Endoscopy and Diagnostic Imaging - Part I: Skin, Nail and by Dr. A. B.R. Thomson, Dr. G. N.J. Tytgat

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.

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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

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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.

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