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dyspepsia / GERD - Coggle Diagram

- - - - Diagnosis
        
        endoscopy --> visible coolumnar lining above EG junction
        
        biopsy --> metaplasia
  - - - Silent GERD
        
        presents with nocturnal cough and throat hoarseness
      - *sequelae and complications of GERD
        
        3 main complications of GERD
        
        1 = Esophageal ulcers
        --> P/C with odynophagia (pain on swallowing)
        --> change of baseline GERD symptoms
        
        2 = Esophageal strictures
        --> from chronic GERD
        --> collagen fibrosis in the esophagus closes the lumen tighter
        --> get sensation of food getting stuck
        
        3 = Barret's esophagus
        --> most insidious
        --> especially since it is silent and no change of baseline symptoms of GERD
        
        Clinical Cases
        
        Clinical Case
        
        Notes:
        
        note that
        
        Clinical Case
- - - - Treat the Heart
        Burn Symptoms
        
        remember SAM ABCD and MS B
        
        Mucosal Resistance
        
        Protect Stomach from
        excess acid without lower it
        
        MS B
        
        Sucraflate
        
        sulphated sucrose
        --> creates (-) charged sugar-gel coat
        around epithelial layer
        
        increases bicarb and mucus
        
        Misoprostonol
        
        PGE2 prostaglandin analogue
        
        increases bicarb and mucus
        
        Bismuth Chelate
        
        primarily increases bicarb and mucus
        
        secondary H. pylori action
        
        Neutralize gastric acid
        
        Antacids
        
        SAM with S/E ABCD
        --> Sodium Bicarbonate
        --> Aluminum Hydroxide
        --> Magnesium Hydroxide
      - Treat Underlying reason for Ulcer
        
        H. pylori or NSAID induced ulcer
        
        Kill Underlying
        H. Pylori Infection
        
        Gram - bacili --> antibiotics
        
        First Line Therapy 10-14 days
        
        Penicilins
        
        beta lactam ring prevent PBPs
        from forming cross-links
        --> amoxicilin
        
        Penicilin allergy
        --> use DNA synthesis target
        --> metonidazole
        
        Macrolides
        
        target 50s ribosomes
        
        ACE
        --> azythromycin
        --> clarithromycin
        --> erythromycin
        
        2nd Line Therapy
        
        3rd Line Therapy
        
        Add bismuth Chelate
        
        has negative H. pylori actions
        
        Add tetrcyclines
        
        (30s ribosomes)
        
        Keep Amoxicilin and PPI
        
        Switch metronidazole and Macrolides
        --> Toposiomerase DNA inhibitor
        
        Quinolone = nalidixic acid
        
        Flouroquinolones (-oxacins)
        --> levoflaxacin
        --> gemfloxacin
        --> ciprofloxacin
        
        PPI OD or BID
        
        omeprazole
        
        esomeprazole
        
        NSAID induced ulcer
        
        caused by inhibiting COX1
        in the stomach and dudenum
        
        Misoprostonol
        
        PGE2 prostaglandin analogue
      - Treat the Parietal part
        of the Ulcer itself
        
        H2 Receptor Inhibitors
        
        1st gen = cimetidin
        
        2nd gen = ranitidine
        
        3rd gen = famotidine
        
        PPIs
        
        1st gen = omeprazole
        
        2nd gen = esomeprazole
    - - Causes
        
        Helicobacter Pylori (invade mucosa)
        --> biggest factor
        --> release toxins
        
        autoimmune
        --> antibodies to parietal cells
        --> lower HCl- secretion and intrinsic factor
        --> increased gastrin release = hypergastronemia
        
        acute factors
        --> same as acute above
        
        H. Pylori vs. Autoimmune
        
        antrum of stomach/1st part of duodenum
        higher gastric acid production
        
        normal/low serum gastrin
        
        neutrophils & acute leukocytes
        
        Helicobacter Pylori
        
        gram (-) rod
        
        require neutral pH environment
        --> need to invade mucosal cells to survive
        
        urease +
        --> can convert urea --> ammonia -->ammonium
        --> increase local pH to survive
        
        corpus of stomach
        
        low gastric acid production
        --> since immune cells attacking them
        
        high gastrin serum levels
        
        lymphocytes and chronic immune cells involved
        
        Auto-immunity to parietal cells
      - Duodenal Ulcer
        
        ~95% b/c of H. Pylori
        
        from H. Pylori infecting the antrum of the stomach
        --> lower portion of the stomach
        
        In a PUD car crash ... "AIR bags in the FRONT ... BLOOD in the BACK"
        
        "AIR bags in the FRONT" = perforation in anterior Duodenal bulb ulcers
        
        "BLOOD in the BACK" = ulcer bleeds happen in the posterior of the duodenal bulb
        --> gastroduodenal artery
        
        *Zollinger Ellison Syndrome
        
        tumor in Islet cells of pancreas constantly secrete gastrin
        --> increases gastric acid production in the stomach
        --> constant duodenal ulcers and PUD
        
        1 more item...
        
        Antrum of Stomach Ulcer
        
        come from H Puylori invade the corpus = body of the stomach
        --> as opposed to the more common antrum
        
        rarer to have stomach corpus ulcers
        --> but are more dangerous since can lead to gastric lymphomas and adenocarcinoma of the stomach
        
        ~70% of these are b/c of H. Pylori
        
        "LESSER is LEFTER"
        --> gastric lesser curve ulcers hit the left gastric artery