gastroentero

• define dysphagia


  difficulty to swallow
• define odynophagia


  pain on swallowing
• types of dysphagia

  1. oropharyngeal dysphagia
  2. oesophageal dysphagia
• oropharyngeal dysphagia is characterized by


  difficulty in initiating swallowing movement
• causes of oropharyngeal dysphagia

  • neurological: bulbar palsy, pseudobulbar palsy, myasthenia gravis and stroke
  • structural: Oral cancer, zenkers diverticulum
• Oropharyngeal dysphagia is MORE for LIQUIDS than solids
• Diagnosis of oropharyngeal dysphagia is done by video fluoroscopy
• oesophageal dysphagia is characterized by barium swallow ad manometry
• esophageal dysphagia characterized by sticky sensation of food after swallowing
• obstructive lesions cause esophageal dysphagia for solids more than liquids
• obstructive lesions causing esophageal dysphagia are diagnosed by endoscopy and biopsy
• motility disorders cause esophageal disorders for both solids and liquids
• motility disorders causing esophageal dysphagia are diagnoses by manometry and barium swallow
• esophageal dysphagia + odynophagia = esophagitis
• causes of esophageal dysphagia

  1. obstruction: esophageal webs and esophageal carcinoma
  2. motility disorders: achalasia and diffuse esophageal spasm
• list the layers of stomach

  
• list the layers of the stomach

  serosa --- muscularis externa (longitudinal, circular, oblique) ----- submucosa ------ mucosa (muscularis mucosa, lamina propria, surface epithelium)
• GERD/ reflux esophagitis: is the reflux of gastric contents into the lower esophageal sphinctor and its subsequent irritation and inflammation
• pathogenesis of GERD is: transient lower esophageal sphincter relaxation or incompetent LES
• risk factors of GERD:

  • sliding hiatal hernia
• clinical features of GERD:

  • extra esophageal: atypical chest pain, recurrent chest infections, laryngitis, chronic cough
• clinical features of GERD:

  1. extraesophageal: laryngitis, recurrent chest infections, chronic cough, acute chest pain
• diagnosis of GERD:

  • IDEAL: endoscopy
  • if endoscopy is normal but symptoms arent: manometry and 24 hour pH test
• Treatment of GERD:

  1. lifestyle modifications: avoid precipitants, elevate head of bed, lose weight and avoid large late night meals
  2. pharmacological: PPI (omeprazole, lansoprazole), H2 receptor antagonist
  3. surgery only if theres severe regurgitation, failure of medical therapy, unwilling to for long term PPIs and barrets esophagus
• complications of GERD:

  1. iron deficiency anemia
  2. barret's oesophagus
  3. esophagitis
  4. benign oesophageal stricture
  5. gastric volvulus
• Hiatal Hernia: is the herniation of stomach upward into the chest through the esophageal hiatus of diaphragm
• clinical features of hiatal hernia:

  1. often asymptomatic
  2. heartburn + regurgitation
  3. paraesophageal hernia can cause gastric volvulus
• types of hiatal hernia:
• types of hiatal hernia

  1. sliding
  2. normal
  3. paraesophageal
• gastritis refers to inflammation of the gastric mucosa
• types of gastritis

  1. acute
  2. chronic (type-A type-B)
• acute gastritis: is the acute inflammation of gastric mucosa
• causes of acute gastritis:

  • NSAIDS
  • alcohol
  • smoking
  • brain injury (cushing ulcer)
  • burn injury (curling ulcer)
  • uremia
  • stress
• presentation of acute gastritis

  • asymptomatic (early)
• define chronic gastritis: it is the chronic inflammation of gastric mucosa leading to mucosal atrophy and intestinal metaplasia in the absence of erosions