By Dr. A. B.R. Thomson, Dr. G. N.J. Tytgat
Written through across the world popular gastroenterologists, this essential assessment booklet has been designed as a medical abilities refresher for examination reasons for gastroenterology and inner drugs citizens and fellows, in addition to working towards physicians. This publication (part 1 of two of this series), masking Cardiology, Endocrinology, Hepatology, and Nephrology. Endoscopy and Diagnostic Imaging is a gastroenterology source ebook which include esophagus, belly, small bowel endoscopies and scientific case stories, esophageal manometry, diagnostic imaging, in addition to examples of GI-disease linked dermis, nail and mouth adjustments. This e-book enhances GI-Practice evaluate.
Read Online or Download Endoscopy and Diagnostic Imaging - Part I: Skin, Nail and Mouth Changes in GI Disease; Esophagus; Stomach; Small intestine; Pancreas PDF
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Extra resources for Endoscopy and Diagnostic Imaging - Part I: Skin, Nail and Mouth Changes in GI Disease; Esophagus; Stomach; Small intestine; Pancreas
36 o Rebound? Nocturnal Acid Breakthrough (pH<4 for >1 hour) o Occurs in up to 70% of GERD patients treated with PPI bid, especially Hp-negative Acid Rebound with PPI’s o Occurs 7 days following cessation of 2–3 months high-dose PPI treatment o Increases BAO but more consistently MAO (but an unphysiological stimulus) o May last up to 11 months o May not be seen in H. pylori-positive patients o Mechanism uncertain ? Hypergastrinemia ® enterchromaffin cell hyperplasia o Relevance to symptom relapse?
Dupuytrens 28. White nails 29. Beau’s lines 30. Nail pitting-psoriasis 31. Psoriatic Nails 32. 01% Grading of Dysphagia: 0 Normal 1 Occasional difficulty with swallowing solids 2 unable to swallow solid food 3 unable to swallow minced food 4 unable to swallow pureed of liquid food 5 unable to swallow liquids or saliva Practice Pointers: Benign Stricture o Rare in patients with GERD 24 o o o o o Dysphagia occurs when the esophageal lumen becomes narrowed to 12 mm Dysphagia with solids, intermittent, slow progression over many months No pain except when solids are stuck Pre-existing heartburn may decrease or even disappear as dysphagia develops Esophagus is heat and alcohol sensitive Malignant stricture o Dysphagia begins when about half the esophageal circumference is blocked o Dysphagia is continuous and progressive; progression is usually rapid o Dysphagia first for solids, then for liquids o Esophagus not sensitive to heat or ethanol o Late pain after mediastinal spread Achalasia o Slow onset of dysphagia, with slow progression over months o Dysphagia equally severe with liquids and solid food o There is often concomitant regurgitation together with substernal fullness o There is no typical impact pain, and pain may be provoked by eating o Spontaneous chest pain is common o Altered sphincter tone causing dysphagia can be overcome by pressure from well centered endoscope Diffuse Esophageal Spasm o Symptoms of dysphagia and/or chest pain (non-cardia chest pain [NCCP]) o Manometric presence of peristalsis with greater than 30% synchronous waves, waves of amplitude greater than 200 mm Hg, and waves of longer than 7 seconds duration o Barium diagnostic imaging may show characteristic “nutcracker” esophageal pattern GASTROESOPHAGEAL REFLUX DISEASE (GERD) A pathophysiological classification of GERD and GERD symptoms, and use this to classify the drugs used to treat persons with GERD.
Motility disorders o Transient lower esophageal relaxations* - Esophageal o LES 25 o o o o - Cholinergics (bethanecol) - Gaba receptor agonists (baclofen) - Hiatus hernia - Stomach (gastroparesis), obstructive sleep apnea - Prokinetics Weak lower esophageal sphincter* Weak esophageal peristalsis Scleroderma and CREST Delayed gastric emptying Damaging factors o Normal / HCl secretion, but reflux of acid - Alginate, antacids, H2Ras, PPIs o Increased gastric acid production o Bile and pancreatic juice - Sulcrafate Resistance factors o Reduced saliva and HCO3 production - Chewing gum o Diminished mucosal blood flow o Growth factors, protective mucus o Perception TCAs, SSRIs Abbreviations: GERD, gastroesophageal reflux disease; H2RA, histamine 2 receptor antagonist; LES, lower esophageal sphincter Printed with permission: Murray JA.