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Gastrointestinal Diseases Group 5: Leticia Bernal Leon Daydig Rodriguez Maria Rodriguez Karina Silveira Instructor: Dr. Alain Llanes Rojas, DNP, APRN, FNP-BC Miami Regional University Diagnosis, Symptoms & Illness Management MSN5600 Gastroesophageal Reflux Gastroesophageal reflux that does not cause symptoms is known as physiologic reflux. In nonerosive reflux disease (NERD), individuals have symptoms of reflux disease but no visible or minimal esophageal mucosal injury Gastroesophageal reflux disease (GERD) is the reflux of acid and pepsin or bile salts from the stomach to the esophagus that causes esophagitis. The severity of the esophagitis depends on the composition of the gastric contents and esophageal mucosa exposure time. Definition & Classification Gastroesophageal Reflux Causes GERD can be caused by abnormalities or alterations in 1. Lower esophageal sphincter function 2. Esophageal motility 3. Gastric motility or emptying Esophageal function studies include the following: Determination of the lower esophageal sphincter (LES) pressure (manometry) Graphic recording of esophageal swallowing waves, or swallowing pattern (manometry) Detection of reflux of gastric acid back into the esophagus (acid reflux) Detection of the ability of the esophagus to clear acid (acid clearing) An attempt to reproduce symptoms of heartburn (Bernstein test) Gastroesophageal Reflux Risk Factors Obesity Hiatal hernia Use of drugs or chemicals that relax the LES (anticholinergics, nitrates, calcium channel blockers, nicotine) Cigarette smoke. Trigger Factors Coughing Vomiting Straining at stool Asthma Chronic cough Sinusitis. Gastroesophageal Reflux Common Symptoms Heartburn that occurs 30 to 60 minutes after meals and when the patient bends over or lies down. Regurgitation of sour or bitter gastric contents Belching, and fullness of the stomach Upper abdominal pain within 1 hour of eating. Atypical Symptoms chronic cough asthma attacks chronic laryngitis sinusitis discomfort during swallowing. Noncardiac chest pain. Dysphagia Gastroesophageal Reflux Clinical manifestations are related to mucosal injury from acid regurgitation and the frequency and duration of reflux events. The symptoms worsen if the individual lies down or if intraabdominal pressure increases because of coughing, vomiting, or straining at stool. Uncomplicated GERD that is responsive to first-line therapy does not require an endoscopy. Patients who do not respond to therapy and those with suspected complications should undergo an endoscopic examination Management & Evaluation Differential diagnosis Gastritis Peptic ulcer Gastric cancer Cholelithiasis Angina pectoris. Gastroesophageal Reflux Diagnosis of GERD is based on the history and clinical manifestations. An upper endoscopy with biopsy is the standard diagnostic procedure for GERD. It confirms the diagnosis and documents the type and extent of tissue damage. Esophageal endoscopy: shows hyperemia ...
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These are simplified slides discussing the regulation of cardiac output and venous return. Learning objectives: 1. Comprehend the determinants of cardiac output and factors affecting cardiac output 2. Comprehend the factors affecting stroke volume and heart rate and total peripheral resistance 3. Identify the factors regulating venous return 4. Discuss the causes of high and low output cardiac failure 5. Enlist the functions of veins and recognise the significance of venous reservoirs Study Resources: 1. Chapter 20, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 30 and 32, Ganong’s Review of Medical Physiology, 26th edition 3. Chapter 10, Human Physiology by Lauralee Sherwood, 9th edition 4. Physiology, Cardiac Output - StatPearls https://www.ncbi.nlm.nih.gov/books/NBK470455/
Cardiac Output, Venous Return, and Their Regulation
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Pud Gastritis Lecture[1]
1.
55 yo male
c/ epigastric pain on/off x 1 mo
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Reflux Esophagitis Peptic
Ulcer Disease, Gastritis, & GI Bleeding Pascale Gèhy-Andrè, PA-C
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Screw the environment
carpooling is bad
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GI Bleeding
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Guiaic/ Hemoccult
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CXR Pneumoperitoneum
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Flex Sig
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Anoscopy/ Rigid Sigmoidoscopy
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Super Duper Pooper
Scooper
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Colonoscopy
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