophageal sphincter relaxation)
3. Complications
  1. Ulcers
  2. Strictures
  3. Respiratory problems
  4. Barrett's esophagus
    1. At least 1 cm of metaplastic columnar epithelium that replaces the stratified squamous epithelium
4. Signs & Symptoms of GERD
  1. Dysphagia
  2. Heart burn
  3. Belching
  4. Bad breath
  5. Erosion of the enamel of the teeth
  6. Regurgitation
  7. Cough and Asthma
5. Investigations
  1. upper GI series
    1. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of digestive tract.
    2. swallowing a barium pill that can help diagnose a narrowing of the esophagus
  2. Endoscopy
    1. Detections
      1. ulcers - abnormal growths- precancerous conditions - bowel obstruction - inflammation - hiatal hernia
    2. Indications
      1. Suspected of having an ulcer who present with alarm symptoms
      2. bleeding in the upper GI tract
      3. Gastric reflux
      4. swallowing difficulties
    3. contraindications
      1. Shock
      2. Acute MI
      3. Peritonitis
      4. Acute perforation
      5. Fulminant colitis
  3. PH Monitoring
    1. is a test that measures how often stomach acid enters the esophagus. Also measures how long the acid stays there
  4. Intraesophageal ambulatory pH monitoring
    1. Records the timing, length, and number of reflux episodes
6. Predisposing factors
  1. Alcohol
    1. acetaldehyde and other toxic by-products of alcohol metabolism interfere with esophageal contractions and impair lower esophageal sphincter function
  2. Chocolate
    1. contains caffeine and other stimulants such as theobromine
  3. Obesity
  4. Pregnancy
  5. Hiatal hernia
  6. Postures
7. Pharmacological management
8. non- Pharmacological management
  1. Fundoplication
  2. Transoral Incisionless Fundoplication
  3. LINX Reflux Management System
  4. Lifestyle

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Heart Burn

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	Created by hamda ali about 6 years ago