Esophageal Disorders. Gastrointestinal Diseases. Peptic Ulcer Disease. Wireless capsule endoscopy. Diseases of the Small Intestine 7/24/2010

Transcription

1 Esophageal Disorders Gastrointestinal Diseases Fernando Vega, MD HIHIM 409 Dysphagia Difficulty Swallowing and passing food from mouth via the esophagus Diagnostic aids: Endoscopy, Barium x ray, Cineradiology, Scintigraphy, ambulatory esophageal ph monitoring, esophageal manometery Esophageal Disorders Reflux esophagitis (GERD) Hiatal Hernia Barret s esophagus Esophageal Varices Peptic Ulcer Disease Hypersecretion of HCL, impaired mucosal resistance factors Role of H.Pylori Bleeding Ulcer Diseases of the Small Intestine Duodenal ulcer Malabsorption Regional Enteritis (Crohn s Disease) Gastroenteritis Inguinal Hernia Wireless capsule endoscopy Single use P ll db itli Propelled by peristalsis Excreted naturally 2 frames/second Last 7 8 hrs (>50,000 images) 1

2 Single greatest cause of morbidity and mortality in the world The GI tract absorbs 9 Liter of water a day = 2 liters of dietary fluids+ 7 liters of digestive fluids. Only ml water comes out in form of stool. Caused by impaired absorption or hypersecretion or both absorption Mucosal damage Osmotic Motility abnormalities secretion Bacterial toxins Acute diarrheal illnesses are common and self limited. Most often caused by adenoviruses, rotaviruses, astroviruses and cdaliciviruses not detectable by ordinary laboratory tests. No antiviral therapy is available. Consider: Medication Antibiotics Travelers diarrgia Tropical sprue Parasitic infections Food poisoning Fever Blood in stool Abdominal tenderness Significant volume depletion 2

3 Chronic three weeks or longer Is it bloody, fatty or watery? Bloody Colitis: IBS or ischemic Fatty Malabsorption: sprue or pancreatic insufficiency Watery Irritable bowel, meds, Inflamatory Bowel Disease: Crohn s disease, Ulcerative colitis Common presentation: abdominal pain, diarrhea, blood in stool Ulcerative colitis involves the colon only involves the mucosa of the intestine Crohns May involve any part of the GI tract Involves the full thickness of the intestine Pancreatic Diseases Gallstones or alcoholism in majority of acute pancreatitis. Alcohol ~ 80% and idiopathic ~ 20% of chronic pancreatitis cases Clinical presentation: colicky RUQ pain, radiation to scapula Nausea, Dark urine May have fever Scleral icterus Tenderness, guarding, rebound Labs Leukocytosis Amylase Bilirubin, alk phosphaase Imaging Ultrasound CT Cholescintigraphy Treatment Meperidine for pain Surgery, laporoscopic cholecystectomy Dissolution Lithotripsy 90% are cholesterol or mixed cholesterol ~20 % are pigment stones 3

4 Acute viral hepatitis Hepatitis A fecal oral, food transmission Hepatitis B needles and sexual transmission Hepatitis C needles Hepatitis D(delta) co infection with Hep B, rare in US Hepatitis E rare in US CMV EBV Chronic Hepatitis definition lasting more than 6 months clinical manifestations can be diverse Hepatitis B Hepatitis C Hepatitis D Autoimmune Hepatitis Cirrhosis of the Liver Alcohol Chronic Hepatitis C Primary Billiary Cirrhosis Wilson s Disease Primary Billiary Cirrhosis Complications: variceal bleeding, ascites, Gastrointestinal bleeding Presentation: bloody stools: bright red blood (BRBP) Currant jelly Black stools Occult bleed Abdominal pain Hypotension signs and symptoms when loss > 1,500cc (25% of volume) Approach: upper or lower? Diverticulosis, Diverticulitis, Small bowel disease Glutten sensitive enteropathy Sprue Giardia AIDS Crohn s Diseases causing malabsorpton and maldigestion Diseases of the pancreas: Chronic pancreatitis Cystic fibrosis Cancer Diseases of the liver and biliary tract Cirrhosis Cholestasis 4

5 Diseases causing malabsorpton and maldigestion Combined defects Hyperthryoridism Diabetes Carcinoid Zellinger Ellison Post gastrectomy 5