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SOEPEL – 5 GASTRO-OESOPHAGEAL REFLUX DISSESE
AHMAD MHD ALDHLAWIY
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CONTENTS …
SOEPEL
DEFINITION
LOCATION
CLINICAL FEATURES
CAUSES
INVESTIGATION
MANEGEMENT
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SOEPEL …
Subject:
A 35 year old patient admitted to the hospital cause of excessive vomiting.
History:
the patient complain with abdominal pain, excessive vomiting, and loss of weight.
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SOEPEL …
Pain analysis:
1. Site: epigastric.
2. Onset: episodic.
3. Character: burning.
4. Associated factors: --
5. Time/duration: 4 months.
6. Exaggerated factors: after eating.
7. relieving factors: medication.
8. Severity: moderate
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SOEPEL …
Object: General examination & Abdominal examination.
Evaluation (DD): achalasia, hiatal hernia.
Plan: Endoscopy.
Elaboration: change lifestyle.
Learning goals: GERD.
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DEFINITION …
highly variable chronic condition that is characterized by periodic episodes of gastroesophageal reflux usually accompanied by heartburn and that may result in histopathologic changes in the esophagus.
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LOCATION …
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CLINICAL FEATURES …
HEART BURN: It is a major feuters, aggrevated by bending, stopping or laying down which promote acid exposure. The complain of pain well be during drinking hot liquid or alcohol.
REGURGITATION: Food and acid into the mouth occurs particular on bending or layig flat.
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CAUSES …
Obesity. Pregnancy. Certain medications, such as asthma medications, calcium channel blockers, and many antihistamines, pain killers, sedatives, and antidepressants.
Smoking, or inhaling secondhand smoke.
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INVESTIGATION …
Assess oesophagitis and hiatal hernia by endoscopy:If there is oesophagitis or Barrett’s oesophagus, reflux is confirmed.
Document reflux by intraluminal monitoring:
24-hour intraluminal pH monitoring or impedance combined with manometry is helpful if there is no response to PPI and should always be performed to confirm reflux before surgery.
INVESTIGATION …
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MANAGEMENT …
Change Lifestyle:
losing weight, if needed
wearing loose-fitting clothing around the stomach area.
remaining upright for 3 hours after meals.
raising the head of the bed 6 to 8 inches by securing wood blocks under the bedposts––just using extra pillows will not help.
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MANAGEMENT … Medication:
Alginate-containing antacids: (10 mL three times daily), if it contain magnesium antacid it will cause to diarrehea, or if it contain aluminum it will cause to concitipation.
The dopamine antagonist prokinetic agents : they enhance peristalsis and speed gastric emptying.
H2-receptor antagonists: used for acid suppression if antacids fail as they can often be obtained over the counter.
Proton pump inhibitors: inhibit gastric hydrogen/potassium-ATPase. PPIs reduce gastric acid secretion by up to 90% and are the drugs of choice for allbut mild cases.
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MANAGEMENT …
Surgery: Fundoplication.
Endoscopic techniques.
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REFERENCES …
Kumar and clark’s 8th edition. Oxforf clinical medicine.
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