Heartburn

Heartburn

1. Anatomy

   • Esophagus
   • Stomach

2. Swallowing

   • phases:
     • 3-esophageal phase
     • 2-Pharyngeal phase
     • 1-Voluntary phase

3. Gastric Acid Secretion

4. 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
   • Diagnosis
     • endoscopy
     • histological examination of biopsies
   • Complications
     • bleeding
     • structures
     • perforation
     • barret esophagus
   • 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

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

6. Helicobacter Pylori

   • 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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